What’s your “House Recipe”? Part II

1. What’s your “House Recipe”?Part II Refining a Skin Management System Mount Carmel April 30, 2008

2. Licensed for Medicare and Medicaid Accommodates long-term, sub-acute and traumatic brain injury residents. 473 Beds 10 units 94% to 95% capacity Mount Carmel in Review • Take in complex wounds • High percentage of Medicaid and Managed Care residents • Long history of advanced wound care management

3. Our “Recipe for Success”

4. How do we take our Skin Management System to the next level?

5. We need to manage our “Noncompliant” residents Dementia vs. High Cognitive Function?

6. Dementia Characteristics • Staff anticipate resident’s needs • Facility develops resident’s plan of care based on experience and evidence-based outcomes • Staff is obligated to “do the right thing” • Ethically • Regulatory • Standards of practice

7. Dementia Characteristics • Do not know how to position self • Are incapable of making informed, rationale decisions • Declared incompetent or incapacitated • Loss of cognitive functioning Always • Loss of physical functioning Sometimes

8. These were NOT the residents that posed the greatest challenge.

9. High Cognitive Functioning • Need to have a say in their own care • Physically dependent, NOT emotionally or cognitively dependent • Have their own agenda

10. High Cognitive Functioning • Alert, oriented X 3 • Trying to maintain what level of Control or Independence they have

11. High Cognitive Functioning Residents-Abilities • Have the ability to make knowledgeable decisions • Have the ability to weigh alternatives • Have the ability to manage risk

12. Which Social or Behavioral Model do we use??

13. Theory of Planned Behavior/Reasoned Action

14. Game Theory

15. Social Cognitive Theory

16. Locus of Control

17. And now for the fancy stuff! The secretingredient

18. Health Belief Model (HBM) • Widely used conceptual frameworks for understanding health behavior • Developed in the early 1950’s • Greatest success for almost half a century has been: • Promote condom use • Promote seatbelt use • Medical compliance • TB Health screening

19. Health Belief Model-Guidelines • Based on the understanding that a person will take a health-related action if that person: • Feels that a negative condition can be avoided. • Has a positive expectation that by taking a recommended action he/she will avoid a negative health condition. • Believes that he/she can successfully take a recommended health action.

20. Health Belief Model-Framework Is a framework for motivating people to take positive health actions that uses the desire to avoid a negative health consequence as the prime motivation. • The perceived threat of a heart attack can be used to motivate a person with high blood pressure into exercising more often

21. Health Belief Model-Key element • Note that avoiding a negative health consequence is a key element of the HBM. • For example, a person might increase exercise to look good and feel better. • This example does not fit the model because the person is not motivated by a negative health outcome, even though the health action of getting more exercise is the same as for the person who wants to avoid a heart attack.

22. Health Belief Model-Key concepts

27. Staff Buy-in Cocoa or Coconuts? • How does staff turn negative behavior into positive outcomes? • How does facility get staff to buy-in? • How does the staff and resident build trust?

28. Reward to Staff (mmm-Cookies) • Individualized plans of care • Staff to encourage the resident to make informed decisions leading to: • Better relationships • More trust and mutual respect • Less demands on staff • Positive, less stressful, more rewarding working environment

29. Health Belief Model-In Review • Based on the understanding that a person will take a health-related action if that person: • Feels that a negative condition can be avoided. • Has a positive expectation that by taking a recommended action he/she will avoid a negative health condition. • Believes that he/she can successfully take a recommended health action.

30. Questions?? Michelle Putz, RN, MBA, BSN, WCC Director of Nursing Office: (414) 325-4246 Email: Michelle.Putz@bhshealth.org Laure Zulkowski, RN, BSN Assistant Director of Nursing Office: (414) 325-4053