Keeping Staff and Residents S.A.F.E.™ from Injuries
Nursing assistants in long-term care are at a high risk for injuries due to job related activities. This is why it is vitally important to ensure that staff members are trained in safe lifting, transferring, body mechanics and the skills to prevent people with dementia from becoming aggressive or combative.
We have found, here at the Alzheimer's Resource Center, that by using dementia based communication and approach techniques you can prevent aggressive incidents and injuries. It is essential that staff are trained to know how to prevent aggressive outburst and what to do if, despite using a correct approach, a resident grabs, punches, bites or chokes. The program, S.A.F.E. Response Techniques in Crisis SituationsTM, teaches staff in all departments techniques to keep themselves as well as their residents safe and calm. This program also teaches staff members to react with knowledge not fear when a crisis situation does occurs.
Recently, I was teaching the S.A.F.E.TM program at a conference focused on "Safe Lifting." At this conference there were speakers who shared their approaches to preventing injures; such as using "no-lift" type policies and by buying equipment to lift residents. My S.A.F.E. Responses in Crisis SituationsTM presentation complimented the other presentations by sharing how to move a person with dementia who may be afraid of the lift equipment, combative or even in pain. It was at this conference that I had the privilege of meeting Anna and Nina. They shared with me their experiences in staying safe, and injury free, while caring for people with dementia and various challenging needs. I asked them if they would be willing to share their experiences with you. Here is Anna's story:
"My name is Anna. I am 34 years old, five feet tall and weigh 118 pounds. I have been a C.N.A. for eleven years in a skilled facility. Why am I stating all of these facts? I have been injury free all of these years. I have taken care of all different kinds of residents. Alzheimer, Dementia, and Bariatric are some of them. I would like to share some of the safety skills that I have found work for me in keeping my residents and myself safe.
Our Facility has very good equipment. We are constantly in-serviced on the usage and safety measures on each piece of equipment. If the equipment is broken, we have an equipment repair book on each unit. We write in the book and our maintenance person looks at the book daily, fixes it if able, and signs off when it is fixed. We are in-serviced on using good body mechanics and demonstrate transfers and changes of position.
Each morning when I come to work, I receive report from my nurse with a copy of the C.N.A. cards for the plan of care for each resident. If I have a new resident I will ask questions such as, "can you turn, can you wash your hands and face, can you walk, and most of all, are you in any pain when you move?" I have had residents become fearful of transfers with me because I am so short and small, so I earn their trust to make them feel safe. I never transfer or ambulate anyone that I do not feel I can do safely. I will always get help. If a Resident can't be transferred according to plan of care, I report it to the nurse. The nurse involves PT and another assessment is done on that the transfer.
I have taken care of Resident's weighing from two hundred to four hundred pounds safely. Our facility has a bariatric hoyer lift that we use. Our policy is to use two people for all hoyer lift transfers, but if I need to use more, I do. It keeps me safe from injury.
We have all been trained to use gait belts for transfers and ambulation. Sometimes a Resident will become combative with this device. I talk to them and explain in a soft tone what it is and how it is used. I will put the gait belt on myself so they can see how it is used and that it does not hurt. I have the resident hold the gait belt and feel it. If this does not work, I will leave for a while and come back to try again and this usually works. If not, I will report it to the nurse, and other interventions are considered.
I have taken care of many residents with Alzheimer's. It is more of a challenge to maintain safety for all involved in their care. I have two residents with Alzheimer's that I take care for at this time. I will call one "Mary". Mary does not like to be approached with directions. I always approach her to the side; speak in a low even voice, "Hi Mary, its Anna." I sing every thing to her and she sings with me. Meanwhile, I am able to do her care. The singing calms her. If she becomes combative with this approach, I change the subject. She loves babies so I talk to her about babies, and finish her care. If Mary says, "Enough", I know that it is time to stop, so I will stop her care and come back to finish her.
I have another resident named "Helen," and she can be very combative with care. I always approach her the same way each day. I always say, "Hi Princess, this is Anna," and hug her. She opens her eyes, but does not reply, and does not become combative. Face washing is scary for her. I give her the washcloth. She will throw it at me sometimes. I keep giving it to her with simple directions and eventually she will wash her face. Every day I give her a drink of Gatorade first thing in the morning. One morning I did not have any to give her and gave her water. She threw it at me. I found some to give her and she drank it all. Each day I put makeup on her and she puckers her lips for me. I tell her every thing I am going to do for her and she stays calm most of the time. One time Helen grabbed hold of my hair and would not let go. I stayed calm and hugged her and said, "I love you Helen, it is me Anna," and she let go and hugged me back and kissed me. I try to stay calm and this definitely helps in keeping us both safe. I have learned that these are many of the techniques that keep my residents and me safe."
Anna Massa and Nina Thone are from the Hughes Health and Rehabilitation Home in West Hartford, CT. Thank you, Anna and Nina, for sharing your experiences. Has anyone else had challenges with keeping staff S.A.F.E.TM from injuries? Please share your thoughts.