To Feel Belonging

"Loneliness and the feeling of being unwanted is the most terrible poverty"           
                                                                              Mother Teresa

 Imagine how residents feel when they come to a nursing home.  This can be isolating and lonely.  Research involving interviews of nursing home residents, staff, and families found that residents often lack social integrity.¹ 

          Social integrity occurs when we feel we belong and are part of a group.  For elders in nursing homes isolation can occur from both within the facility and from the outside community.  When new residents come to the nursing home, it is important to introduce them to other residents and help them to form friendship and become part of the group.  It is especially important that residents who are more cognitively aware are paired with others residents with whom they can develop relationships and have conversation. We should also encourage families to be involved and to help the resident be a part of the outside community as much as possible.  These are important ways to help elders maintain social integrity. 

Teeri, H., Kilpi, H., Valmaki, M. (2006).  Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives, and nurses in Finland.  Nursing Ethics, 13(2), 116-129.

To Feel Respected

"One word frees us of all the weight and pain of life: That word is love.” 

                                                                                             Sophocles

 

          We don’t often think of the daily duties of our nursing assistant staff as being sacred.  But, providing intimate personal care to a frail elder really is a holy act.  In a research study, staff, residents, and families in nursing homes were interviewed.  One theme that emerged was that elders often felt a lack of physical integrity.¹  The inability to perform activities of daily living can be demoralizing and can lead to depression or withdrawal. 

          What can help our residents maintain a sense of physical integrity is receiving assistance in a compassionate and caring manor.  When staff is abrupt or don’t take the time to talk to residents while providing care, residents can feel like a burden.  Having a consistent trusted caregiver can be a blessing to a nursing home resident.  As leaders we must foster the sacred relationship that staff members have with the residents.  We must acknowledge the need for consistent assignment of caregivers and reward the caring and compassionate acts of our staff.  This is a way to improve the quality of resident life.

To Feel Dignity

“Every life deserves a certain amount of dignity, no matter how poor or damaged the shell that carries it”     

  Rick Bragg       

                                                                                                        

           Leaders in long term care must recognize the problem of loss of self-esteem and dignity faced by elders in the nursing home environment.  In a research study, staff, residents, and families in nursing homes were interviewed.  A theme emerged involving loss of psychological integrity.  Psychological integrity involves the right to make your own decisions and to feel valued and respected¹.

           Every individual needs to know that they have dignity, no matter how frail, handicapped, or cognitively impaired.  Part of giving elders a sense of psychological integrity is to provide them with the ability to make their own decisions, to have a voice in what happens to them, and in the care that they receive.  Staff can help elders feel respected and honored when they allow individuals to choose their own schedules and allow them to feel that they are in charge of their care. 

           Equally important is to learn about the background, history, dreams, and desires of our residents.  It is so important to appreciate each resident for their unique characteristics.  As leaders in LTC, it must be our mission to instill this respect and appreciation of our residents in our staff.   We must provide education and be firm about allowing each resident the right to autonomy.  Each day we need to celebrate our residents with a sense of love, gratitude, and respect.  

Teeri, H., Kilpi, H., Valmaki, M. (2006).  Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives, and nurses in Finland.  Nursing Ethics, 13(2), 116-129.

                                                                                      

To Feel Whole

"There is in all things visible a hidden wholeness"     

 Thomas Merton

   What does it mean to feel whole?   Individuals who have a sense of wholeness feel complete.  They feel fulfilled and content. The opposite is to feel emptiness and a void.  Teeri, Kilpi, & Valimaki (2006) described this sense of inner wholeness as having integrity.  It stems from the Latin adjective integer which means to be whole or complete.  These researchers used interview data obtained from elderly patients, relatives, and nurses to examine feelings of residents in LTC.  They found three common problems faced by residents in nursing homes.

    First were problems related to a patient’s psychological integrity.  Psychological integrity includes the right to make your own decisions and to feel respect for one’s human dignity.

    Second were problems related to physical integrity.   Physical integrity includes the concern over being dependent on another and the compassion and respect of those involved in responding to physical needs

   Third were problems related to social integrity.  Social integrity includes the problem of loneliness and the need to be involved with others within the institution and from the outside world.   

   As leaders, we need to be aware how this impacts the quality of our resident’s lives.  We must work to combat the problems that impact integrity. In coming posts we will examine each of these three problems in more detail and discuss ways to help our residents to have integrity.

Teeri, H., Kilpi, H., Valmaki, M. (2006).  Long-term nursing care of elderly people: identifying ethically problematic experiences among patients, relatives, and nurses in Finland.  Nursing Ethics, 13(2), 116-129.

Everyone Stands Together

This is a video our team participated in during the St. Joseph County Nursing Home Collaborative.  This is a great way to collaborate and empower front line staff.

Being the Best You Can Be

    The highest level on Maslow’s hierarchy is the need for self-actualization.  Self-actualization means to reach your highest potential and “be the best that you can be”.  Personally, I feel I am working at this level when I am making a difference for others and giving of myself openly and wholeheartedly.    Being a leader, helping staff to learn, grow, and become better people is motivating for me. This gives me energy and passion.

    When you search you own heart, what motivates you?  If you are a nurse leader in long term care, my guess is your mission is to help others.  Sometimes days get long and the stress can be high.  But when you realize the difference you  make, it's all worth it. We all have a chance to write our stories every day.  What will you write today?  Natasha Bedingfield says “live your life with arms wide open, …today your book begins, the rest is still unwritten."

Creating Shining Stars

        The highest levels of self-development according to Maslow’s hierarchy include the need for self-esteem and self-actualization.   This week we will look at the fourth level of the hierarchy which is the need for self- esteem.  This means to feel respected and valued by others.    We can help our staff develop self-esteem and become shining stars by offering opportunities for growth and recognizing outstanding performance. 

      A learning community offers educational opportunities through facility education programs, supporting staff to further their education, and by offering financial assistance such as tuition reimbursement or scholarships. Another way to support staff in their development is to allow them to take increased levels of responsibility.  Allow staff with special expertise to participate on committees and give in-services.  It is true that you develop an even greater level of knowledge when you are called upon to teach on a topic.  This will not only create a shining star, but will also make your job as a manager easier.  Ask staff for ideas to improve the work environment and include them in quality assurance plans.
     Recognizing outstanding performance helps build self-esteem.  Give compliments to staff on a daily basis.  At one workplace they use a thank you board for staff to give thanks and compliments to each other.  Employee of the year or month programs and certificates for outstanding performance are other ways to build self-esteem.  I like to send a text message to a staff member, letting them know that I noticed something outstanding they did that day.  One of the greatest joys of being a leader is seeing individuals develop confidence, self-esteem and truly “shine”.

Belonging

     The third level of Maslow’s hierarchy is the need for belonging.  Everyone needs to feel that they belong to a group.  People need the support of friends and family in both their personal and work lives.   Staff celebrations, newsletters, and parties are an important part of creating an environment where people feel they belong.  We recently had a words with friends tournament at my work place in which any staff member could participate.  Staff were placed in a double elimination tournament.  This simple idea created a lot of camaraderie among the staff.  Other ideas to build a sense of belonging include bowling leagues, softball teams, cook outs, carry ins, holiday parties, talent contests.  Working together for fundraisers and participating in an Alzheimer’s or Breast Cancer walk promotes a sense of belonging and helps others.  Promoting teamwork and supporting friendships at work are important ways for individuals to build community and feel a sense of belonging.

The Basic Needs

     Last week, we discussed the lowest level of Maslow’s Hierarchy of needs. The next level is the need for safety and security.  The first two levels of the hierarchy are considered the basic needs.  Individuals do not become motivated by higher level needs until their basic needs are met.  Staff in long term care often have difficulty having basic needs met.  I have seen staff struggle with health care needs of their families, finances, and security.  One problem such as a sick child can lead to a call off which then snowballs to not having enough in the paycheck to pay for gas or rent.  Calling off also creates the problem of job security

     Often staff cannot afford insurance to meet their health care needs.  When someone in the family is sick the emergency room is utilized.  Preventative care is not used.  This can contribute to attendance problems.  Staff members also need to feel they have some measure of job security.  When people are in fear of losing their job, they cannot move up to the higher levels of motivation.  Ways we can support the staff in meeting these needs include financial planning classes, employee assistance programs, low cost insurance plans or health care provided at the facility, free flu vaccines, and supportive supervision.  Once the basic needs are meet, individuals can begin to focus on personal growth and fulfillment.