Laguna Honda Hospital Resident

Laguna Honda Hospital Resident

Sunday, October 7, 2007


From Resident Perspective -

A Resident, sometimes, needs an inordinate amount of do ordinary things.

Resident Care Ideal: A hospital-wide mindset
where ALL workers are caregivers.

Caregiver is someone ''willing and able'' to fulfill ''needs and preferences'' of Resident.

Resident (needs and preferences):
GENERATED by IDT meeting.

EVERY Resident has an IDT (care team).

IDT is care team - made up of Staff, etc.
InterDisciplinary Team.

IDT meeting: Meeting of
care team and Resident.
(FOUR times per year)

NO Matter HOW You Look At It,
We Are ALL In This Together.

IDT or Care Team -

Every Resident Has IDT (Care Team)

IDT and YOU -

IDT and YOU -

---Every Resident has different NEEDS and PREFERENCES. It is very rare if we find any two who have the exact N’s and P’s, someone else may have.
---Every Resident has an Interdisciplinary Team or IDT, to help with the management of his care. The IDT team is made up of your doctor, the nurse manager, the charge nurse, your dietician, your activities therapist, your social worker and whoever else may be a part of your aid team. It is also made up of YOU.
---The IDT will help the Resident to identify the N’s and P’s, that best suit his care. And that both sides have come to a happy agreement. Once we have identified the Residents N’s and P’s, we then convey the N’s and P’s to his CNA of the day.
---We remember that the best CNA-Resident relationship, is one that works. The relationship seems to work best when the N’s and P’s of the Resident are provided for him/her by a CNA who is Willing and Able to carry them out.

When the Ground Rules are straight, then we should have a more natural and healthier communication for all parties concerned.
Hospital-Wide Mindset - Where ALL Hospital Workers Are Caregivers.

Resident-Centered Care Conference -
(The Second Article Was Written About 18 months, After The IDT and YOU)
---This is the new name chosen for the IDT. It spells out what it intends, from the beginning. It is easier to understand, right out of the gate.
---There was a committee formed that had as its intention, to ''continually improve communication,'' at the Hospital. There was a poster developed that put the results and conclusions we came to, in the meetings, into an easy to read version that will be prominently displayed throughout the Hospital.
---There is a real effort to put residents first, and not just give the idea, ''lip-service.'' In my own opinion, I hope that a Care Team Member checks in with each resident, at least once a week, just to see how he/she is doing and if anything new is going on. To me this will keep things current and fresh and forge more of a bond between the Resident and his Care Team.
---In my case, I like the fact that a member of my care team came into my own space and we talked for a bit. This person would see me in the hallway and ask how I'm doing, but I noticed it didn't seem to have the same effect that an actual ''visit and short chat,'' did. It was nice that she made some time for me. We talked of things outside of here, and, it seemed the beginning of a ''better'' relationship. There are efforts made to bridge the gap existing, sometimes, between staff and resident. To do this, we need the cooperation of EVERYONE, here. Take Care.

Saturday, October 6, 2007


---This should be a place to get things done, after a try with your IDT has come up short. The chain of command would be to begin with the nurse manager of the unit. If you were unsatisfied with the nurse managers and IDT advice, then bring issue to Residents Council.
---We know that the above scenario doesn't come into play, very often. And that is for a number of different reasons. I started to think of the different ways and reasons that it doesn't work, and it comes down to the fact that the chain-of-command is NOT well-known.
---To top it off, we, for the most part, don't have a ''good,'' relationship with the person that we would take the issue to, anyway, if it was a perfect world.
---In my estimation, I think that if Residents felt ''comfortable,'' with members of their IDT, and trusted their judgments and decisions, they would use them more often. But, by the same token, the members of the IDT have to PROVE that their judgments and decisions are worth trusting. Some, of what goes down, as trustworthy decisions and judgments, makes you wonder.
---I believe that if the Resident has a top notch support mechanism, in place, the above would NOT be as problematic. He would naturally go to the party, who could resolve the problem.
---Personally, I find that the person I want to talk to, is NOT ALWAYS AVAILABLE. I, myself, find I play the ''waiting,'' game, a lot. I believe, also, that if the ''team,'' worked more as a unit and were more on the same page, that we would see a marked improvement.
---People tend to be more self-centered than Resident-Centered...and that includes, both, Residents and Staff. People prioritize differently - You may NOT be the priority, at that moment.
The Golden Rule - Treat Others As You WANT To Be Treated.

Resident-Centered Care -


---There is a buzzword going around. It is a term, actually. It is - Resident Centered Care. Contrary to what you may have heard, it wasn’t created to give the staff nightmares, or something else to worry about. But, I’ve noticed that when left on their own with terms like this, they can’t help but worry…or at least, wonder. WHAT DOES THAT MEAN? Staff and Resident, alike, are looking for a definition.
---Suitable Definition, To Me -
---To me, it is where the rubber meets the road. Resident-Centered Care is where staff and resident have a DIALOG. They have to hash out it’s meaning. It may be different in every case. There really is NO definition that will fit everybody, all the time. There is NO real blanket definition.
---Personally, I think, it is where the Resident states, what he wants. When you know what you want, I think you are at least, halfway there. It really doesn’t matter if it is possible or impossible, foolish or right-on, the staff will swoop down upon it and help you make your idea fitting and realistic.
---It takes, ‘’two, to tango.’’ There is a good chance that the Resident, with his idea, will need help to accomplish his goal, anyway. We, as Residents, have to be realistic with it all. Otherwise, it doesn’t have a ‘’snowballs chance in hell,’’ to get done. As sad as it may seem, we NEED the SWOOPERS.
---BUT, it is through this process of give-and-take, that we reach a comfortable agreement of dealing with the task at hand. When both sides are happy with the role each plays in the situation – We have a done deal. Then, the carrying it out part, is the easy part. Be Well.
EVERY Resident Has An IDT (Care Team)


Resident-Staff Communication


---The Communication between the Resident and Staff is what I really mean, when I say that the focus should be on the IDT. To me, the IDT situation is where the Rubber meets the Road.
---From my observation, I have seen many cases where the Resident cannot communicate his needs to the staff, and vice-versa. They seem to be on a different page. Sometimes it seems there is a different book. I think the Objectives of each are different. The Resident seems very concerned with the immediacy of his needs, while the staff, per se, are broader in there thinking, and more casual about the situation.
---I think that the word URGENT says a lot. Residents think that there is an urgency, where sometimes there is NOT. BUT, the fact that the Resident thinks this, and hence, the Resident is reacting to this has got to be dismantled, in my estimation.
---The other-side of the coin, is that the Staff thinks that certain situations are more URGENT than the Resident, does. The Staff can even be taken aback by the Resident’s non-challance, in a situation.
---Staff and Residents have different priorities. They think different things are ‘’important.’’ The Staff seems more concerned doing things according to the book – To keep their jobs or because, to them, this is the best way. It may be the way they think it is done, and questioning it doesn’t enter the picture.
---The Resident response is laced with their upbringing, etc. but their time-frame is different. Earlier, I said that the Resident is on the ‘’doing it immediately, schedule,’’ and the Staff is prioritizing, etc. TRYING TO FIT IT ALL IN BEFORE THEY [leave, break, etc.]
---The Staff doesn’t seem to understand why the Resident isn’t ready when they are, and vice-versa. A classic example is when the nurse is ready with the medication, sometimes, the Resident is nowhere to be found. Their availability is much different, in many cases.
---Here we have a brainstorming point:

1. Interests are different
2. Staff and Resident should DO many, more things together. [Clubhouse Model] – Almost a mentoring situation where Staff and Resident share and exchange ideas, etc. [They Talk, Together]
3. People need to feel engaged, included, etc.
4. People have to feel they are part of the team. No matter what part they play, their part is important. [Realize that their part is important-Don’t fake it]

---What may begin by just needing ATTENTION at first, grows into a more comfortable setting where actual SHARING may take place.

---Residents may have much too say and to some it may just be rambling, that is okay. It is a very relative situation. You may NOT want to hear the Aunt Margaret Story. Many staff do NOT know how to disengage from a Resident Rambling. Brainstorm:

1. Resident may not know he is rambling or being repetitive
2. future

----How to deal with Resident Rambling. You have to actually hear what Resident is saying. You could help him be more specific.

This Occurs Very Often:

---Many Residents are trying to squeeze too much information into the time that is allotted them, by the Staff. Resembles Resident Rambling - but isn't. Some end up saying nothing, because somewhere in their past they were thwarted as they made this attempt. It is too painful to even try, now, or they are so out of practice, that they don’t know where to begin.

QUESTION: Out of it, or out of practice with

---Dealing with APATHY [Brainstorm]:

1. Be sure it IS APATHY Could just be out of practice with communicating.
2. Still find likes and dislikes. It may be difficult, but they are usually in there.

Know that some communicate too little, while some are trying to fit it ALL in. The Staff person involved is the time keeper by his/her reaction[s] and response, in the exchange.



---When we have the right attitude, we can do almost anything. When our attitude is right, there is very little that can stop us. When our attitude is wrong for the situation we are in, getting out safely becomes something we are not sure of.
---There are so many words that we have to define our ''attitudes.'' We can be happy, sad, confident, needy, etc.. Our feelings to what we are relating to, denote the attitude we have towards it. Our attitudes cross all of Human Emotion.
---When we are comfortable with what we are relating to, we are more relaxed. The opposite is also true - If we are NOT comfortable with what we relate to, we are nervous, more stressed, tense, whathaveyou. This is reflected in our BP, also.

---When we have an OBJECTIVE Attitude and
Outlook, we seem to do better. We see things as they are as opposed to putting our own SUBJECTIVE spin on things. What we want to do is to’’see’’ the Needs and Preferences that have us make the choices we do.
---I would suggest that you look at a list you make of ''Needs and Preferences,'' and see which are real and separate out the ones you only ‘’think’’ you need. With this list, it should be clear to you where you stand and why you have the ATTITUDES you do. There is a good chance you will remember – How they became part of your personal inventory. By listing ones ''Needs and Preferences,'' we are listing the very things we consider important for our survival. We will then see the attitudes, we have come up with, to get our ‘’N’s and P’s,’’ met. They can be surprisingly creative, if you find that you been very honest. Be Well.
Treat Others, Like You Want To Be Treated.

Friday, October 5, 2007

We ALL Need Someone We Can ''LEAN'' On -

Venting To My
(Pictured: Just Kidding)

---We ALL seem to need someone that we can talk to. Someone who listens to us as we get things ''off of our chest.'' He can be a friend, a professional person, a relative or anyone who has a good ear and hears what we're saying. He may be someone that helps us put things into words if we are having trouble with that, ourselves.
---Have you ever noticed that some people are better to talk to than others? Some understand you better. Some are better at listening and know what you seem to need to hear. They ''get'' where you are coming from and you actually enjoy your time together, ''unburdening'' yourself. This usually happens when we don't feel that we are being ''judged'' by the other person. In fact, the more accepted we feel, the more ''open'' we usually find ourselves.
---As they say, you shouldn't keep your ''music'' inside. In fact, it may not be ''music'' until someone hears it. You may feel a bit exposed, but if someone lets you know it is ''okay,'' than suddenly it is ''alright,'' [especially if you hold him in much respect.] You feel good. All of a sudden you have some kind of positive relationship. Remember, ALL relationships have three components-1] The way you ''see'' it, 2] The way he or she ''sees'' it, and 3] What you two agree upon.
---The only reason I say the above is that I know how good it feels to get your frustrations out. I used to do this for a living and I, myself, have been through many sessions. I have seen myself and others feel better in the process. I used to think that what bothered me was so different, but you soon learn there is little you can say that hasn't been heard or said before, in some form or other. People tend to have the ''same'' emotions, just over ''different'' things. We are also clearing out our insides for something ''new,'' which takes care of some of that ''boredom.''
---One of the Neuropsychologists and myself [I had a stroke] have a session every Friday. It is an opportunity to ''get it out.'' Over time, I see that this relationship has ''grown,'' and I look forward to seeing him. As with any new relationship, we had to get to know one another, but now I feel comfortable in telling him just about anything. He has become a friend. It is taught in the 12 step programs that you are only as ''sick as what you keep secret,'' so having someone to talk to, is a valueable commodity.
---I urge everyone to find someone to talk to. There are many professional and non-professional people, here. Don't let things get to the breaking point before you do something. It is like a radiator valve that you learn to turn on slowly and when necessary, to let off some ''steam.'' As I said earlier, there is not much you can say that has NOT been heard before. Having another to talk to keeps the frustrations down and manageable. It keeps you current and present.
---ALL of the ''good-stuff'' is inside, but you may have to weed the garden, first. Give ''it'' a try, and see if it doesn't reap benefits, eventually. Give it some time. There are many people here willing and trained to talk, if you want to. There are psychologists, psychiatrists, therapists, nurses, chaplains, volunteers, etc. Out of that bunch, there must be someone you can talk to. Be Well.

Float Situation - Pt. 1

The ''Float'' Situation
Part 1

---Contrary to opinion, I do not dislike floats. In case you don't know, they are the people who fill - in for the regular workers on your Ward. They come in all shapes and sizes, varying degrees of life experience, intellect etc. In other words- They are like everyone else.
---What I do dislike is this - The training period. By this I mean, the period of time it takes me to teach my particular float the many, many things that I need them to do for me. The difficulty is that I have virtually no usable hands, except theirs. In addition to this, I have many idiosyncratic ways, that repeating them, to a different person [in what sometimes seems a daily situation] is also difficult for me. It increases my stress, etc. It becomes very much a teaching of the same boring class, ad finitum.
---As people, I have no opposition to those who have chosen this as their work. In fact, these are the very people who are learning a trade that I utilize constantly. I feel it is safe to say I probably need what THEY do, more than, say - many other professions [at least directly.]
---At first, I didn't even know there existed a job like this. Before I was in the hospital, it just never came up. I could do things for myself and never thought about what it is people do, who can't. It was my job to do for me, and that is about as far as it went.
---Then I needed help. And with no questions asked, they helped me. I had a stroke and if left to my own devices - I wouldn't know what to do. I was quickly plugged into a system that made it ''possible'' for me to continue on, in a different capacity, but nonetheless, continue doing what I do, whatever that is. I think finding ourselves is what we do - and everyone does it different no matter what the circumstance.
---They have given me another lease on living, and I am grateful. I have been ''different'' now, for four-plus years. In a certain way, they are part of my immediate family, no matter how dysfunctional it gets, sometimes. But, that seems the nature of families, anyway.
---It is NOT the CNA that I have a problem with, but the amount of my own idiosyncrasies. I have a lot of preferences and I verbalize them. To me, they are very natural, as I spent about fifty years - doing each one. But, when someone else does them, that's usually where the ''problems'' begin. I'm supervising someone else doing what I did, and did very easily. I forget that everyone has there own set of the way they do things, and the person making my coffee, for instance, may have a different idea from myself. They begin making it their way. [Do you know how many different ways there are to make coffee?]
---It can be like a dance, where you ''trade - off'' who is leading. I am not as flexible as some would like, while others prefer my direction. Well, I don't know exactly why I never could dance, and in kindergarten I got a check mark next to - doesn't work well with others. I'll work on my flexibility, just please tolerate me, while I do. I'll try to not sound like a tyrrannical dictator the next time I need two Equals in my coffee, and, ''God forbid,'' you forget. Just kidding.
---I am Thankful to all and Hope they know that. Be Well.

Float Situation - Pt. 2

The ''Float'' Situation
Part 2

---The situation I speak of is the Resident and immediate (usually very intimate and fundamental) caregiver, the CNA (Certified Nursing Assistant). This has all the earmarks and potential for one of the most important relationships that either have ever been in, or could just be ''two ships that pass in the night.'' Or, the situation (relationship) could fall somewhere in the middle.
---There seems to be different camps on this situation. There seem to be those Residents who prefer certain CNA's and those who go with whomever comes down the pike. There is also the CNA to consider. There are some who prefer certain residents and those who don't care as much. We cannot assume that every Resident and CNA is the same and each is interchangeable. We know from the evidence of the present circumstance, that this is not the case.
---How do we make beneficial and necessary changes when they need to be done? We must look at the ''factors'' that are the essential factors in the Resident - CNA relationship, and those that are not. Since it is the easiest, and because it is the most obvious, we will start with what the relationship is NOT.
---The CNA - Resident is not spousal. The CNA is NOT the
husband or wife of the Resident, or vice - versa. If an aspect of this exists, than the relationship is not purely a Helper - Helpee relationship. We have to know our boundary lines, and what we are doing.
---I think there are Residents who don't really know what [exactly and actually] the CNA does and really don't know what can be expected in the CNA - Resident relationship. I have seen a list of the different skills the CNA is able to provide, but, at present, some don't apply. All I really know or knew is that I had a stroke, and these CNA people will help. I have since learned that many of my own needs were not covered by that list, and to have the ''PERFECT'' relationship with a CNA, their ''Life experience'' and their ''Efficiency level'' enters into ''it'' constantly. A good match for me doesn't necessarily mean that ''the best CNA in the world,'' has to be found. But, I presently do better with a bit of structure or sameness.
The Rules Of Any Relationship:
1. The Way YOU See It.
2. The Way HE/SHE/THEY See It.
3. What The TWO Sides, Agree Upon.

---I should be my own best CNA as I, myself, am the only one who can second - guess ME, on a continual basis. Well, we know this is NOT possible, as there are certain things I can not do for myself.
---It seems then a Helper is needed. My duty is to identify my ''needs'' and ''preferences'' and have a relationship with a CNA who is ''willing'' and ''able'' to deal with them. A good match seems to be one that ''works'' and the relationship that ''most'' naturally fulfills this criteria.
---A solution to this whole dilemma would be to ''cluster'' Residents together whose Needs and Preferences ''match'' the Willingness and Ability of the CNA's who agree to carry them out. The CNA who prefers a ''Float - type'' situation are placed with Residents who don't care as much. To him, one CNA situation seems to fit as well as another. Be Well.

Thursday, October 4, 2007

The Creation Story -

---Like You Have NEVER Seen. You Are What You Eat...Hmm.
(Picture is an Old Advertisement)