Transcript Cognitive screening Instruments

HELP Project Planning Tool
In this section think about….
 Will you be able to do all of the HELP interventions?
 Will you have to modify any of the original HELP
interventions?
 How will you go about recruiting, training and
retaining volunteers?
 What type of attributes will you look for in
volunteers?
Categories of HELP Interventions
 Elder Life Specialist Protocols/Volunteer Interventions
 Comprehensive Gerontological Assessment,
Interventions and Protocols
 Interdisciplinary Interventions
Elder Life Specialist Protocols
Risk factor
Cognitive Impairment
Sleep Deprivation
ELS Protocol
Daily Visitor /Orientation/ Therapeutic
Activities
Sleep Enhancement
Immobility
Early Mobilization
Vision Impairment
Vision
Hearing Impairment
Hearing
Dehydration
Meal Assistance/ Fluid Repletion
Sleep Enhancement
 Criteria- difficulty falling asleep or sleeps poorly at home or in hospital
 Intervention
 Avoid sleeping pills
 Instead:
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Back rub (if not contraindicated)
Warm blanket
Warm drink such as herbal tea or warm milk
Soft music
Early Mobilization
 Criteria- all patients assessed for early
mobilization
 Intervention-
ELS/CNS consults with Physiotherapist
to determine appropriate mobilization
protocol:
 Active range of motion exercises 3
times per day
 Supervised walking 3 times per day
according to PT guidelines
Healthy Eating/Fluid Repletion
Criteria-appetite rated as poor
InterventionAssist with set-up of meals
Encourage food intake
Ensure regular mouth care
Assist with menu completion
Criteria-clinical evidence of
dehydration and
Urea X10/Creatinine> 0.7
Intervention- Encourage fluids
if not contraindicated
Healthy Vision/Healthy Hearing
Vision
Criteria- if near vision in both eyes <20/70
Intervention
- Eyeglasses clean and on
- Magnifying glass
Hearing
Criteria-<3 whispers from each ear on whisper
test
Intervention
-Hearing aids in and turned on
-Consider use of hearing amplifier
Orientation/Daily
Visitor/Therapeutic Activities
 Criteria- all patients are enrolled
 Intervention-Orient 1 time per day if MMSE >20, orient 3 times
per day if MMSE <20
-Explore patient’s interests and possible
therapeutic activities
-Discuss current events, structured reminiscence,
word games
(Inouye et al. N. Engl. J. Med. 1999, March 4 340 (9): 669-676)
In this section you will learn
about…
 Elder Life Clinical Nurse Specialist’s (CNS) practice
roles in HELP
 Nursing specific HELP protocols
 HELP education strategies
 Program operations
CNS’ Role in HELP
 Clinician; CNS as an expert clinician of older adults
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population conducts focused assessments and interventions
based risk factors and “geriatric vital signs”; emphasis is on
prevention of delirium and functional decline; post-discharge
follow up
Consultant; CNS as a consultant shares her knowledge with
patients, families , nurses , unit manager, allied health and
physicians
Educator ; CNS as a staff coach; a mentor; a resource for staff,
patient and families
Leader; CNS as a change agent, role model, patient advocate,
resource for staff, coordinator of provider education program and
gerontological nursing in-services.
Researcher ; CNS participates in transfer of knowledge
HELP Nursing Protocols
Targeted Risk Factor Approach using protocols
 Evaluation of Cognitive Status
• Delirium Protocol
• Dementia Protocol
• Psychoactive Medications Protocol
 Sleep Enhancement Protocol
 Early Mobilization Protocol
More Nursing Protocols…
 Hearing Protocol
 Fluid Repletion Protocol
 Discharge Planning Protocol
 Optimizing Length of Stay Protocol
 Additional Areas –
Education strategies employed at HHS…
• On demand
• Scheduled education sessions for staff and students
• Annual Seniors month education
• HHS new staff orientation; yearly staff review sessions
• Orthopedic staff orientation
• Seniors HHS Corporate initiative – environment,
culture and clinical processes
• Gentle Persuasive Approaches , e-learning
• RNAO fellowships (many!)
PROGRAM OPERATIONS
 Record and maintain ELNS interventions progress reports
 Serve as a liaison between the program and nursing
administration
 Track and address quality assurance
 Provide clinical and administrative support for ELS and
volunteers
Recruitment Training and Retention
HELP Project Planning Tool
In this section think about….
 How will you go about recruiting volunteers
 What qualifications will you set for the volunteer
role?(age, personal attributes, previous experience,
time commitment, police check, health clearance)
 How will you go about training the volunteers?
 What strategies will you use to help retain volunteers?
Recruitment
 Work closely with Volunteer Resources
-provides volunteer recruitment, screening and general
training. They also identify hospital volunteers who seem
suited to undertake the additional training to become a HELP
volunteer.
 While the program seeks volunteers of all backgrounds, it has
become a sought-after experience for many college/ university
students, especially those interested in the health care field.
 Look for a mixture of different types of volunteers. If you only
draw from the student population you will struggle with
covering shift during student downtimes like exams
Volunteer Qualifications
 Reliable and caring; enjoy working with older people
 Mature in judgment
 Discreet, empathetic behavior and ability to exercise
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diplomacy in
talking to patients, patient’s family and staff.
Ability to relate with sensitivity to all patients
Ability to work independently and assume responsibility
Ability to refer questions to others as needed
Minimum time commitment of 1 shift per week for 6
months
Training
 Training should be done a minimum of three times a year
 Volunteers attend 12 hours of classroom training which includes
 An overview of the Volunteer Manual and HELP videos
 Guest speakers which include Physiotherapist to demonstrate safe
mobility with patients , Speech Language Pathologist to help
instruct on meal assistance, a Recreation Therapist to provide
training in Montessori based activities, and a member of the
Alzheimer Society to provide an overview of dementia
 12 hours of ward training which includes
 Includes a detailed tour of the environment-where to find supplies
and how to get information
 Shadowing a several different experienced volunteers during their
shifts
Retention
 Consistent and ongoing support and
mentorship from HELP staff
 Volunteer Recognition