Culturally Informed Enrichment Project - Individualized Attention FINAL PAPER.docx

ELDERLY COMMUNITY ASSESSMENT 14

Culturally Informed Community Assessment: Increasing Individualized Care to Residents in a Nursing HomeNatalie Bertucci, Amanda Grzych, Kristin Alonso,Anita Gilbert, and Xiomara Zelaya (Section One)Magahn Stanga, Alissa Allen, Sheena Powell, Sally Trammell and Megan McIntosh (Section Two)Accelerated Student Contributions: Initial Assessment and Literature ReviewReva BroussardAnastasia Mcpherson-RichardsonBrittany YoungOur Lady of the Lake College of NursingOctober 12, 2014

Introduction In 1996, Ollie Steele Burden Manor was established under the Franciscan Values as a non-profit, long-term healthcare facility, as means to provide care for the growing geriatric population. The organization is composed of four units that can accommodate up to 174 beds. The facility is capable of managing a broad level of care and acuity, supported by different skilled care units. Residents are housed based on acuity in either the secured dementia, skilled, or one of the two general population units. Together they share a registered nurse manager, two licensed practical nurses (LPN), a single patient care assistant (PCA), and nine certified nurse assistants (CNA). Ollie Steels landscape embodies peace, serenity and promotes health with its beautifully designed gardens that encompass covered walkways and a two-mile walking trail. In attempts to better accommodate the needs of its residents, the sidewalks surrounding the facility are wide enough to accommodate wheelchairs and assistive devices. Overall, the institution provides a multitude of services such as: a primary care physician, nurse practitioner, pharmacy, Medicare services, physical therapy, occupational therapy, speech therapy, social services, dietetic services, dental consulting, beauty/barber services, maintenance, housekeeping and laundry services, activity coordinators, and spiritual services.St. Rose MarieSt. Rose Marie is one of the general population units located near the front of the facility. It houses fifty beds with seventeen private rooms and thirteen semi-private rooms. Currently twenty-six residents reside on the unit. There is a common area and a sunroom, which lends itself for socialization, dining services, and activities throughout the day. During meals, patients requiring assistance are wheeled to dining tables where meal trays are brought and placed, for their convenience. To ensure each resident receives his or her proper tray, it is paired with a printed ticket that notes the residents name, diet, and room number. During this time, a PCA and multiple CNAs assist residents with meals while LPNs administer medications. PopulationCurrently, the residents of St. Rose Marie range in age from eighty-two to one hundred and one. There are twenty-five widows and one single resident residing on the unit. All patients speak English with the exception of one. One individual is quadrilingual speaking English, German, Russian, and Greek. The unit houses patients of different race and heritage such as Caucasian, Asian, and African-American. Currently, there are twenty-one white females, four white males, and one black male. There are religious individuals practicing Pentecostal, Methodist, Catholic, and Baptist denominations. Although Ollie Steele is affiliated with Our Lady of the Lake Regional Medical Center, a Catholic-sponsored institution, it accommodates all religions by offering various services for all denominations. Educational levels range from high school to college graduates with occupations of homemakers, school teachers, professors, priests, and military veterans. The health history of the residents is extensive. Illnesses include, but are not limited to hypertension, cardiovascular diseases, dehydration, gastrointestinal esophageal reflux disease, urinary tract infection, hyperlipidemia, cancer, depression, anxiety, vitamin deficiency, anemia, debility, dementia, Alzheimers, and osteoporosis. Residents can be transferred to acute care facilities if they experience injuries such as falls, urinary tract infections, or a decline in health. The nurse contacts the primary care physician upon any changes in health status or hospitalization of the residents. As a result of hospitalizations amongst residents, nurses have noticed a trend within the past ten years that clients are living longer lives with multiple chronic diseases.Social OrganizationThe activity coordinators develop and plan activities monthly. These activities are placed in multiple areas throughout the facility and patients rooms. Activities range from puzzles, trivia, arts and crafts, games, musical therapy, bingo, creative writing, sing-a-longs, physical activity, wine and cheese tasting, popcorn and movie night, and spiritual services. Outside activities include wheelchair racing and sitting on the front porch. Internet and library services are also accessible on the unit.Environmental HealthThe unit of St. Rose Marie has access to multiple environmental resources. Drinking water is readily available in the common area, as well as a water fountain near the library. The water is clean and free of pesticides and chemicals. Residents are offered snacks throughout the day if their prescribed diet allows.The facility offers designated smoking areas to patients who have been cleared and approved by the physician of any respiratory illnesses or other complications. In case of a fire emergency, there are fire alarms strategically placed throughout the building and fire extinguishers nestled within the halls. Overall, maintaining the general health and vitality of the residents is a priority. The staff promotes assurance of health by keeping its residents informed. Residents and visitors have access to updated health and wellness information at their leisure. The information is posted on bulletin boards in the common area and is kept current by personnel. Furthermore, fitness equipment is readily available for physical training with supervision.

Health Care OrganizationIn large organizations, it is helpful to establish roles amongst staff in order to function more efficiently. At times, the lack of finances can put a hindrance on staffing which can affect clients. The staff at Ollie Steele is responsible for different roles in order to operate an effective and safe environment for its residents and visitors. For example, in order to provide safe quality care, duties are divided between the nursing staff. The duties include medication administration, assessment, charting, and notifying physicians of any changes in health status. The PCA and CNAs have multiple responsibilities in order to provide a comfortable environment for the residents. The PCA is responsible for linen changes and bed making. These tasks are to be completed by noon, in order to allow residents to rest after lunch. The CNAs assist residents with activities of daily living, in order to accommodate their needs. Housekeeping keeps the facility hygienic by cleaning on a regular basis. Office personnel are assigned specific roles to help Ollie Steele operate more efficiently. The secretarys role is to answer phones and monitor patients charts. The staff works collaboratively to provide care and allow the unit to operate with cohesion. There is an uneven ratio between residents and staff, even with the staff working collaboratively. The unit addresses the issue through hiring of PCAs from outside agencies; however, there is still a lack of individualized attention. The Nurse Manager of St. Rose Marie, Gayle Turner, expressed concern regarding the lack of quality time with residents. In order to improve this issue, we are developing a Service-Learning program, Open Your Heart to the Elderly. This program will incorporate students from Our Lady of the Lake College that will volunteer ten hours of their time to Ollie Steele. Students will gain leadership skills and appreciation for the growing geriatric population. Residents will experience companionship and individualized attention through socialization with students. Literature ReviewA lack of social interaction between residents and staffing on the St. Rose Marie unit at Ollie Steele Burden Manor has been identified as a major problem. According to the literature review, elderly individuals and patients with dementia respond better with more one-on-one interaction on a daily basis. Increasing volunteer involvement within the community, promotes more quality and individualized care. According to McDonnell (2014), volunteers participated in various activities with patients ranging from holding simple conversations to dancing. McDonnell (2014) stated that the activities and volunteers were able to individualize the care, rather than having the same activity provided for everyone. The interventions implemented were based upon the patients wants and needs for that particular day. With the variety of activities, the study authors suggested that the patients responded well because the intervention was patient-centered. The staff also welcomed the volunteer services because it complemented the care provided, rather than just duplicating it (McDonnell, 2014). Other than implementing interventions, knowledge of the health status and cultural beliefs of the residents in the facility are also important. Volunteers must be knowledgeable and familiar with the residents on the unit in order to ensure safety and engage in activities that are appropriate to the patients needs. Neno and Neno (2007) suggested that the volunteer coordinator of the facility, unit manager, nurse mentor and supervisor on the unit become involved in planning activities for patients. This would offer Effective teamwork [and] effective integration of volunteers (p. 229) to provide basic education for both staff and volunteers. Volunteers can learn a great deal about the residents by talking with them (Neno & Neno, 2007). Through conversing, the volunteers can be enlightened about the residents lives, experiences, and religious beliefs. This article mentions the use of booklets or pamphlets to learn about different religions in order to connect with patients of a different faith (Neno & Neno, 2007). Religion is a sensitive topic, therefore the volunteer coordinator should address religious beliefs during the initial interview phase when pairing volunteers with residents (Neno & Neno, 2007). Nursing students are a great choice for volunteers in a long-term care facility due to their critical thinking skills and their knowledge base of healthcare. The article by Kruger, Roush, Olinzock, and Bloom (2010), stated that nursing students can play an intricate role in a nursing home, as well as have more clinical experiences throughout their nursing program using the home-based model. Through working with a diverse population at a nursing home, the students gain comfort and communication skills. Kruger et al. (2010) suggest that staff and volunteers coordinate together to plan activities and appropriate interventions for the residents. By doing so, the nursing students can benefit by seeing the big picture, and making a difference in the community (Kruger et al., 2010). Damianakis, Wagner, Bernstein, and Marziali, (2007) states that it is important that the volunteers understand how the quality of life can affect cognitively impaired residents. It describes a model for training the volunteers in order for them to provide better care. Through cognitive training, volunteers gain the knowledge to provide compassion and patience while communicating. This understanding, promotes conversational skills in order to engage residents in social activities (Damiankis, et al., 2007). The results of this study revealed that the volunteers knowledge of quality of life and understanding cognitive behavior of the aging population, had a positive impact as well as decreased social isolation. It has been found that the lack of social interaction in the nursing home is due to a disconnect between healthcare staff and residents. Neno (2010) found that the involvement of volunteers within the nursing home improves social interaction and mental health. Close interactions between volunteers and older adults can enhance positive health in the aging population. Since studies find that close relationships between volunteers and residents can be used to support health and enhance well being, nursing facilities should encourage and support these relationships (Neno, 2010). Damianakis, et al. (2007) states that a lack of social interaction can lead to chronic depression. Social interaction can decline due to the death of parents, spouses, or siblings. Some signs that a resident is experiencing depression may include a change in interaction patterns, withdrawal, decreased memory, and increased stress levels (Damianakis, et al., 2007). In order to decrease depression among residents, volunteers can encourage participation in activities such as: befriending other residents, engaging in yoga, going on social outings, fundraising, and getting manicures and pedicures. GoalOur goal is to provide individualized attention for the residents of St. Rose Marie by incorporating Ollie Steele Burden Manor into Our Lady of the Lake Colleges Service-Learning program. Must be measurable

InterventionIn the Service-Learning program students will dedicate ten volunteer hours to spend with residents at Ollie Steele. In order to facilitate this goal, we discussed with Dr. Rhoda A. Reddix, Service-Learning Director, the steps to incorporate Ollie Steele into Our Lady of the Lakes Service-Learning program. The program will increase volunteer involvement and social interaction within the older adult community. This will be feasible due to the lack of financial involvement needed to incorporate the project into the Service-Learning curriculum. Students can gain credit hours while contributing to their local community and supporting the healing mission of the Franciscan Missionaries of Our Lady. They also benefit from the rewarding experience of befriending individuals from the older adult community. To gain volunteers, a member of the Ollie Steele staff or a current senior nursing student will present a PowerPoint to each class. We developed a presentation called, Open Your Hearts to the Elderly that introduces Ollie Steele, the benefits of volunteering and potential activities that the students will engage in. These activities might include: hat making, fiestas, dancing, puzzles, trivia, bingo, singing, popcorn and movies, and spiritual services. Another rewarding experience of volunteering at Ollie Steele is to create a written life story for the residents. The life story can be documented into a journal that holds all major life events and can be given to the residents families or kept for personal use. This is a good way for the students to develop companionship and appreciation for the older adult population. The presentation also addresses many false beliefs that might hinder student involvement. These false beliefs include: performing linen changes, assisting with bed baths, changing briefs, and feeding the residents. These issues have been addressed in hopes of correcting the negative stigma that is placed on long-term care facilities. Upon arrival at Ollie Steele, students will be greeted by an activities coordinator who will provide a tour, the facility rules and guidelines, a brief description of expectations, and acquaint them with the residents of St. Rose Marie. After the initial meet, students will schedule future days and times to begin to participate in activities with the residents. EvaluationIn order to evaluate the effectiveness of our intervention, we first have to ensure that Open Your Heart to the Elderly is added to the Our Lady of the Lake Colleges Service-Learning Curriculum in January of 2015 by Service-Learning Director, Dr. Rhoda A. Reddix. Once established, the number of students that enrolled and completed the program will determine future continuance of the program for upcoming semesters. Additionally, Ollie Steele Burden Manor staff will evaluate whether volunteers were beneficial to the residents in increasing individualized attention.Reflection for Enrichment ProjectFirst, we met with Gayle Turner, the unit manager of St. Rose Marie. During this meeting, we established the need for more individualized attention for the residents on this unit. To fulfill this need, we brainstormed ideas and determined the most beneficial intervention was to implement Ollie Steele into the Service-Learning program at Our Lady of the Lake College. To move forward, we scheduled a meeting with Dr. Rhoda A. Reddix, Service-Learning Director, to discuss the steps to include Ollie Steele in the Service-Learning curriculum. After this meeting and further discussion amongst our group, we decided that utilizing a PowerPoint presentation would draw students too this facility, as well as be cost effective. Our group met on multiple occasions to compile ideas, develop the PowerPoint presentation, and write the Culturally Informed Assessment and Change Project for a long-term care facility. We worked as a team to successfully develop an implementation that would meet our goal criteria and be beneficial to Ollie Steele. Throughout the implementation process we found the experience of working as a team, as well as with the Ollie Steele staff to be positive. Our major success is that we have developed the first student driven Service-Learning project. If implemented, it will be a mile marker in history for Our Lady of the Lake College. A barrier we endured was financial constraints. For example, it was suggested to offer the Service-Learning classes a brochure on the Ollie Steele facility. However, we determined it would be more economically feasible to develop a PowerPoint presentation.We learned how to develop a culturally informed change project for a long-term care facility. In doing this, we established relationships with the nurse manager of St. Rose Marie and activity coordinator at Ollie Steele, along with Dr. Rhoda A. Reddix. We also learned that a lack of individualized attention can affect the physical and emotional health of the geriatric population. Overall, we truly enjoyed working on incorporating Ollie Steele into Our Lady of the Lake Colleges Service-Learning curriculum and would not have done anything differently. The next step would be to have our successors follow up with Dr. Rhoda A. Reddix, in order to get this project lifted off the ground to ensure that the project begins in January of 2015. The section two students followed up with the aforementioned managers and directors in an effort to implement the service-learning project for the 2015 spring semester. We first met with Gail Turner to discuss the incoming freshman and our goals for the implementation of this program. We discussed what she would expect from the students of Our Lady of the Lake College in terms of level of professionalism and behavior. She stated that participating students would be allowed to wear business causal clothes, closed toed shoes and a college issued student badge, for identification purposes, while on the premises. We then attempted to designate a staff member to be the Ollie Steele representative for the service learning presentation so the students are informed and given the opportunity to complete the required hours at the nursing home. This designation is still pending. We then arranged a meeting with Ms. Stacy Anderson, the activities director of Ollie Steele Burden Manor to discuss when the students would be able to go to the nursing home and if she would volunteer to be the student contact person. She expressed that the students would be allowed at any time as long as they gave a twenty-four (24) hours notice so the students can be informed of the activity schedule for the day as to provide a variety of options throughout the nursing home. She agreed to be the contact person for the students and is corresponding with the marketing department as to provide a consistent explanation of the opportunities at the nursing home. Lastly, we reached out to Dr. Rhoda Reddix, the service-learning director for Our Lady of the Lake College for the implementation of service learning project. She expressed her excitement about the opportunity for the students due to the program being the first student-initiated program. She enjoyed the prototype of the PowerPoint presentation to be presented to the students and just needed to be informed on who would be the presenter of the PowerPoint. These questions were sent to Ms. Anderson at the nursing home and are pending a response. When a response is recieved, Dr. Reddix will extend a formal invitation to OSBM for the service learning session.

ReferencesDamianakis, T., Wagner, L., Bernstein, S., & Marziali, E. (2007). Volunteers experiences visiting the cognitively impaired in nursing homes: A friendly visiting program. Canadian Journal on Aging, 26 (4): 343-356. Retrieved July 2, 2014 from file:///C:/Users/floyd/Downloads/30099289.pdfKruger, BJ. Roush, C., Olinzock, BJ., & Bloom K. (2010). Engaging Nursing Students in a Long-term Relationship with a Home-base Community. Journal of Nursing Education, 49 (1), 10-16. Retrieved July 1, 2014 from http://web.b.ebscohost.com.ezproxy.ololcollege.edu:2048/nrc/pdf?sid=7ec09e96-7457-483a-a16a-27e4b328b05b%40sessionmgr111&vid=5&hid=117McDonnell, A., McKeown, J., Keen, C., Judith, P., & Bennett, N. Introducing on-ward volunteers to work with patients with dementia. Nursing Older People, 26, 28-33. Retrieved July 7, 2014, from http://web.a.ebscohost.com.ezproxy.ololcollege.edu:2048/nrc/pdf?sid=47944b8a-ca0e-446a-afa1-8bdb059e27be%40sessionmgr4005&vid=5&hid=4214.Neno A. & Neno M. (2007). Working with volunteers: key issues for gerontological nursing-application to practice the contribution of volunteers in a long-term care setting: a case study. International Journal of Older people Nursing 2, 227-331. Zhang N., Unruh L., & Wan T. (2013) Gaps in Nurse Staffing and Nursing Home Resident Needs. Nursing Economics, Volume 30 Retrieved July 6, 2014 fromhttp://web.b.ebscohost.com.ezproxy.ololcollege.edu:2048/nrc/pdf?sid=ebd3a196-91fe-469b-afe6-cb3296acc473%40sessionmgr111&vid=7&hid=117