Tag Archives: Nurses

The NICHE difference: Preparing Our Long-Term Care Workforce for Tomorrow

We are thrilled to have recently announced our collaboration with NICHE – Nurses Improving Care for Healthsystem Elders, a nation-wide nursing education and consultation program designed to improve geriatric care in healthcare organizations through education and mentorship.

The NICHE Acute Care Program, founded in 1992 is part of NYU Rory Meyers College of Nursing.  The program promotes the use of evidence-based clinical interventions and establishes nurses as leaders to effect positive change in caring for the growing aging population.  NICHE empowers front-line nurses to build a team and develop organizational and workforce competencies to improve the health and wellbeing of older adults they serve.

The NICHE long-term care(LTC) program prepares nurses and certified nurse assistants (CNAs) to achieve organizational goals for the care of older adults patients.  The NICHE-LTC promotes the use of evidence-based clinical interventions and establishes nurses as leaders to bring about changes in the quality of care delivered to older adults in LTC and PAC (post-acute care) facilities.

The LTC curriculum is designed around the Centers for Medicare and Medicaid Services (CMS) Five-Star Quality Rating System so organizations uphold the nationally recognized standards for LTC.  A few examples of Quality Measures include:

  • Ability to move independently and participate in activities of daily living
  • High-risk residents with pressure ulcers
  • Re-hospitalizations, emergency department visits, and discharge to the community
  • Moderate to severe pain
  • Falls with major injury
  • Antipsychotic medications

NICHE resources include highly engaging webinars, Need to Know patient and family consumerism, LTC Leadership Training, Implementation Courses, and Clinical and Quality Improvement Modules, and an Evaluation and Recognition Process.

Our shared mission that quality training empowers staff will lead to higher CNA retention and improved care:

  • Nursing homes whose nursing staff have enhanced knowledge and skills perform better on quality metrics.
  • CNA’s who receive specialized training on common health issues experienced by older adults are capable of providing better care to residents and feel more confident in performing their work.
  • Opportunities for CNAs to participate in training programs not only empower them with knowledge and skills to carry out their work but also reinforce their important role in achieving organization-wide quality improvement goals.
  • CNA’s who receive high-quality training are more likely to report that they are satisfied with their jobs and job satisfaction is directly linked to CNA retention.

Quality elder care is critically important and NICHE programs provide the tools and resources that elevate Acute and Long-Term care organizations to a level of excellence.  As the need for dementia training increases, our relationship with NICHE will serve to better prepare the workforce for the special needs of those living with cognitive differences.

Pam Brandon is President/Founder of AGE–u-cate® Training Institute and a passionate advocate for older adults and those who serve them.  Pam is the creator of the Dementia Live® Sensitivity Awareness Training program and led the development of  the Compassionate Touch® training for persons living with Dementia and End-of-Life care.  

The Important Role of Faith Community Nursing

Faith-based hospital organizations recognize the impact of partnerships with their local faith-based communities.  The important role of faith community nursing programs is to bridge the gap in helping congregational nurses to meet the needs of their faith communities.

Who are faith community nurses?  They are licensed, registered nurses who focus on the intentional care of the spirit, assisting the members of the faith community to maintain and/or regain wholeness in body, mind and spirit.  Often this program integrates a covenant between the hospital, the faith community and the registered nurse.

How can faith community nursing programs help with dementia care?   Caring for a loved one with dementia can be a heavy burden.  Families often turn to their faith communities after their families for education, support and resources.  If hospital faith nurses are able to coordinate information, services, education and support through a faith community nurse who works directly with those members, transfer of important information to those families becomes critical.

If families are able to call upon the expertise of a health care professional who is medically qualified, has experience in helping caregivers and individuals living with dementia, this can be a huge help to that family in keeping their loved one safely at home, finding needed respite services or community-based care.

As hospitals branch out with community clinics, expanding their physical reach to neighborhoods, the role of outreach efforts to bridge educational services with faith communities is a huge opportunity and benefit for the hospital, community organizations and ultimately the families who desperately need access to support, education and resource information.

The role of faith community nursing will no doubt evolve with the fast growth of the aging population and rise of family caregivers.  The “village” concept is taking hold with the initiatives of many aging services, hospitals and grass-roots efforts coming together to reach homebound older adults who too often don’t know where to turn or how to start to look for help.

Pam Brandon is the President/Founder of AGE-u-cate Training Institute and a passionate advocate for older adults and those who serve them.  The creator of the internationally recognized Dementia Live sensitivity awareness program.  


What Nurses Need to Know about Parkinson’s Disease

As a  geriatric nurse, I rather frequently see the effects of age and disease on the body. Of course, different diseases manifest in different ways, and while some of those signs and symptoms may mirror those of old age, others may not. As a result, it is important that I, and other geriatric nurses like me, recognize how Parkinson’s disease might affect a patient under our care so that we can better care for them and meet their needs.

Do you know how Parkinson’s affects patients? Years ago, I went on a bicycle tour with some friends. As I was one of the strongest cycles in our group, I was responsible for towing the trailer in which we had stored most of our camping gear. It obviously made cycling more difficult, so I was working harder. Later I realized that my rear brakes had also locked up, so in addition to towing the trailer, I was also trying to ride through my brakes.

And that’s sort of what Parkinson’s patients experience. It’s a bit like trying to drive with a foot on the brake pedal. Everything is much more difficult and can be a bit herky-jerky, sluggish and uncoordinated.

Dopamine’s effect

In large part, this is because of the effect dopamine normally causes in our body and brain. Because Parkinson’s patients don’t have enough dopamine (the chemical responsible for body movement control and coordination) in their brain, they have less control over their body movements. In essence, the brain is putting the brakes on their movement, and while they can try and fight through it, they have far less control as a result of the decreased dopamine.

A chronic condition

This is exacerbated by the fact that Parkinson’s is a chronic degenerative condition, meaning it never goes away and continues to worsen as patients age. Fortunately, it is not normally diagnosed early in life; the average age of onset is 60, though some (roughly 10 percent) Parkinson’s patients may be diagnosed as early as the age of 30.

Worse, no one yet knows what causes Parkinson’s, which means there’s no cure. (In fact, diagnosis can be rather difficult, as there’s no yet agreed upon test, either.)

So about that dopamine?

The substantia nigra is a small center in the brain stem, just above the spinal cord, which is responsible for dopamine production. As we noted earlier, dopamine is the neurotransmitter responsible for balance and movement, so decreased dopamine causes problems. And for Parkinson’s patients, that’s exactly what happens: As they age, the substantia nigra degenerates, resulting in less and less dopamine production, which in turn causes diminished control of movements, including tremors and a loss of control.

Given that most experts agree that symptoms don’t present until 75 or 80 percent of the substantia nigra has already degenerated, the onset of Parkinson’s usually comes as a surprise, and then can progress rather quickly as more cells die and less dopamine is produced.

Researchers still don’t know why the substantia nigra degenerates, either, or how to stop it. At this point, the best they can do is try to artificially replicate the dopamine levels available to the body through medications that temporarily improve coordination and movement.

Parkinson’s progression

Most Parkinson’s experts use the Hoehn-Yahr scale, which breaks down patient’s disease progression into five stages. Let’s look at each stage a little more closely:

  1. In the first stage, symptoms are generally mild, and may only affect one side of the body. This may simply manifest as slight changes in posture, facial expression, or walking.
  2. In the second stage, posture and walking are more clearly affected, and on both sides of the body. Minor disability may also manifest in the second stage.
  3. In the third stage, symptoms are quite obvious, and balance and walking are quite affected. Even standing may be difficult, and coordination begins to require significant help.
  4. In the fourth stage, disability is sufficient enough that patients can no longer safely live alone. Slow, stiff movements are the norm, and walking requires assistance.
  5. In the fifth stage, disability is more severe, and patients can no longer walk or stand without significant assistance. As a result of heightened and severe disability, patients become completely dependent on others in this fifth and final stage, and require constant care as a result.

Given that each stage may last many years, however, patients often have time to adjust to their new normal before entering the next stage, hard as those adjustments may be—both for themselves and for their support networks of family and friends.

Parkinson’s major symptoms

While the symptoms that manifest for Parkinson’s patients may vary somewhat, in general, there are several main symptoms that affect Parkinson’s patients.

  1. Tremors. Tremors are most noticeable when patients are at rest and usually start with the hands or feet, though they can also affect the face. Generally, tremors occur at a consistent rate of 4-6 shakes per second and may occur on one side of the body (in stage 1) or both (in stage 2 or later). Stress and other factors may make tremors worse.
  2. Rigidity. Rigidity or stiffness is the result of tense, tight muscles, which can make movement difficult. It may affect arms, legs, or other muscle groups altogether. This can sometimes lead to difficulties in swallowing, eating, breathing, or talking. Additionally, facial rigidity can lead to decreased facial expression, which can also affect their ability to communicate well.
  3. Slowness of movement. This slowness, also known as bradykinesia, isn’t necessarily predictable in when it strikes, either, which can be doubly frustrating for Parkinson’s patients. As a result, routine things like eating, dressing, or bathing can take far longer than expected, which can add to frustrations and stress, which in turn can sometimes make other symptoms (such as tremors) worse.
  4. Unsteadiness. Postural instability for Parkinson’s patients is the result of both rigidity and decreased muscular control, and can result in poor posture, droopy shoulders, a lowered head, coordination issues, and accidents. Parkinson’s patients may fall easily, or may have trouble with what might otherwise seem like routine tasks; just think about trying to chop vegetables if your hand is shaking and you don’t have very good control of your arm, for instance. This, too, can be an incredibly frustrating part of daily life for Parkinson’s patients.

Takeaway points for better care

I want to leave you with a few key points I’ve picked up that have helped me be a better nurse to my Parkinson’s patients:

  1. Parkinson’s will eventually affect every part of the mind and body, and as a result, it’s incredibly important that you are clear with Parkinson’s patients. Don’t tell them it will get better, because they also know that’s not the way the disease works.
  2. There is no cure for Parkinson’s. The best you can hope for is treatment that helps them manage their symptoms. Kindness and patience go a long way.
  3. It’s also important that you help Parkinson’s patients preserve their bits of independence as best you can for as long as you can. Even if it seems like it is taking them forever or is difficult for them, allowing them to still complete simple tasks on their own is still better than doing those tasks for them. These are adults for whom a disease is returning them to childhood, so be patient and kind with them.
  4. Don’t ever take their anxieties, anger, or frustration personal. Remember how hard this must be for them, and remember, kindness and patience go a long way, especially as stress can exacerbate their symptoms.
  5. Watch for mental health warning signs. Anxiety, depression, and withdrawal are all incredibly common for Parkinson’s patients, who can watch their abilities slip away from them regularly. It’s important that you keep an eye on their mental health as well as you treat them, and report warning signs as you see them, so they can get the appropriate mental health care.

Parkinson’s is a debilitating disease or can be, and good healthcare can go a long way. As a geriatric nurse, I’ve seen that all too well in my own caregiving.

Multiple Sclerosis – An infographic by GeriatricNursing.org

Rebecca Evans is a geriatric nurse who is consistently surprised by how much age can be far more of a mindset than a number.  She believes that access to the right information can improve a patient’s care, as they are better able to advocate for themselves.  More information can be accessed at geriatricnursing.org.

AGE-u-cate Training Institute develops and delivers aging and dementia training for professional and family caregivers. We welcome guest bloggers who have valuable information to share with others.   Please contact us at info@ageucate.com