Patients in long-term care require frequent adjustments in treatment and an awareness of changes in their behavior. Medications may have to be increased, decreased or changed. As the debilitating effects of age and terminal diseases add to a patient’s fragility, more supervision is required than necessary compared to the patient initial arrival to a long-term care facility.
The Importance of Staff Review
Record keeping is an integral part of long-term patient care. The facilitating nurse entrusted with the care-keeping of the patient will be the one most likely to notice changes in behavior or health. His or her advocacy should be informing the staff of these changes to institute remedial changes in medication or treatment. In cases such as Alzheimer’s or dementia, patients can increasingly become an endangerment to their safety and even to the safety of others if they begin exhibiting signs of hostilities. By bringing changes to the attention of the staff members, steps can be taken to adjust patient care in accordance to the patient’s new disabilities or effects on cognizance due to medication or advanced stages of the disease.
Emergencies are frequent with long-term care. Changes both in health and behavior can be sudden and life-threatening. Modern technologies offer new ways to deal with emergency situations. Refresher courses on emergency preparedness and staff policy should be a part of both the training for new nurses and an annual requirement for the working staff. This helps keep the staff aware of what to do in an emergency situation and reinforces staff policies on the correct procedure.
Falls are the most frequent jeopardy to the safety of the increasingly fragile health of a patient. Over time, patients with walkers may be confined to a wheel chair and the wheel chair patient eventually bed-ridden. Many falls take place in the evening when it is assumed the patient is asleep. Vigilance must be taken at all times to ensure the patient is resting comfortably and not trying restlessly to get up and about. Give assistance when appropriate to help the patient feel empowered. Grips, lowered beds and grab bars can help patients trying to move about on their own. Keep obstacles cleared from the likely pathway that the patient will take. Keep items such as drinking water, remote controls, books and other things the patient might want, close enough for the patient to reach them without endangering his or her safety.
Fragile patients often have the tendency to neglect their personal hygiene. In cases such as dementia or Alzheimer’s, they may have an aversion to bathing. Debilitating diseases and old age weaken the immune system. Care should be given to keep the patient bathed, and bed pans should be changed promptly. Incognizance is another frequent problem with long term care patients. Be aware of the patient’s needs and discomforts, change clothing and bedding as often as needed.
Nursing is a full-time job. Many hospitals and nursing homes are under-staffed as the demand for qualified nurses continues to exceed the availability of nursing care. This can put an enormous strain on the nursing staff, causing them to make mistakes or become more lax in their duties. Every effort should be made to ensure there is a good nurse/patient ratio and nurses should feel appreciated for giving quality care. How the nursing staff feels they are being treated will directly affect the fairness with which they treat their patients.
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