Focus on special needs helps older patients heal
Elderly recover in setting designed for them
In an inpatient setting, there are many barriers to educating elderly patients. One is delirium, which can be caused by many things, including a change in environment, multiple medications, sleep deprivation, pneumonia, pain, or an infection, according to Barry Gallison, MS, APRN-BC, a geriatric nurse practitioner at New York-Presbyterian Hospital and Weill Medical College in New York City.
A new 19-bed geriatric unit at the health care facility will help avoid delirium and overcome other barriers to education of the elderly that can prevent them from returning to independent living. The unit is designed to help patients 75 years and older regain their level of function prior to their illness through the therapies offered on the floor.
"The goal of the unit is to offer therapies to help the patient remain independent or live at home with assistance," says Gallison. The unit is patterned after the Hospital Elder Life Program model, he says.
Although not all features have yet to be implemented, when completed the program will benefit patients in the following ways:
• Help prevent delirium
Each bed has an orientation board where pertinent information pertaining to the patient is posted. Patients will know the date and what to expect each day, such as any tests for which they are scheduled. Also, each bed has its own clock.
• Regular ambulation scheduled
Physical therapy will work with specially trained volunteers who will ambulate the patients three times a day.
• Sleep hygiene program
To help patients sleep well at night, a sleep hygiene program is planned where patients might be given a warm beverage and gentle back massage before bedtime. The overhead speaker system will not be heard in patient’s rooms at night, either. "We don’t like to use sleeping aids with this population because it leads to falls," says Gallison.
• Good nutrition promoted
A dietitian is part of the care team to ensure that each patient is getting the proper nutrition. Specially trained volunteers help patients with their meals, opening packages and feeding patients if needed.
• Restraint-free policy
Rather than using restraints, which can make a patient more delirious, whenever possible a nurse’s aide is placed in a room to monitor the behavior of one to two patients and make sure that they don’t get out of bed. The aide helps the patients to the bathroom when necessary and provides constant supervision.
• Geriatric-friendly environment
There are plans for remodeling the unit which include installing a synthetic material that is much like a rug only it is an inch thick so it will help to prevent patients from breaking bones when they fall. In addition, beds will sit closer to the floor so that patients won’t have so far to fall.
A communal dining area will make it possible for patients to come out of their room at mealtime and socialize. "Patients won’t be isolated in their rooms eating alone," explains Gallison.
A wander guard system will be put into place so patients won’t have to be restrained if they are wanderers. An alarm would sound if they leave the unit.
• A team approach
There is a multidisciplinary approach to care on the geriatric unit that includes a social worker, nurse practitioner, nurses, physical therapist, dietary, and medicine, says Gallison. The patient assessment is a team effort, he says.
Source
For more information about making units geriatric patient-friendly, contact:
- Barry Gallison, MS, APRN-BC, Geriatric Nurse Practitioner, New York-Presbyterian Hospital and Weill Medical College, New York City. Telephone: (212) 746-1383. E-mail: [email protected].
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