By: Cindy Quisenberry

1. Understanding People By: Cindy Quisenberry

2. Mindful • Continually being aware Mindful Caregiving Paying attention to details, looking at situations openly, being observant, and being willing to change

3. routine Pattern of activities you set with each resident individually; something repeated on a schedule

4. Quality of Life (QOL) A broad multidimensional concept that usually includes subjective evaluations of both positive and negative aspects of life. Although health is one of the important domains of overall quality of life, there are other domains as well—for instance, jobs, housing, schools, the neighborhood. Aspects of culture, values, and spirituality are also key aspects of overall quality of life that add to the complexity of its measurement.

5. What are questions that you can ask to learn about a person’s values? What do or did you do for a living? What is or was special about your job? Do you go to religious services? Tell me about your family. What is important to you? How do you spend or like to spend your free time?

6. Quality of Care The balance of science and caring skills, which are the tasks you must perform, and the art of caregiving, which is your personal caregiving style. These two are equally important and must work together. If either is missing, you cannot give quality care and meet your patients’ needs for quality of life. ie: Talking to your patients/residents while you are doing tasks – it is not just about getting the job done.

7. Best way to learn about your patients is to ask questions (put yourself in their place) How do you like to start your day? How do you like to bathe? What do you need help with? What can I do to make you more comfortable? What do you do in your spare time? Does anything give you trouble when getting dressed? How much would you like me to help with your personal care? Is there anything you like or dislike?

8. values Beliefs people have about what is important to them. Being healthy and active Respecting persons with authority Being able to take care of oneself Making money Practicing religious beliefs Being useful Having close friends Family Privacy

9. contracture Deformity caused by a permanent shortening of a muscle or ligaments, or by scar tissue

10. resuscitate To revive from apparent death

11. Culture The customary beliefs, social forms, and traits of a racial, religious, or social group Culture has a strong influence on values. Food preferences Personal care practices Clothing choices Family relationships Personal space

12. Patient History Knowing the patient’s/resident’s history will help you to understand them better.

13. Quality of Life Dignity – a feeling pride and self-respect Perception – a mental image of something Single-minded – an attitude of seeing someone in only one way Bladder Training – a care plan to help a resident regain voluntary control of urination Alternative – a choice, a different possibility Eden Alternative – a type of long term care environment; to make every life worth living, you must help prevent loneliness, helplessness, and boredom (must learn how to care, not just how to treat) Habitat – a place where plants and animals are found growing naturally

14. Quality of Life Eden Alternative A long term care facility is transformed form an institution that treats resident into a home – one that meets residents’ needs for companionship, their need to care for others, and their need for variety. (Developed by Dr. William Thomas)

15. Ethics Knowledge, awareness or study of good and bad, right and wrong, and moral duty Never argue with a patient or family member about their values or ethics.

16. Psychosocial Need Involving psychological, emotional, and social aspects of mental health • Something necessary for a person

17. Ethical Decisions based on values

18. General Terms for erikson Assertive – being confident Generativity – ability to produce or create something Gross Motor Skills – abilities in the larger physical skills (ie: running, catching a ball, etc.) Fine Motor Skills – (ie: drawing a picture, writing, etc.) Hierarchy – a specific organized order or ranking Integrity – being whole or complete Theory – a set of ideas or principles offered to explain something observed

21. Another way of wording Maslow’s Physical Needs Safety and Security Needs Social Needs Status Needs Self-fulfillment Needs Other Needs of Residents Sexual Needs Spiritual Needs

22. People’s Rights Chemical Restraint – medication used to sedate a patient or slow their muscle activity Physical Restraint – any mechanical device that restricts a resident’s movement or access to their body Sedate – to calm with drugs Coercion – making someone do something against their will, often by a threat Discrimination – a prejudiced or unfair action because of some characteristic of the person Reprisal – retaliation against or punishment of a person for doing something

23. People’s Rights Interference – act of obstruction; preventing a person from doing something Right – something one has a just or legal claim to Self-determination – freedom to make your own choices and choose your own actions Confidentiality – keeping information private Ombudsman – person required by law to investigate complaints by residents or other violations of rights Status – state, situation Grievance – a formal complaint

24. People’s Rights Retaliation – the act of getting revenge or punishing a person for doing something Corporal punishment – physical punishment Involuntary seclusion – isolation of a resident against their will Neglect – failure to do something that should have been done Transfer – move to another room in the facility Allegation – a person’s statement or intended legal action

25. People’s Rights At risk – has a probability of having some type of medical incident (ie: falls, seizures, allergies, asthma, heart disease) Incident – something happens that is unusual; it could be medical or behavioral Securing – making something safe Belittle – to make a person seem smaller or less important Sentimental Value – the value of the object comes not form the money it could be sold for, but because of the associations and memories it has for the owner – perhaps it was a present from a parent, child, or spouse

26. People’s Rights Verbal Abuse – includes using profanity, calling a resident names, yelling at a resident in anger, making oral or written threats, or teasing a resident in an unkind manner Physical Abuse – any action that causes actual physical harm. This includes handling a resident too roughly; giving a wrong treatment to a resident; or hitting, pushing, pinching, or kicking a resident Negligence – failing to act in the same way that reasonable person with the same training would act in the same situation Gross Negligence – any action that shows no concern for the resident’s well-being

27. People’s Rights Sexual Abuse – includes sexual acts between a patient and a staff member. It may also include touching patients in an intimate or suggestive manner, making sexual comments or allowing another patient/resident to engage in unwanted sexual acts with a patient/resident Mental Abuse – includes any action that makes a patient/resident fearful, such as threatening them with harm or threatening to tell others something they do not want them to know. It includes actions that belittle or make fun of a resident

28. People’s Rights Theft – (of stealing) of a resident’s belongings is another form of abuse Battery – the unlawful beating or use of force – or even touching Advocate – someone who takes the side of another person and speaks for them Hearing – initial examination in a criminal procedure

29. Legal Rights In the early 1980’s a study was done of what residents need to feel protected in long term care facilities. This led to the passing of OBRA 87, the nursing home reform bill. This reform defined residents’ rights.

30. People’s Rights All People Have the Right to: Exercise One’s Rights Privacy and Confidentiality Information Choose Notification of a Change Keep and Manage Their Own Funds (or have someone else do it for them) – Protection of Resident’s Personal Funds File a Grievance – Grievance Rights Admission, Transfer, and/or Discharge Right to be Free from Restraint or Abuse

31. People’s Rights Mrs. Morrison tells you that at home she had tea everyday at 1515. You tell her the kitchen is closed from 3-4, so she can only have her tea after 1600. But the kitchen in fact does NOT close, and you told her this b/c your shift ends at 1530, and from 1500-1530 you are busy reporting to the charge nurse and finishing documentation. You did not want to do anything for residents during that time. You were more interested in finishing your paperwork so you could go home. Did you violate this resident’s rights?

32. People’s Rights It is warm day and you have been working hard at the facility all day. You feel very warm. When you go to care for Mr. Simpson, his room feels hot to you. You open the window and do not close the curtain, so that you can cool off while you give care. Did you violate this resident’s rights?

33. People’s Rights Mr. Connors’ son calls while he is in the bathroom. He asks you to tell his dad to call him back. You want Mr. Connors to take his shower now, b/c you are behind in your work, so you decide to tell him about his son’s call later on. Did you violate this resident’s rights?

34. People’s Rights Mrs. Cain would like to wear her new pink dress that went to the laundry over a week ago. On your break, you saw that her dress has been ironed and is hanging in the laundry room, but you didn’t fell like taking it to her just then. So you tell Mrs. Cain that you called the laundry and they said the dress is still not ready. Did you violate this resident’s rights?

35. People’s Rights The charge nurse tells you to call her when a resident’s family member arrives for their daily visit. The charge nurse wants to report to them the fact that you accidentally scratched the resident when giving personal care. When they arrive, you do not tell the charge nurse. Did you violate this resident’s rights?

36. People’s Rights Mr. Belcher continually offers you money. He tells you that you are the best healthcare worker in the facility. You always say no. One day he offers you what he calls lunch money and says, “I have so much money, I wish you would take it.” So you do. Have you violate this resident’s rights?

37. People’s Rights A patient complains to you that you never answer their call light on time. She says, “Please ask the charge nurse to come see me.” You say, “I’m doing the best job I can,” and you do not tell the charge nurse about the resident’s complaint. Have you violate this resident’s rights?

38. People’s Rights Mrs. Sartain’s Alzheimer’s disease is getting worse. She requires more skilled nursing care and is being transferred to the second floor this morning. The charge nurse asks you if you have prepared the resident for the change as requested. You did not prepare her, b/c you thought she wouldn’t understand you. This morning you go into her room to pack her belongings. Mrs. Sartain is extremely upset and surprised by having to move. Did you violate this resident’s rights?

39. People’s Rights You hear a resident swearing at another CNA. The CNA tells the resident, “No dinner for you.” Later, you serve the resident their dinner but do not report the other CNA’s behavior. Did you violate this resident’s rights?

40. Role of the Family Family – a group of persons of common ancestry or associated by marriage; includes significant others, or persons important to the resident Stress – physical or emotional reaction that causes mental tension Guilt – negative feelings experienced by someone who has committed an offense or believes they have done something wrong to another person Feedback – information received that is corrective or evaluative

41. Role of the Family Why is the family important? Family members: Are familiar to residents when everything else in the facility is at first unfamiliar Can bring comfort to a resident Can share their knowledge about a resident Can help care for a resident May provide financial support

42. Role of the Family Being friendly with family members helps create a positive relationship with them The patient’s relationship with family members is an important part of the patient’s life Admission of a family member to a facility is often a stressful time for the whole family Family members can often be angry with staff Family members need support as they go through the adjustment process Family members can help motivate and cheer up a patient Family members can play an important role in caregiving

43. Role of the Family Patients’/Residents’ care conferences and council meetings are great times for family members to get involved Family members are good sources of information about the patient Always give your full attention when sharing information with a patient’s family member Talking on the phone is an important way for patients to stay in touch with family members. Encourage family members to be involved in events and activities that are important to the patient. May need to bring in a social work, when family members become upset (ie: due to decline in the patient’s health, etc.) Handout – Roll of the Family

44. Pulling It All Together It is important always to be interested in who a patient/resident is. You cannot just walk into a resident’s room thinking that how you see them today is enough for you to give them the best care possible. As you read the following poem written by a resident, think about your responsibility to get to know all your residents.

45. Pulling It All Together The legal penalties for violating a resident’s rights are severe. They show how important your role is to promote patients’ health and well-being. Many patients are vulnerable b/c their physical and psychological frailties. You must keep the facility environment safe for them. Treating them with dignity and genuine respect as unique individuals helps protect their rights. If you do your job in a caring way, you do not have to worry about violating residents’ rights.

46. Pulling It All Together Think about why you want to be a healthcare worker. This will help you be successful in your work. Being a healthcare worker is a career, not just a job. You should look forward to doing it because you can make a difference in patients’ quality of life and care. The keys to quality caregiving include adopting a philosophy of mindful caregiving; being open, observant, caring, and willing to change; and balancing the art of caregiving with the skills of your profession.