Read the chapters and answer the questions

Case

The Pyjama Man

A male resident insists on wearing his night pyjamas throughout the day. When asked about it, the resident said, “I feel more comfortable in my pyjamas than in pants and shirt. I do dress up when I go out though, but at home I can wear what I want.” The staff has been trained to groom residents appropriately in accordance with the time of day. The nurses know that the annual certification survey would take place at any time, and the facility could be cited for not dressing this resident appropriately. Besides, the activity director has stated to the nurses that the ladies are particularly offended when this resident shows up at social functions. “They refer to him as ‘the pyjama man,’” she said. The situation was turned over to the social worker who explained to the resident the facility’s policy on grooming and that dressing up was good for his self-esteem. The resident simply retorted, “Leave me alone, I will not wear pants and shirt.”

Questions

1-Did the social worker handle the conflict appropriately? How should she have approached the issue?

Case 1

Fallen Out of Bed

Both cases were contributed by Laura M. Wagner, PhD, RN, GNP, FAAN; and Katerina Melino, RN, BA, MS, University of California, San Francisco, School of Nursing.

Mary Branscombe is an 83-year-old woman who was admitted a week ago to a skilled nursing facility. She was transferred from an acute care hospital, where she was treated for 2 weeks following her first stroke. Before her recent hospitalization, Mrs. Branscombe lived at home with her adult daughter, son-in-law, and their four children. She required little to no help with ADLs. Now, with the change in her condition, the family does not think that she can return home to live with them. Mrs. Branscombe’s gait remains unsteady. The physical therapist at the hospital tried to have her use a wheelchair, which she refused and insisted on ambulating independently.

Mrs. Branscombe’s other medical conditions include glaucoma (diagnosed 3 years ago), osteoporosis (diagnosed 22 years ago), and depression (diagnosed 14 years ago, after death of her husband). Her prescriptions include alendronate (for osteoporosis), fluoxetine (an antidepressant), warfarin (a blood thinner), and timolol eye drops (prescribed for glaucoma).

During the 7:30 a.m. nursing rounds, Mrs. Branscombe is found on the floor beside her bed. She is confused, disoriented, and in a lot of pain. She tells the nurse that she attempted to get out of bed to use the bathroom and fell as she was climbing out of bed. It is unknown if she hit her head. Mrs. Branscombe is transferred to the emergency room where it is determined that she has sustained a hairline hip fracture.

Questions

1.  What nonmodifiable and modifiable risk factors does Mrs. Branscombe have for falls?

Case:

iPods for Alzheimer’s

Contributed by Anne P. Stich, MMS, MPS, PA, Health Science College of Arts and Sciences, Bellevue University, Texas.

Nell, the activity director for a Continuing Care Retirement Community (CCRC) complex, has learned about the benefits of music therapy. She is convinced that the residents of the 30-bed Alzheimer’s unit, named Rosewood Court—a specialized unit in the complex’s skilled nursing facility—can really benefit from music therapy. However, she faces the dilemma of how to deliver the music that would appeal to the residents that range in ages from 52 to 91.

At the next interdisciplinary meeting of the Alzheimer’s unit, Nell made an appeal backed by current research on music therapy. During the ensuing discussion, most of the participants quickly dismissed the idea of providing a variety of piped-in music for the entire unit because it would create negative distractions for both residents and staff. The discussion focused mainly on the individual desires and interests of the patients. Most members of the team would like Nell to explore the feasibility of putting individualized music on iPods for each resident. Because the technology is rapidly changing, many people have upgraded their older iPods; Nell may be able to find used iPods for each resident.

Assuming that used iPods could be procured, selecting, obtaining, and downloading numerous musical genres that would appeal to individual tastes would remain a daunting challenge. Nell was given the responsibility to find the answers. She quickly arranged a brainstorming session with her six activity assistants who had responsibilities for the various units of the CCRC. Nell summarized the ideas generated by her activity team:

•  Purchase of iPods will be very expensive. They should find ways to obtain donated iPods.

•  They should identify how many residents would be able to use individualized music.

•  They should ask family members about the residents’ individual tastes in music.

•  The staff will not have the time to search for music, procure it, and download it to iPods. The facility should find ways to obtain music. Family members and volunteers could be solicited to assist with finding sources for obtaining at least some of the music.

•  The CCRC has a formal Adopt a Grandparent program in which the second and third graders from the local Lawndale Elementary School participate. Ms. Johnson, the principal, should be contacted for leads to try and enroll students from the Lawndale Middle School to help download music and teach the staff on how to access music from the iPods.

Associates in the Activity Department assisted Nell in developing a brief survey for families:

A.  Did your relative enjoy music prior to his/her admission to Rosewood Court? What kind of music? Please check all that apply:

B.  Are there specific songs or music that your relative associates with good times in the past?

C.  Do you have any of this music on vinyl records, tapes, CDs, or other media?

D.  Would you be able to lend your media so we can download the music to iPods?

With Ms. Johnson’s help, the 24 students of the seventh-grade social studies class at Lawndale Middle School made it a cultural project. With the enthusiastic support of Mr. Reibold, the social studies teacher, the students helped with finding music on the Web and downloading it. The CCRC paid the nominal cost for the downloads. A local recording studio donated the time to convert some of the music from other media to a downloadable format for the iPods.

Nell and Mr. Reibold arranged a field trip for the students to meet the facility’s residents. Each student presented the individualized iPod to each of the residents in the presence of family members, staff, volunteers, and a few guests from the local community. The students also gave a demonstration on how to use the iPods. Some of the residents tried their “new” iPods. Muffled laughter was heard and smiles were seen forming. Nell and her activity staff were delighted. The celebration ended with cake and punch.

Questions

1.  Suggest some ways how Nell could obtain used iPods for the residents.

2.  Is there any other alternative to the use of iPods?