Your Granny's Nurse: Instilling Compassion Where there is None

According to a congressional study, one in every 25 Americans over the age of 65 has been a victim of abuse.  In research conducted by Beth Hudson Keller, Director of Education and Training at CARIE, and Dr. Karl Pillemer, Associate Professor at Cornell University, nursing assistants in 10 Philadelphia-area nursing homes self-reported abusive behaviors over a one-month period.


51% reported that they had yelled at a resident in anger
23% had insulted or sworn at a resident
8%  had threatened to hit or throw something at a resident
17% had excessively restrained a resident
10% had pushed, grabbed or shoved a resident
2%  had slapped a resident
1%   kicked or hit a resident with a fist

Many of our employees today, are expatriates of war torn countries, including our own. Inner city life can be just as heart hardening as war.  Many may never have known true compassion. It is our job to instill a sense of compassion, where there is none.Many believe that by being "task oriented" they are doing a good job, and they are, but being a caregiver entails much more than efficiency. It means caring about their charges.

Do you want this type of caregiver working in your facility?

So, lets talk about how we can prevent abuses, neglect and disinterest in our employees.

I have compiled a list of techniques that can help instill a sense of compassion in our caregivers.


 Sensitivity training.

Sensitivity training involves instilling EMPATHY in a caregiver.

The easiest and possibly most effective empathy builder is one I have used extensively during my years as a Nurse aide instructor. It is simply asking each participant to list 10 things they cannot live without. Slowly, in threes, ask them to delete items, with the admonishment, that the deleted items can never be had again. 

I must advise, that this may not be an effective tool to use on our foreign born population. Too many of them have already lost everything, and it would be callous of us to make them rehash it.

For the following exercises,  I would advise getting  the caregivers written permission. In today's "lets sue whom we can" mindset, we do not want a disgruntled employee filing suit because they were restrained against their will.

Supplies: While Kits are available @ YourGrannysNurse.com, you can make your own.

Earplugs: insert into a nurse/aide's ears for at least an hour.

Blindfold:

1) Apply, and take the student for a wheelchair ride about the home. Demonstrate abrupt stopping, pulling backward and spinning around. Ask them where they are, when you finish. Remember, No horseplay permitted. This should be a serious attempt at instilling empathy, not a "fear factor" challenge. 

2) Apply and feed the "resident" a meal...puree at your own discretion.

Waist restraint: Tie 'em up, encourage fluids,( I find a 20oz. of Mountain Dew does the trick the quickest)  and wait...Sooner or later they will have to go...

Sling/swath: apply sling to one arm, preferrably the dominant,  swath both legs together. This demonstrated hemiplegia. Practice transfers,  in and out of bed, toilet, chair.

Instruct someone not to speak, no matter what.

In a classroon setting, there are several options for a group.

Have dietary bring in med cups of puree foods for the class to try, make sure you include a healthy cup of the delicious Ensure.

Place dry beans on their seats and instruct them not to move their behinds, for 2 hours.See how long they last.  This demonstrates how it feels to have wrinkled garments or linens underneath a patient.

Instruct everyone to cover one eye.  Half left, half right. Conduct inservice/meeting from various areas of the room.

All of these techniques should be followed by discussion of the FEELINGS the exercise elicited.


INSPIRATIONAL READINGS:

Inspirational readings are those poems or essays that make us go "Awww"
and make us feel all warm and fuzzy.


Make a habit of reading an inspirational essay, or poem at monthly Inservices. Discuss it afterward. 

Hold an Inservice and ask each participant share a  personal story of a patient that touched their lives. Positive or negative stories should be encouraged. I have learned more from my "problem patients" or "PIA's" than I have the model ones. 

Here is one I'll share with you.
"The 'F" Word"...by Me

"She called me the "F" word" Carol cried, as she exited Mrs. Griner's room. Tears were streaming down her usually rosy cheeks. It was almost expected. Mrs. Griner had been in the Nursing home for ten years now, a victim of MS that left this former artist a bitter, angry soul.

She had a knack of wringing tears out of the most seasoned professional, but I thought Carol could handle her.We forewarned each new aide that Mrs. Griner would be a test to them."Helen Griner has MS", I would tell them "She can't control her own body, but she will certainly try to control yours.", we admonished. Assigning a "Newbie" to her was in itself a test. We figured, if you can handle  Helen Griner, you can handle anyone.

I had tried my best with Carol. She was nevertheless, green, young and idealistic.  Three weeks out of her Nursing Assistant Training Course, she was just getting a feel for the Nursing profession.I have to admit, Carol was a natural, or so I thought, until this moment.   I try to instill a sense of compassion and empathy in all the aides I train, and Mrs. Griner would try the patience of a saint. "Move my left foot a little to the left. Now, up a little bit. No, thats too much" and a myriad of other demands that taxed the nursing home staff. She directly caused the resignation of at least four aides, that I am aware of.    On average, she rang her call bell approximately every twenty minutes. In other words, she was a "PIA", or Pain in the Ass.

Her family had all but abandoned her, her son visited regularly, once a month, and paid more attention to whomever was on the other end of his cell phone, than his mother. The woman was lonely in a building full of people.

I took Carol aside, and embraced her. "Carol, I know Mrs. Griner can be exasperating, but you can't let her little tirades get under your skin. Remember the poem I read you in class, "Look Closer See Me"? It was a story of an old lady, in a nursing home that pleaded for the staff to look cloesr, to see the person that was inside the old, wrinkled up, body that no longer worked as it should". Carol looked at me with swollen, red eyes. She said, "Ya know, I have made a special effort with Mrs. Griner. I make a special effort to stop in her room when her call light is NOT ringing. Just spending a few minutes with her when she's not 'in need" seems to decrease the times she does ring." "then why are you crying?" I asked. "Because the "F' word she called me was "Friend". My job is done

I have many stories such as this on my website, all hewn from my years in the nursing home. 

Humor

 Humor has its place in the nursing home as well. Being  a woman of some weight, southern, and a bleach blond opens up a myriad opportunities for humor, all aimed at myself.  

I tend to tell people who comment on my weight that, yes, I DO in fact, own a mirror, and that they can kindly replace the 20 points they remove from my IQ when I open my mouth and a wee bit of hillbilly comes out .

Humor can help diffuse many different situations from staff conflicts,to calming hostile residents.

Remember that everyone has a  different homor threshhold.  Some appreciate  slapstick comedy, while others may go for the racy, or sophisticated humor. It is up to you to differentiate what  the situation calls for. 

I advise every nursing home administrator to invest in a humor box.

A humor box can include: joke books, a red rubber nose, "Groucho Glasses" a variety of funny videos , ie: Marx Brothers, I Love Lucy, various stand up comics, Burns & Allen,  balloons, a variety of sitcoms etc...  

Even the most hostile patient will calm down if you approach him in Groucho glasses.

** The above is an excerpt from my May 2007 Speech, entitied"Your Granny's Nurse"Compassionate Care of the Elderly",   given at the annual Ohio Health Care Association (OHCA) Conference. 

*** Humor kits, Inspirational readings and Sensitivity training kits are available at Yourgrannysnurse.com