Managing Resident Expectations in Senior Care

Transcription

1 Managing Resident Expectations in Senior Care

2 Objectives Discuss the top reasons that residents are dissatisfied, complain, and exhibit behavior issues Define key strategies for managing resident expectations Understand communication barriers Discuss how low health literacy can affect communication and satisfaction 2

3 Resident dissatisfaction Research suggests that for every complaint, there are 26 others who are also dissatisfied, but don t speak up. However, they will tell up to 10 family members/friends about their dissatisfaction. Source: Shaw, C. (2013). 15 statistics that should change the business world-but haven t. Beyond Philosophy blog. Retrieved from 3

4 Top five resident complaints about nursing homes Poor staff service Poor food quality Resident lifts Night-time disturbances Loneliness ( nobody to talk to ) Source: Institute for the Advancement of Senior Care. (2010). Top five resident complaints about nursing homes (and what to do about them). Retrieved from 4

5 Other possible causes of resident dissatisfaction Complaints not addressed Poor staff attitude Boredom Poor communication Roommate conflict 5

6 Remember... the resident is angry, not you 6

7 Resident-on-resident abuse: A common problem Findings from Weill Cornell Medical College survey of 2,000 residents in 10 skilled nursing facilities in New York: Anger, slaps, shoves, and aggression can occasionally lead to serious physical assault. Every year, several homicides result from attacks by nursing home residents. 1 in 5 residents experienced some form of aggression at the hands of other residents every month. 6% of the incidents involved hitting, kicking, or biting. 16% of the incidents involved screaming or cursing. 2% of the residents exposed their genitals or made unwanted sexual advances toward other residents. 10% of the residents experienced unwelcome entry or access to their rooms or possessions. Source: New America Media. (2015). Resident-on-resident abuse a common problem at nursing homes. Retrieved from 7

8 Risk factors that can lead to resident-on-resident abuse Crowded conditions Lack of private spaces Understaffing, poor training, and high turnover rate Ongoing unresolved conflicts between residents Staff becoming desensitized and viewing conflicts as normal behavior Dementia, confusion, or mental illnesses Poor coping mechanisms Source: New America Media. (2015). Resident-on-resident abuse a common problem at nursing homes. Retrieved from 8

9 Behavioral issues Manipulative residents Play on guilt of others Make threats Exhibit impulsive behavior Keys to managing conflicts Be aware of your own emotions Attempt to understand and manage residents expectations Enlist fellow staff members when necessary and support each another Develop a plan for consistent feedback 9

10 Escalation to violence typically follows a pattern Warning signs Baseline calm: becoming agitated Pre-assault: Verbal and nonverbal behaviors Threatening violence Abusive remarks Physical agitation Pacing, restlessness, clenched fists, louder speech, profanity Assault/acute excitement: out-of-control verbal and physical behavior requiring immediate intervention 10

11 What to do in a rapidly escalating situation Have an escape route. Do not let the resident get between you and the door. Stay calm, speak in a normal tone, and use simple sentences. Do not talk when the resident is shouting. Do not argue, become defensive, or react to abusive statements. If possible, call for help before the resident s behavior escalates. 11

12 De-escalation techniques Be open-minded and empathic. Respect the resident s personal boundaries. Use a nonthreatening tone and body language. Maintain objectivity. Focus on the resident s emotions. Redirect resident when challenging authority. Define parameters. Source: CPI. (2016). CPI s top 10 de-escalation tips. Retrieved from 10-De-Escalation-Tips-US/CPI-s-Top-10-De-Escalation-Tips 12

13 Risk strategies to improve resident expectations Give your undivided attention to each resident. Keep it simple. Choose language that the resident can understand. Pay attention to the resident s verbal and nonverbal communication. Be aware of your body language and tone of voice. 13

14 Risk strategies to improve resident expectations Have a process to identify and respond to resident/family complaints. Educate staff about the process. Appoint a staff member to respond to resident/family complaints. Encourage residents and family members to attend resident council meetings and family council meetings. 14

15 Risk strategies to improve resident expectations Implement surveys to collect data to determine trends regarding resident satisfaction. Be empathic the residents feelings are real to them. It reduces tension and helps resolve issues, even if you disagree! Avoid overreacting remain calm and professional (your response may affect the resident s response) 15

16 Understanding Communication Barriers 16

17 Reasons for communication breakdowns Distorted or poor message delivery Failed to tell something important Daydreaming Prejudgment Heard only part of the complete message Misunderstood 17

18 Indications of ineffective communication The receiver is: Not listening Missing the point Confused Not understanding the message Sending a false message to be left alone 18

19 Communication tools Briefings planning Huddles problem-solving Debriefings process improvement What went well? What could have gone better? How will we improve next time? Any team member can request a briefing, huddle, or debriefing 19

20 Standards of effective communication Complete Clear Brief Timely Communicate all relevant information Convey information that is plainly understood Communicate information in a concise manner Offer & request information in an appropriate timeframe Verify authenticity Validate or acknowledge information 20

21 SBAR A framework for effective team communication Situation What is going on with the resident? Background What is the clinical background or context? Assessment What do I think the problem is? Recommendation What would I recommend? Situation Assessment Background Recommendation 21

22 Handoff The transfer of information (along with authority and responsibility) during transitions in care. Handoffs should include an opportunity to ask questions, clarify, and confirm information. 22

23 Communication challenges Language barriers Distractions Physical proximity Personalities Workload Varying communication styles Conflict 23

24 Health Literacy 24

25 What is health literacy? Health literacy is the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Source: Institute of Medicine. (2004). Health literacy: A prescription to end confusion. National Academies Press. Retrieved from 25

26 Case examples An elderly woman discharged from the emergency department develops a lifethreatening infection because she doesn't understand the warning signs listed in the discharge instructions. A man baffled by an intake form in a doctor's office reflexively writes "no" to every question because he doesn't understand what is being asked. 26

27 National Patient Safety Foundation: Low health literacy About 1 in 5 adults read at the 5th grade level or below Affects 50% of adults in the United States More than 66% aged 60 or older have inadequate or marginal literacy skills 69% do not understand or read the information contained in informed consent forms Only 50% take medications as directed Source: Institute of Medicine. (2004). Health literacy: A prescription to end confusion. Retrieved from 27

28 The impact of low health literacy Verbal instructions about care Low health literacy can impair your residents ability to understand: Treatment plans (less compliant) The informed consent process and related forms The healthcare system Source: ODPHP, Fact sheet: Health literacy basics; National Network of Libraries of Medicine. (2013). Health literacy. Retrieved from 28

29 Low health literacy red flags Forms that are incomplete or incorrectly filled out Problems articulating concerns or symptoms Inability to name medications or describe medication regimen Excuses, avoidance, or embarrassment Rudeness, hostility, or suspicious behavior Source: Egbert, N., & Nanna, K. M. (2009, September). Health literacy: Challenges and strategies. The Online Journal of Issues in Nursing, 14. Retrieved from Vol142009/No3Sept09/Health-Literacy-Challenges.html 29

30 Interacting with older adults It is important to communicate with older residents in ways that are respectful and informative. Source: Patient Education Update. (2012). Interacting with older patients: 13 tips on better communication. Retrieved from 30

31 Teach-back technique I want to be sure that I did a good job explaining your problem. Can you tell me... What is your problem? Why do you need to do it? What do you need to do? 31

32 Risk strategies for verbal communication Use layman s language to explain medical terms (e.g., high blood sugar for hyperglycemia ), and use visual aids to illustrate difficult concepts. Allow time for questions and restate information as needed. Ask open-ended questions. For example, So, you re having pain? becomes Can you tell me more about your pain? 32

33 Risk strategies for verbal communication Use a technique such as teach-back to ensure resident comprehension. Consider cultural beliefs and practices that may influence your interactions with residents. Provide language access and assistive technologies, including interpreter services, to meet the resident s needs. 33

34 Risk strategies for written communication Ensure resident educational materials are written in plain language (4th to 5th grade reading level). Limit content to what residents really need to know. Put the most important information first. Present information in a logical order, group related information together, focus on one topic per paragraph, and use descriptive headings. Use a font size of at least 12 points; avoid overuse of capitalization and italics, which are difficult to read. 34

35 Risk strategies for written communication Use words that are well known to individuals without medical training. Use examples and visual aids (e.g., illustrations or tables) to make complex material easier to understand. Ensure that content is appropriate for the age and culture of the target audience. Use available plain language resources from the National Institutes of Health, the National Library of Medicine, and professional associations. 35

36 Health literacy resources National Patient Safety Foundation: Ask Me 3 National Library of Medicine: East-to-Ready Health Materials National Quality Forum: Improving Patient Safety Through Informed Consent for Patients With Limited Health Literacy Publications/2005/09/Improving_Patient_Safety_Through_Informed_Consent_ for_patients_with_limited_health_literacy.aspx The National Academies of Sciences, Engineering, and Medicine: Health Literacy: A Prescription to End Confusion hmd/reports/2004/health-literacy-a-prescription-to-end-confusion.aspx MedPro Group: Checklist for Patient Comprehension documents/10502/ /checklist_patient+comprehension.pdf University of Michigan: Plain Language Medical Dictionary taubman-health-sciences-library/plain-language-medical-dictionary U.S. Department of Health and Human Services: Plain Language Thesaurus for Health Communications info/plain_language_thesaurus_for_health_communications.pdf 36