Week 17-18

This week has been incredibly productive, and it's only Tuesday. My homework was barely submitted in time, but that's what happens.

Today 2/14 was the deadline for submitting content to the Graphic Medicine 2023 contest, and I made it in time. This means that after 10 days shy of 4 months, I am done with my entire game!

Last Friday I met with Cindra McCrann, an adjunct RN instructor referred by Dr.Lauren Cline. Cindra was hilarious, and great to talk to. I asked Cindra which gaps in knowledge or bad habits she has observed in Memory Care for new caregivers and nurses. She said that number one is checking allergies! She mentioned a detail that most people don't often consider- food allergies. Nurses and Med techs spend time referencing medication allergies and interactions between medications, but not much time considering food allergies, since we don't work in the kitchen, and kitchen staff receive this information on move-in and are responsible for all administration of food for the resident. However, typical mushy foods that are used to administer crushed medications, are either applesauce, flavored pudding, ice cream, or syrups. If an individual has a chocolate, vanilla, or strawberry allergy, these may be extremely problematic, but are staple delivery methods that everyone uses. Both Cindra and myself have witnessed this error occurring, and luckily 'allergies' have been mild and without significant consequence to the patients. Cindra and I reflected on incidences where both family members and staff have offered a glass of thickened or thin liquids to a resident without checking their swallow orders. For safety, special swallow orders are crucial to consider, to prevent aspiration- yes, many people 'choke' on water every day due to dysphasia. Cindra advises that to be successful, caregivers should acknowledge their residents before interacting in other ways (physical touch, redirection). She emphasized the importance of single step directions, rather than complex ones. Cognitive decline is hard enough, without considering the executive function required to initiate tasks and following directions. She also mentioned that at some point, we just agree with a resident who insists on living their alternate reality, but try to repeat it back to them. It turns out that Cindra and I have shared at least one work experience in Memory Care, which was awesome. What a small world!

On Monday I met with Laura Das, SNF/LTC Memory Care RN BSN, also referred by Dr.Lauren Cline. Laura had some great insight and solid practices to recommend for success in this setting. When asked about new caregiver gaps in knowledge, she expressed that actually what bothers her most about Memory Care staff behaviors, is often seen in more matured caregivers who are set in their ways. Laura's primary concern here is infantilizing the individual with Dementia, and speaking only with the family member, avoiding the patient/resident directly. Along with this, comes condescending and devaluing the intelligence of the patient. We agreed that respect is important despite cognitive decline. Wehave to remember that these individuals have been functioning adults for longer than most of us have been alive! She emphasized the distaste for the act of outright lying to the resident. Many individuals will tell false truths or redirecting statements that aren't accurate, with the intent of passifying and being able to push off the issue until later. Laura suggests instead to actively engage the resident and ask them clarifying questions and to help them with their side-quest, rather than dismissing them for ease.

Laura addressed a beautiful point- that we should all be emphasizing putting forth extra effort to communicate and include those with hearing or visual changes that isolate them from equal access. These individuals still need engagement to maintain their cognition, mental health, and coordination, yet are so easily isolated by their disabilities.

Laura addressed the importance of trying non-pharmaceutical efforts before trying medications, since they don't solve problems. Try alternative support methods!

Laura's tips for success are to remember that resident behaviors are symptoms of the disease, not themselves. Look for the person underneath, and try to connect with them and get to know who they were before. She stated that behaviors also often have a source (although usually very unrelated to the behavior manifestation), but it takes investigative skills to figure this out. We must come prepared with plans and strategies, but to expect them to be rejected at any point. Be person-centered in your approach- they aren't cut-outs! This disease is based in fear and confusion, so find what their fears and concerns are, and support them in creative ways.

Laura advised that although it takes extra time, being sure to individually engage every one of your residents is more efficient, since this will keep them engaged in a fun reality, so they don't have as much time for their alternate, upsetting realities. The more you know about them, the more comfortable they may feel with you.

I'm onto the printing process now, but first, more f@*king homework!