Archive for March, 2010
Are Your CNAs In the Know about Quality Improvement?
Here’s a true story that says a lot about the perception of quality in the United States:
IBM decided to have some of their computer parts manufactured in Japan. In the contract, IBM stated that they would accept three defective parts out of ten thousand. When the parts were delivered from Japan, they arrived with a letter. It said, “In Japan, we have a hard time understanding American business practices. But, the three defective parts you ordered have been manufactured separately and are included with your regular order. We hope this pleases you.”
So, how do the CNAs perceive quality at your workplace? Here are some basics that you might want to cover with them at your next inservice meeting:
What Is Quality?
Quality is doing the right things to the right people at the right time…and doing things right the first time.
Quality saves money. Doing things right the first time requires less money than having to deal with the consequences of poor client care.
Quality means doing the right things right. When each employee strives for 100% quality, everyone benefits.
Quality focuses on the results of your client care—not just on getting the care done.
Quality is everyone’s responsibility. (It’s possible to measure quality so that every health care worker understands what “good care” means.)
What Are the Benefits of QI?
Have you ever heard the saying, “If it’s not broken, don’t fix it”? So why bother trying to improve when the quality of care may already be good? Health care organizations that focus continuously on quality benefit in many ways:
- The clients receive the best possible care.
- The employees have a clean and safe workplace.
- Problems can be identified and solved before they become serious or widespread.
- Staff members from different departments work together to solve problems.
- The organization avoids wasting resources…including supplies, money and employee’s time.
- Surveys from the state or from JCAHO are less stressful because meeting (or exceeding) standards is a way of life for every employee.
- The workplace gains a positive image in the community.
And Remember…
In health care, quality can’t always be measured by how quickly clients get well. No matter how hard they try, health care workers are never in complete control over their clients’ health status.
For example, hospice employees care for people who are dying. It would be unfair to measure the quality of hospice care based on how many clients get well and go home! Instead, there need to be other measurements such as: Is spiritual counseling offered to every hospice client and his family? How many clients at the hospice die free from pain?
The methods for measuring quality vary somewhat from one health care workplace to another.
Spending a lot of money on client care does not guarantee good quality. Poor client care can be just as expensive—if not more so—as quality improvement programs. Think about it. It can cost up to $30 thousand to heal just one bed sore. And, if a client falls and breaks a hip, it can cost up to $35 thousand! Preventing these problems would cost much, much less.
Changing the way things are done does not necessarily mean the old way was “wrong”. It could mean that a QI team at your workplace has come up with a better way to do something…or an easier way…or a quicker way…or a cheaper way. There’s always a reason for change. If you’re not sure what that reason is…ask!
Quality improvement is the responsibility of every employee. Even if a workplace has a special QI nurse or a large QI committee, all employees are still responsible for doing their part to improve quality of care.
Get Excited about Quality Improvement
Share the results of any quality improvement studies for your workplace with your nursing assistants.
Suggest that some of your CNAs volunteer for the QI committee at your workplace.
Remind all your CNAs that they are the experts at the tasks they perform every day. If they see ways to make their job—or their client care—better, it is their responsibility to share their ideas.
For more information about quality improvement, please check out our inservice, Understanding Quality Improvement.
Happy Teaching!
Linda
Keep Your CNAs In the Know about Dementia
The numbers are staggering. For every 15 Americans (age 71 and older), two of them have been diagnosed with dementia. And, around the globe, at least 35 million people live with dementia. That number is expected to hit 65.7 million in 2030 and 115.4 million in 2050! With statistics like these, it is more important than ever for nurse aides to be armed with information about dementia. Here are some of the basics that you can share with your CNAs:
What Exactly Is Dementia?
When you hear the word “dementia”, you probably think of Alzheimer’s disease. And, it’s true. Alzheimer’s disease is one form of dementia. However, there are many other types of dementia.
What exactly is dementia? It is a slow, progressive loss of mental functions, including: memory, thinking, judgment and the ability to learn. Dementia is not considered a disease by itself. Rather, it is a syndrome-or group of symptoms- that can be caused by many different diseases. The symptoms of dementia are often severe enough to keep people from performing normal daily activities.
In the United States, an estimated 5 million people have dementia. Most people with dementia are over age 65 and the risk for dementia increases with age. Does that mean that all senior citizens “lose their minds” at some point? No way! Consider this: more that half of all people over age 100 do not have dementia.
It’s true that the brain changes as people get older. But these normal age-related changes, such as a decrease in both short-term memory and the ability to learn, do not affect a person’s ability to function. Dementia does.
What Causes Dementia?
There are many different causes of dementia, including:
- Diseases that affect the nerve cells in the brain, such as multiple sclerosis, Alzheimer’s, Parkinson’s, Huntington’s and Pick’s disease.
- Vascular disorders such as a stroke.
- Toxic reactions from excessive alcohol or drug use.
- Brain tumors.
- A lack of specific nutrients in the diet, such as vitamin B12 and folate.
- Infections that affect the brain and spinal cord.
- Head injuries.
- Radiation therapy to the head.
- Cardiac arrest.
- Chronic illnesses of the kidneys, liver or lungs.
For Your Clients with Dementia, Remember…
Focus on strengths! Most types of dementia cause an inevitable decline of a person’s memory, intellect and personality-usually during the middle to late stages of the disease. During the early stage of dementia, it is especially important to focus on the person’s remaining strengths…and not on what he or she is losing. For example, Mr. Smith has trouble remembering what he hears, but does quite well with visual cues. So, his aide put simple written instructions and pictures on the walls of Mr. Smith’s living area.
Stimulate, don’t overwhelm. There is a fine line between providing stimulation to people with dementia and overwhelming them. Get to know each client as an individual so you learn what their limits are. For example, Mr. Green may become agitated by all the sights and sounds after a ten minute walk, but Mrs. Hall is content to sit and watch her neighbors for over an hour.
Last in, first out! For most people with dementia, the things they learned most recently are the most easily forgotten. Allow your clients to focus on what they do remember.
Childlike, not childish. People with moderate to severe dementia tend to lose the ability to care for themselves. Just like small children, they need help with eating, dressing, walking and toileting. But, remember, just because some of their needs and behaviors may be childlike, they are not children. Be sure to treat them as adults; don’t patronize or “talk down” to them.
Personality Plus! Typically, dementia tends to exaggerate personality traits that already existed. For example, someone who was bossy in his younger years may be completely domineering due to dementia. Or, dementia may make a person who was always tidy become obsessed with neatness.
Ten Warning Signs of Dementia
Keep these ten warning signs in mind as you go through your work day-especially if you care for a number of elderly clients. If you notice these signs developing in any of your clients, report the situation to your supervisor. Your observations may help them receive an early diagnosis-and treatment- for dementia.
- Memory loss
- Problems performing everyday jobs
- Difficulty with language
- Confusion about time and place
- Poor or impaired judgment
- Problems with abstract thinking
- Misplacing items
- Changes in mood or behavior
- Changes in personality
- A loss of initiative
Keep in mind that depression, side effects of medication and alcohol abuse are among the problems that can mimic dementia.
If you’d like more information about dementia for your nursing assistants, consider our Understanding Dementia inservice. We also have a popular inservice entitled Understanding Alzheimer’s Disease.
Happy Teaching!
Linda Leekley BS, RN
You are currently browsing the Be In the Know! blog archives for March, 2010.
