Director (Cincinnati, Ohio)最新文献

Without question, working in Long Term Care (LTC) is demanding and stressful. In addition to the intrinsic stressors staff must face daily in nursing homes, often, they must also struggle with executives and managers who add to the stress. It takes only one thoughtless supervisor to create a work environment that goes from bad to worse, in an instant.

Union activity has dramatically increased. In light of this renewed union activity, it is essential that employers who wish to maintain a union-free environment carefully consider the following information now before any union activity begins.

Tiotropium is a major advance in the management of COPD. Clinical trials have shown that this product administered once a day improves overall lung function, reduces dyspnea, improves quality of life, and reduces hospitalizations. It does have the common adverse effect of an increase in dry mouth. The once-a-day dosing and easy-to-use HandiHaler device should improve patient compliance. Overall, based on the product profile, tiotropium appears to be an effective first-line agent in the management of COPD in the nursing home.

Of all the issues facing the long term care industry today, perhaps none are more prominent than the two issues of resident falls and bed siderails (restraints). Across the country, care providers are facing the reality of reducing and eliminating patient restraints, including siderails. At the same time, resident falls have also come to the forefront as an extremely important issue; it's now nearly impossible to find a facility without a special Falls Committee focussed on reducing the injuries sustained to residents, often caused when they are transferred or climb out of bed.

The authors conducted a series of two hour training programs in twenty five nursing facilities involving 479 CNAs. The focus was on how to deal with resident aggression. In the process of presenting 42 programs, we were impressed by the CNAs. In fact, the CNAs taught us about themselves, their work and their lives. This paper shares what the CNAs taught us.

In summary, all three types of aerosol therapy have a place in patient care. While MDI and DPI use is more efficient, less costly, and less time consuming, nebulization is still indicated under certain circumstances. As the length of hospitalization for COPD patients decreases and the cost burden shifts, nurses in the LTC setting are caring for more acute COPD residents. Prevention of exacerbations is an important focus of care in the LTC setting. With a good understanding of aerosol devices, the nurse can greatly impact the goals of respiratory disorder management. It is important for the nurse to be well versed in the use of aerosol therapies to provide adequate instruction to residents. Many nurses and other staff in the long-term care facility are unaware of proper inhalation technique with MDI use, and staff education is essential. Accurate care and use of aerosol medications will prevent medication errors and help the LTC facility comply with CMS regulations. The nurse can use resident teaching time to assess the resident's condition and capabilities with the device. If a resident is having difficulty with a device for any reason, the efficacy of the device may be greatly impacted. In such cases, the nurse can provide reinforcement teaching or recommend a change in the type of aerosol therapy. Not only must the nurse teach and continually evaluate the appropriateness of the therapy and its use, but also assess the resident for any side effects. Through continual assessment, implementation, and evaluation, the nurse has the opportunity to affect the resident's condition, and quality of life. [table: see text]