Course excerpt from The Nursing Home Resident: A Holistic Approach
“The impending crisis, which has been foreseen for decades, is now upon us. The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.” Institute of Medicine
“In order to treat elders in a holistic manner, all staff in a skilled nursing facility require education in person-centered care. It can be too easy to see residents as nothing more than a job to finish. Education about the complicated issues of aging can help staff see the resident as a whole person. Maintenance staff will know how to speak to the person with difficulty understanding. Dietary staff will know when to comfort the lonely resident. The receptionist will know who can go outside safely, and who should be accompanied.
Research has identified the need for training in long-term care facilities. Topics identified by staff include pain and symptom management; communication with residents, family members, and the facility team; time management; self-care; and identifying goals of care. Management identified staff educational needs in the areas of end-of-life care, communication, basic symptom assessment, and management skills (Cimino, Lockman, Grant, & McPherson, 2016).
It can be very difficult to treat an elder in a long-term care facility with dual diagnosis – substance misuse and serious mental health. These elders can have complex care needs, including serious medical issues, social adjustment problems, and emotional dysfunction. Education of all staff in the facility is important, so staff know the appropriate responses to the elder as well as actions to avoid (Cacchione, Eible, Le Roi, & Huege, 2016).
The incidence of long-term post-traumatic stress disorder is recognized as a phenomenon that affects not only in veterans, but also elders who have experienced trauma. Hualquil (2018) notes that long-term care facilities have many residents who have experienced significant trauma: a stroke, surgery, or a car crash with severe injuries. Perhaps the elder fell at home when showering and lay in the shower for hours (or days) until someone noticed their absence and sent help. Training in PTSD symptoms and appropriate responses are needed for long-term care staff to address the needs of elders who have experienced trauma. Staff should also be aware that PTSD can be present in any resident, not just a combat veteran.
Compassion Fatigue and Burnout
Even though death is part of the job in long-term care facilities, staff are often ill-prepared to deal with recurring death and grief. Close relationships between front-line staff and residents result in staff grieving when a resident dies. Some facilities have memorial services or remembrance groups, but this is rare. Even if these services are offered, they are provided as unpaid time. Staff may not want to ask for help with their grief, afraid of being seen as incompetent. Staff may detach themselves emotionally from the residents they care for as a self-protective measure. This strategy, however, results in a poor relationship with residents, who rely on staff for emotional support and validation (Marcella & Kelley, 2015).
Working daily with death can lead to compassion fatigue and burnout. Gentry and Baranowsky (2013) found the professionals most vulnerable to compassion fatigue fit one or more of the following categories:
- People who expect a lot from themselves. They will push for better performance even if they are worn out.
- People who require positive feedback from work and/or a positive outcome from their work.
- People with low levels of compassion for themselves.
- People who believe exhaustion if acceptable if it produces results.
- People with a large, complicated caseload.
- People who identify with those who are traumatized.
- People who work in an unsupportive workplace.
- People with no access to a support network.
A systematic review of interventions for compassion fatigue (Cocker & Joss, 2016) found the best results for intervention focuses on education of healthcare professionals at risk for compassion fatigue. An educational program included a four-hour seminar that provided education about compassion fatigue’s psychological and physical effects, symptoms of burnout and compassion fatigue, and factors that make a person vulnerable to compassion fatigue. Participants received not only seminar handouts, but a CD with guided imagery, website access to online resources, and a DVD that contained information about Gentry’s five elements.
Di Biase and colleagues (2016) found that a compassion resiliency program that educated healthcare professionals about compassion fatigue decreased clinical stress and increased both mindfulness and awareness of work/life balance. Participants were better able to recognize signs of compassion fatigue in themselves and others.
Looking to the Future
The Institute of Medicine, looking forward to the upcoming change in our country’s demographics, issued a report, Retooling for an Aging America: Building the Health Care Workforce (Fineberg, 2008). The report notes that more healthcare professionals with specific skill sets will be required to treat older Americans. The care needed in the future should follow these principles:
- Healthcare for the older population should be comprehensive, coordinated, and person-centered.
- Care should include preventive as well as supportive services.
- Evidence-based practice protocols should be followed.
- Services need to be provided efficiently, through interdisciplinary teams.
- Older persons need to be active partners in their own care.
Demonstration projects are underway to test new models of care that reflect changing demographics and the need for more efficient and effective care. Healthcare professionals should monitor research to determine evidence-based practices that best fit their practice and clientele.”
To learn more about the needs of the population and the continuum of services offered in long-term care facilities, as well to expand your knowledge about issues that affect the care and quality of life in older adults, read our updated course The Nursing Home Resident: A Holistic Approach.
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