Resident-centered care

Health Progress, Nov/Dec 2001 by Gould, Marianne Osborn

Planners carefully considered the use and placement of nurses' stations in both the new and old buildings. To keep the staff involved and physically present in the activities of the residents, their work spaces were incorporated into the living areas of the units. In the Pavilion, cabinets adjacent to the residents' family rooms function as staff workstations. In the old building, the old nurses' station was eliminated and cabinets in each family room now function as staff work space.

Surprisingly, constructing the new building was the easy part of the renovation. The real challenge for Teresian House staff was adjusting to their new work space amid the residents as well as to their place in the new organizational structure, which now centers on a team-based approach.

The concept of a leader directing a team of staff representing all departments replaced the idea of an BRN manager of a floor with supplemental help from various departments. In keeping with our vision, this leader is called the resident-- centered care coordinator (RCC). He or she is trained as a mini-administrator and has overall responsibility for a 40- to 50-- resident unit. The RCC leads a team consisting of an RN, an LPN, nurses' aides, resident assistants, a social worker, an activities coordinator, and housekeepers. This team performs all the tasks necessary to address resident needs on an assigned floor.

Each team reviews all the tasks performed for residents and collaborates on a list of global duties, defined as tasks that can be performed by any team member as long as the task does not exceed the scope of his or her job description. The scenario of a resident turning on a call light is a good example of these global duties. Any member of the unit team can answer a call light. The person answering the light may not be qualified to bring the resident to the bathroom or to administer medication, but that person may move a box of tissues closer, pull a shade down, or alert the nurse to a request for pain medication. In addition to lowering the noise level on the floor, the prompt answering of call lights illustrates one advantage of the team approach, which is quick and efficient response to resident requests.

To prepare the team to care for individual resident needs, a preadmission assessment form is used. Completed by the resident and family before admission, this form lists items such as medications the prospective resident receives, preferences for meal and bath times, placement of bed, and interest in church and other outside activities. By reorienting the information on this assessment, the unit team can form a picture of the resident's life in the community and use it as a basis for an individualized care plan.

The preadmission assessment form also reflects our shift in focus from the medical model-requiring the resident to fit into the established routines of the facility-to a focus on the facility accommodating, as much as possible, the routines of the resident.

The physical and organizational changes implemented by Teresian House have resulted in profound psychological, social, and spiritual benefits for the residents. The cluster concept enables the different personalities and interests of each resident to blossom. Large parties and gatherings still happen occasionally, but the day-to-day activities center in a homelike group. With few exceptions, residents are now allowed to age in one place, eliminating the fear of being sent to another floor when physical capabilities diminish. Replacing the institutional aura with the more homelike environment allows for more family-- oriented gatherings. Residents are now more relaxed and interact more with staff and other residents. Each floor can cite numerous anecdotes of the positive effects of this new environment.