Tag Archives: Nurses

EXPIRY DATE

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There comes a time when you have to think about putting your loved one into an aged care facility. This decision is not to be taken lightly. I have been asked numerous times to advocate for a ‘Good Nursing Home’  sorry I cannot do that. I can only say I am not completely happy with any aged care facility I have ever worked in and I’ve been working in aged care for approximately 20 years.

When I began working in aged care, things were so different. If I managed to get a tea break, I would go to the staff room to make a coffee and sitting in that staff room were carers and Enrolled nurses who would all be discussing the care of the residents. These wonderful people (miss them terribly) knew everything about their residents. Off the top of their heads they could give you the run down on their likes and dislikes, allergies, at risk behaviours etc. They would discuss new ways to help their residents. for instance if an elderly person was having trouble with dressing, eating, showering, they would put their heads together to come up with new and inventive ways to address the situation, approach the Registered Nurse with this idea and we would work on it together. From there, it would be taken to an allied health specialist such as Physiotherapist, doctor, nutritionist etc and the life of the resident would be made so much better. These brilliant carers knew about equipment which would make their jobs easier and using it on the resident to make it safer. Safety was a big issue and they understood it and complied with regulations.

Those were the good old days.

Now, walking into a staff room all you see are staff sitting around the tables talking to their friends and relatives overseas. Ask any one of them about a resident and you get an answer like this, ‘Look at the notes’ ‘Look at the care Plan’ or ‘I don’t know’ They have absolutely no idea or any intention of understanding the care of the elderly they are there to care for. Even if the resident had been there for a number of years. They weren’t interested. To the carers these days, it’s just a job and to get through it as fast as possible so they can go home. Now don’t get me wrong. There are a few excellent carers working in aged care facilities. They are the ones who do care. They do their jobs well and will even stay behind to finish doing what they need to do to make it easier for the next shift and to ensure the resident is left the way they are supposed to be left. Clean, well fed, in no pain, comfortable and any issues they have spotted reported to the RN.

If the RN needs to know anything about a resident now, we need to go into the shower to examine the resident ourselves. We are checking for fragile, dry skin. Skin tears, toenail and fingernail length, pressure areas, we check their ears and eyes, nose and a lot more. Ask a carer now and I doubt if they even know who they just showered.

This might sound like I’m bagging carers but it’s the way things are now. Aged Care Facilities cannot run without money, and to make a profit they need to have the least number of staff on the floor at any one time. If there is 35 residents there will be 4 long shift carers for the entire shift and a few short shift carers. The short shift carers are there to help with the showering and meals. They go home early. Meanwhile the long shift carers will remain to assist with toileting after lunch and helping the residents with lunch. They will do a ’round’ which is to check continence pads and to toilet other residents who are able to go to the toilet but just need some assistance. There is no time to sit and talk to a resident. To ask them how they feel or do any little minor thing the resident would like.

Every time I see a commercial showing how wonderful an aged care facility is and how splendid the smiling, cheery staff are I seriously want to barf.. What a load of rubbish.

To see the picture clearly, you need to go there and see staff running their legs off, Sweating under the strain on heavy lifting, carrying, pushing and pulling and count how long each staff member has to attend each resident. I did a count once and it was frightening.

Read my next post for the breakdown.

Aged care facilities are not designed for the happiness of residents, they are there to make money. Full stop. Now I know this is going to sound really disgusting but I was at a facility one day and I asked where all the usual carers were and was told, “They are having an inspection and they only want to see white faces here” I nearly fainted. How racist and bigoted can anyone be??? I wondered who was coming and what sort of people they were to  say this..  If I had called the media over this, there would have been hell to pay. But as I have said before. Nobody wants to know. And it would have been difficult to prove.

I sort of feel fortunate working as an Agency Registered Nurse at times because we get to move around from facility to facility and we see it all.

Every Aged Care Facility has at their front door a charter of rights and responsibilities. These points are a legal requirement and they need to provide evidence to show it. To prove this, they have reams and reams of paperwork and documentation and the staff are required to fill out all documentation to show they are doing the right thing. Ha!

Aged Care Facilities also have people (Accreditation Team) come to check on all their paperwork to make sure this ‘Evidence Based Practice’ is being adhered to. (Stop laughing)  I was hired to do an afternoon shift one day and when I arrived, I saw 4 RNs sitting in the Nurses Office completing forms and filling out papers ready for the inspection. They were even signing medication charts where there were many, many signature omissions. Some signatures were from other Agency Registered and Enrolled nurses from months previous. But as long as the tiny little square had a squiggle in it, it was ok.  All care plans had to be updated with the correct information included which should have been done on admission. If and when the facility passes all their ‘standards’ they whoop whoop for days after and throw a celebration. This is a very serious issue. To not pass ‘Accreditation’ is the worst thing for all staff, the residents and the facility not to mention the boss who runs the facility. It doesn’t reflect well on any of them.. The Government will impose sanctions on the facility to prevent them from taking in any more residents until they meet the ‘Standards of Accreditation.’ The facility will only be allowed to have a certain number of residents. Cuts to funding is taken very seriously.

The one thing you need to make sure of if you put your family member in an Aged Care Facility is to be there on admission and make sure they have all the information on your relative/friend. The admission form is paramount to ensuring staff know who is responsible for having the say over financial matters, who makes decisions regarding their health and welfare, are there any toxic relations between family members which could impact on the health and happiness of your family member. Allergies, every aspect of daily living is included and should be addressed. Do they have a funeral organised and with whom? What are the details? Burial or cremation? Who is the funeral Director? Sleeping times, food likes and dislikes, clothing requirements, continence. Do they use continence aids? Do they have enough clothes and shoes? Are they labelled oh and please remember to label their dentures and spectacles. There’s nothing worse than removing dentures or spectacles to find out your family member has been wearing someone elses. Do they have an ‘End of Life’ care form completed? Don’t leave until it’s done. It will save you so much time and make it a bit easier for staff in the case of a death or an emergency. Do they have any old injuries? Do they have pain? There is so much but it must be included. The admitting nurse needs to get baseline readings. This is Blood pressure, temperature, pulse, weight, height, urinalysis and a whole lot more. So if the resident has any health episode the Nurse has the baseline to go by. Any differences will show us there is something wrong. There is a change in their health status and it needs to be investigated further.

Read my next post for the times given for each resident attendance.

 

 

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Brain injury

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We should all know when you hit your head your brain suffers from an injury. No matter how small or insignificant you may think it is, it’s not.  Hitting your head is serious.  Your brain is floating in a fluid inside the skull and if you hit your head, the brain does bang against the wall of the skull. Researchers are now asking for all children’s sports to be non contact. Even wearing a helmet does very little to protect the brain from injury.. The brain still gets quite a thump even within a helmet..

Ok so I work in the health care industry and at least once per shift I am confronted with someone who has ‘had a fall’

After we assess the severity of the fall and check for physical injuries. We begin the arduous task of doing Neurological obs.

Physical signs are bleeding from the eyes, ears, nose, mouth.

Swelling around any part of the body.

Broken bones.

Neurological obs are taken over a 24 hour period and involve charting…

Eyes, reaction to light and pupil size.

Any weakness in either side of the body.

Response to our questions.

Patient awareness to time and space unless they are not able to vocalise this due to dementia etc..

Blood pressure.

Temp.

Respirations.

Pulse.

These Neuro obs are taken every 15 minutes for the first 4 hours.

Then half hourly for the next for hours.

Then hourly and then 4 hourly.

If any specific problems arise it will be after the first hour post fall (unless it is observed immediately) so we must  monitor the patient closely and prevent further falls.

Giving medications which cause drowsiness, such as sleeping tablets, antispyschotic medications etc must be reviewed and their use carefully measured as the patient can easily be mistaken for a brain injury when they are actually suffering from the effects of a sedative.

Researchers are now stating anyone who suffers from a concussion due to a head injury should rest for a week.

This allows their brain to recover.. The worst case scenario is a form of dementia in later life..  Look at Muhammad Ali, the world famous boxer.  He is now suffering from Parkinsons disease. Footballers are also at risk of this too and there is a couple of them here in Australia who have been told they have Parkinsons disease/dementia due to severe brain injuries whilst playing their favourite sports.

Children are particularly clumsy and quite often fall/trip and hit their little heads..

If this is a regular occurrence with your child,you may want to ask yourself why? Why are they tripping over so much? Do they wear correct and properly fitting shoes? Do they have orthopaedic problems? Are they so tired in the day time due to lack of sleep they are not able to get through their day without tripping and falling? Sometimes this is the answer..

Does your child go to a day care centre, Kindy or school? Do they get enough rest whilst there?

How much sleep do they get at night?

Do the day care workers observe them and prevent them from running especially if they are prone to falls etc…?

Is there a particular time of the day these children fall over? There could be a pattern.

If your child has a fall and hits their head I would advise you to take them to see the doctor asap and get them checked out. The doctor will check their neurological responses and give you advice on how to care for them at home. Make sure they get plenty of rest. Lack of sleep in babies can cause seizures too.. Didn’t know that did you?

So if you have a child who has had a fall and hit their head or just hit their head on anything, keep an eye on them for the first 24 hours. Look for either sided weakness in their grip, with their legs (can they lift their legs up in the air). Is their grip the same on both hands and can they lift their legs up one at a time to the same height?

Do they sleep too much? Are they overly drowsy? Not able to wake them “as usual”..

Is their facial expression vague? Do they forget things?

There are so many signs and symptoms of concussion from a hit to the head but you will know the capabilities of your child so keep an eye on them and get them to the doctor for a check up asap…..

I have witnessed a worst case scenario post fall and it is not pretty so I urge you to keep in contact with your doctor and document anything you can so you can show the doctor.

Doctors rely on our documentation so they can see what has been happening.. We keep the records and they get this information which helps them to diagnose the problem…

There is so much to it but this is it in short.

Marilyn xxx