Orientation for Geri Psych Staff

1. Orientation for Geri Psych Staff

2. Overview The rapid growth of the aging population is associated with an increase in the prevalence of progressive mental health disorders. Geriatric nurses and other clinical staff have a central role in assessment and management.

3. Orienting Geri Staff on Medical Issues • Dementia is a clinical syndrome of cognitive deficits that involves both memory impairments and a disturbance in at least one area of cognition. • Dementia affects about 5% of individuals 65 and older. • 13.2 million patients are projected to have AD by 2050.

4. Orienting Geri Staff on Medical Issues cont. • It is important to orient the staff on the parameters of assessments. • This will alert the staff of any cognitive or functional decline in our older adult patients.

5. Cognitive Parameters • Orientation: person , place , time • Memory: ability to register, retain, recall information • Attention: ability to attend and concentration on stimuli. • Thinking: ability to organize and communicate ideas. • Language: ability to receive and express a message.

6. Physical Assessment • The Geriatric nurse is taught to complete a physical assessment with a focus on the neurological and cardiovascular systems. • Complete a thorough evaluation of all prescribed, OTC, herbal, and nutritional products taken. • Proper evaluation of laboratory test

7. Nursing Care Strategies • Monitor the effectiveness and potential side effects of medications given to the elderly. • In particular, look at changing your night med pass time to earlier in the shift to avoid drug hangover effect, around 7:30-8:30 p.m. • Provide appropriate cognitive-enhancement techniques and social engagement. • Ensure adequate rest, sleep, fluid, nutrition, elimination, pain control, and comfort measures. • Avoid the use of physical restraints as much as possible.

8. How to Communicate with Cognitively Impaired Patients • Choose simple words and use short sentences. • Use a calm tone of voice. • Don't "baby talk." • Reduce noise and other distractions to help your loved one focus. • Do not to interrupt. • Avoid criticizing or arguing. • Be sure to listen when your patient talks. • Don't get too close or crowd your patient when talking. • If your patient gets confused, take a break. Talk about something else if it helps. • Choose a time of the day when your patient tends to be calm and receptive for your talk.

9. How to treat patients with Behavioral Issues • Combative Behavior • Stay calm and avoid arguing. • Reduce noise and other distractions to help your patient focus. • Reassure your patient that they are safe. • Offer your patient a choice of relaxing activities like taking a nap or going for a short walk. • Avoid crowding or "cornering" your loved one.

10. Sleep Problems • Set a calm, quiet tone in the evening to encourage sleep. • Keep the lights dim. • Play soft music. • Stick with a bedtime routine. • If you are going to use a sleep aid with the patient make sure to start out with the lowest dose first to try and minimize a drug hangover in the mornings.

11. Wandering Behavior • Softly redirect the patient back to their room. • Have therapeutic activities scheduled during the most prevalent wandering times. This is also known as sun downing, usually from 3:00 p.m. until 9:00 p.m. • Since they are in a new environment (hospital) you will need to spend a great deal of time re-orienting the patient to the unit, over and over due to short term memory loss. • Make signs to put on the patients door to help them find their room. • Exercise is also helpful along with keeping a routine.

12. Hallucinations and Delusions • Some people with Alzheimer's confuse TV and reality. So avoid violent or disturbing TV shows. • Distract your patient with a short walk. • If you can, turn the patients attention to a favorite activity. • Make sure your patient is safe. Be sure your patient cannot hurt themselves or others.

13. Environment of Care Safety Issues • Make sure the patient room is not cluttered so the patient does not trip or fall. • Most avoidable falls occur when a patient is trying to get to the bathroom. Placing a bedside commode within reach and eye sight of the patient can help reduce these falls. Also, nursing staff making frequent pee rounds and offering to take patients to the bathroom even if they may say no can also reduce falls. • Make sure the day rooms are under constant supervision to ensure patient safety in the day rooms. • Matte finish floor wax minimizes glare and reduces falls.

14. EOC, Safety Continued • Have small boxes on the unit of things the patient can go through and just touch or smell and keep themselves busy. • Might be helpful to give a patient a “work assignment on the unit” so they can feel valued and still feel like they are offering something to the human race. • Make sure the hallways remain clutter free so the patients can see their routes and not fall. • Highly recommend chair alarms that attach to the patient and the chair to alert staff when a patient moves too much in their chair. • Highly recommend bed alarms and they be turned on anytime a patient is in the bed not just sleeping. • Make sure the unit doors automatically lock so when a patient wanders they can not leave the unit.

15. Family Involvement • Have open visitation times except in the early mornings when you are providing morning care. • Meet regularly with the family member’s and utilize their assistance when appropriate, also take these opportunities to educate the families on better ways to manage their loved one in the home. • Disease education is paramount for affected family members, they will never get enough…. • Helping connect family members to outside resources and benefits to reduce caregiver burnout will be very important.

16. Staff Well-Being • Don’t forget to take care of each other when working on a Geri Psych unit. • Nurse are great caretakers but sometimes struggle caring for themselves. • Remember this is about team work, not job titles (PCA,RN,LPN. Etc). • It truly takes a village to work on a Geri Psych unit, you will survive and be better for your patients working together as a team.