Healthcare assistant identify changes in depression in patient

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An antibiotic was started. Even with the antibiotic, her bowel movements continued to be liquid and frequent over the next week, and she was eating less.

Yesterday she had a fever of How did Ms. A get so sick with only diarrhea? What changes might you have noticed about Ms. When might you have decided to do something about it? What could you have done? The case in the Student Workbook is the same. You may not need to use much or any of the clinical detail in your teaching; it is provided here in case it is relevant.

Once the case has been presented, pause and invite participants to comment. Questions to get discussion going and draw on prior knowledge might be of the "survey" type:. You might ask participants to brainstorm ideas about ways to communicate that would prevent this situation. Keep in mind that you are trying to get participants to think in terms of teamwork rather than blame.

Try to get them to talk with each other, not just to you. Have them discuss a topic in pairs or in groups of three. This method makes it easier for a shy person to be heard as the less shy member of the pair or team can speak up for both or all of them.

If the number of participants is small, you could lead the case discussion with the whole group. Larger groups may be broken up into smaller ones, with each taking one or two questions and then reporting out to the whole group. Or, you could divide the participants into groups according to what they do i. This technique has participants take on roles in a clinical interaction. There is no written script, and the "actors" don't have to memorize anything. Set-up: Ask participants about their previous experiences with role play.

Explain the goals of this exercise and relate them to the key learning objectives. Make sure everyone is familiar with the overview of the case.

Only the "actors," however, will know the details of their roles. It may be helpful to provide the description of the role play to those who are not participating as actors in the role play. Assign the roles: You may have actors play a role similar to the one they have in their real jobs, or you might encourage them to try out a new one. A licensed nurse, for example, could take the part of a resident, or a nursing assistant could act as a licensed nurse.

Involve as many people as possible in the role play. Because role play requires participants to be somewhat emotionally open, they may feel anxious or resist being an actor. Your own positive attitude and a light touch will help.

Any participants who are not assigned to a role should be asked to be observers. Conduct the role play: Participants act out their roles in the "scenario" you provide example below , based on the case. Try not to interrupt the role play while it is running; just let the interactions flow naturally. Before the scenario, explain how much time it will take, and that it will be followed by discussion. It should take only minutes, followed by perhaps 5 minutes of discussion.

Don't let the role play go on for too long—most of the learning happens in the first few minutes. If actors seem too carried away by their roles, remind them to keep it simple. Scenario 1. Two roles: Mary and Marli. Mary is worried about how depressed Ms. A seems. She has tried unsuccessfully to get Ms. A to talk. Marli is concerned about there not being enough people on the floor to get all the work done, and thinks Mary is spending too much time with Ms.

Marli has had the experience of bringing concerns to the RN and nothing being done. They talk about whether they should mention anything about Ms. A to anyone else. Tell the role players to simulate the interaction between the nursing assistant and the licensed nurse, making it clear when the interaction is happening and in what setting e.

Tell them their goals are to: 1 get all the information across, 2 communicate about the situation in a timely fashion, and 3 be able to push if the message does not seem to be getting across. You can also tell the role players that the purpose of this role play is to discuss barriers to communication and how to effectively overcome the barriers. Discuss the role play: Discuss the issues that came up in the role play. Everyone's input should be included. After each scenario is played out, ask the actors: What went well?

What did not go well? What would they do differently next time? Ask observers for their opinions about what the desired outcome was in each situation and how they might have handled the situation differently.

Conclude the role play: Encourage a round of applause as the participants transition "out of role. Consider with the group how to apply the role play to real life clinical situations. Emphasize what was learned during the role play. Thank your participants for attending. Let them know that you enjoyed being with them. Hand out the post-tests. Emphasize how important it is to complete the post-tests because they can get feedback on what they've learned based on their answers to the pre- and post-tests.

Tell participants that you will provide the correct answers and rationales for the tests after they are done. It is often hard to get what is taught in a classroom or in-service learning session translated into action as part of resident care. Even if the teaching has gone well and the learning was taken in and appreciated, it can be hard to put the new learning into practice. There are many possible barriers. For instance, the system of care may not accommodate the new practice, or the culture of care may not accept the change, or the leadership may not be aware of the new learning and so may not make room for it.

Following up after a teaching session with a quality improvement project in which the new learning is put into practice by the whole team can help a lot. Quality improvement projects use a step-by-step approach to improving care by taking a long, hard look at what needs to be done; starting out with a small change, watching it, adding to it, and continuing in this fashion until the job is done. There is a method at work here, and the method is described in the next section, "Quality Improvement.

Quality improvement methods often include a teaching step. This module can be the teaching material for that step. If the quality improvement project is to improve the way nursing assistants and licensed nurses detect and communicate changes in a resident's condition, then this module is perfect for the teaching portion of the project. The three main components are to:. QI is a team approach that involves everyone in thinking about innovation and recognizing that the key to improvement is the people who care for patients.

It is not about individual rewards and punishments, but rather QI relies on measurement to improve the center's performance as a whole. In this example we focus on detection of changes in a resident's condition. Most likely, a process to get to this point is already in place at the center. Still, it is helpful when starting the project to make sure everyone believes in its importance. Collect data to support your assumption that there is a problem and establish a baseline for measuring improvement.

Leadership teams must include one or a few people with enough institutional authority to help get the resources that the project team needs. The ideal team size is five to nine members. Additional temporary members with special areas of expertise can be invited to particular meetings as needed. For a "detection of changes" improvement project, the following project team members are one example of a good team. The aim should include a "stretch" goal that may be hard to reach but is achievable—for example: Decrease the rate of resident falls by 50 percent in 12 months.

Examples of measurement data include a "process measure" like compliance rates for use of the Early Warning Tool or SBAR, or documented nursing notes in a resident's chart on reports of change. To show improvement, you should be able to plot the variable being measured on a run chart a graph that displays observed data in a time sequence.

Tools that you can use to collect and analyze data include process flow charts, brainstorming, cause and effect diagrams, and consumer focus groups. New South Wales Department of Health. Get team consensus on priorities and changes most likely to result in improvement and then decide on an intervention.

Many interventions focus on what is done—for instance, changing or adding a protocol. These are good, but they often don't work as well as they could unless they go along with changing the culture to appreciate the importance of the new protocol. The best interventions tend to address culture with team meetings and other educational or inspirational materials at the same time that the new protocol is added.

Usually, culture change includes implementing and disseminating some core teaching. The cycle begins with a plan and ends with an action based on learning gained. It should specify who, what, when, and where. The end of one cycle leads directly to the start of the next one. The way you document observations may be simple, such as counting and recording on a tally sheet, or it may be more complex, such as using sophisticated tools for data analysis.

If the data do not support the intervention, they may not be appropriate. Look at the data for clues about what to change, and run another PDSA cycle. When you have finally arrived at a sustained change of the kind you intended, that final version of the intervention may be implemented on a larger scale. This means making it a permanent part of normal business throughout the unit or setting.

It may mean applying the intervention throughout the nursing center, for instance. In this case, it would probably mean ensuring that all nurses and nursing assistants take the online teaching and demonstrate their familiarity with SBAR and Early Warning Tool.

Relevant support processes have to be implemented at the same time. For instance, the rollout of education will need to be supported with suitable in-service learning time.

To provide evidence that the intervention resulted in improvement in all places where it was implemented, you will need to collect, analyze, and display the data. For example, you might create an annotated run chart showing changes in reported use rates for SBAR, unit by unit in the whole nursing center, after nursing assistants started using a new form to document changes in a resident's condition.

You will be able to choose your measure from the experience you gained in the Intervention Phase as described previously. The QI step that fails most often is sustaining the improvement.

When the project is done, even if it has been successful, if it is not monitored and no one is assigned to make sure the new standards are kept up, it will probably fade away. First, you will generate and look at relevant data on detecting resident change in your area, probably with some of your lead team members. For instance, you might survey staff about how long they think it usually takes between the onset of a behavior change and getting a nurse or physician evaluation. Then you will ask questions and discuss how this state of affairs stacks up against other institutional priorities.

When you have decided that this is the area you want to work on, you will form your teams; you will have a leadership team of one or a few people and a project team of five to nine. The project team will write a mission statement and select measures that the leadership team will review, adjust as needed, and approve. Next, the project team will decide which problem to address in order to help detect change.

Whatever the intervention, it will likely be essential to enhance the culture of awareness and the importance placed on the topic.

That is usually where the teaching module comes into play. The project team will decide what area to work in first and will identify what process to change. Then the people in that unit will be educated about the topic area. In the case of detecting change, the primary intervention may be teaching this module, but it is likely that there will be a corresponding change in standard operations.

For instance, daily rounds may add a specific question for every resident: Did you notice anything new about Mr. Or it may add this question to the format used by nursing assistants in their change-of-shift verbal and written reports.

Each QI effort may have its own intervention to enhance detection of change. Finding the right person to teach the module is important. It is essential to find someone that the participants will look up to and respect for their knowledge of the area.

A person who teaches well is also very important and not always easy to find. The person can be a lead nurse or other clinician, a QI officer, or a special guest teacher. When the teaching is done and the new protocol is starting, the project team will assign someone to collect and review the data. That person will look at it, decide what seems to be working and what seems to not be working, adjust the protocol, let the staff know, and try again.

He or she will continue until things seem to be where they should be for a sustained period of time. Next, the protocol and education will be rolled out throughout the relevant area—say, the whole nursing center.

A small number of key measures will be collected that the center can monitor to know how well the implementation worked. Finally, a routine measure—such as the rates of documented nursing assistant reports of change, documented communications from nursing assistants to licensed nurses about change, or reported SBAR or CUS use rates—should be chosen as a quality indicator.

The leadership team then needs to ensure that the quality indicator is routinely collected and reviewed by a responsible member of the center in order to ensure that the improvement is sustained over time and, if it falls off over time, that attention to the problem is renewed.

Internet Citation: Module 1. Detecting Change in a Resident's Condition. Content last reviewed March Browse Topics. Topics A-Z. Quality and Disparities Report Latest available findings on quality of and access to health care. Notice of Funding Opportunities. Previous Page. Next Page. Detecting Change in a Resident's Condition Module 2. Communicating Change in a Resident's Condition Module 3. Falls Prevention Appendix 1-A. Suggested Slides for Module 1 Appendix 1-B. Suggested Slides for Module 2 Appendix 2-B.

Suggested Slides for Module 3 Appendix 3-B. Instructor Guide This module focuses on detecting changes in a nursing home resident's condition.

Principal Message The single most important message your audience should come away with is that it is essential to notice and report change in a resident's condition, and it is everyone's responsibility to do so. Content by Session This module is designed for presentation in two sessions. Your teaching goals for both sessions of the module are to: Have participants understand what it means to be in a safe work environment with open reporting and to buy into that as something they want to be part of at their nursing center.

Develop participants' knowledge and skills in detecting changes in a resident's condition. Return to Contents Objectives of the Session Objectives are separated into knowledge and performance objectives.

Knowledge Objectives for Participants For all: Understand why detecting change is important. Understand how to know a resident's normal baseline condition. Understand how to watch for change. Understand how to follow up at the first sign of change. Performance Objectives for Participants For all: Summarize a resident's normal baseline condition for other team members.

Identify whether changes in a resident's condition are important or not important. Promote behaviors that improve change detection. Decide when to report or when to ask for help when observing changes in a resident's condition. Return to Contents Preparing for a Session 1. Assess the Needs of Your Audience These training materials are meant to be used as a complete package.

Consider Your Teaching Method s Most instructors find that a combination of methods—lecture and interactive—works best. Consider using a selection of these teaching methods: Lecture with slides.

Whole group discussion. Break-out group discussion. Case discussion. Role play. Using the Slides The Student Workbook is not meant to be used as a prepared speech.

Adults are usually most motivated to learn when: They see the subject as directly related to their own needs and goals. They see ways for their learning to be applied to their own work settings. They are responsible for their own learning. Their own knowledge and skills are appreciated. Practical, hands-on experience is part of the instruction.

Case Discussion The case tells a story. Role Play "Learning through acting" gives participants a chance to use what they know and practice something new in a real-world setting. Writing It Down With all these techniques, it's useful to note participants' ideas and questions—a flip chart works well. More information on how to teach this material is, in the "Giving Your Presentation" section.

Preparing a Handout for Participants These training materials are meant to be used as a complete package. Learning Settings that Work for this Module Think ahead about the kind of setting that will be available and best allows your targeted group to participate in the training.

Equipment You will need equipment that allows you to display slides and also record discussion points and questions from participants. Slide projector and screen. Flip chart. Overhead projector with transparencies. Hand out the pre-tests. Explain that pre- and post-tests help participants evaluate themselves and help you evaluate the course.

Have participants complete the pre-test. Introduce the topic and review session objectives using slides. Present the material. Return to Contents Recommended Teaching Methods For this module, a mix of teaching methods may be the best—some interactive lecture, some case discussion, and some role play. Interactive Lecture The "stand-up" lecture works well when it's about something participants care about, and when the speaker is engaging.

Your session will be most effective if you: Grab participants' attention in the first few minutes. Involve them in fine-tuning the focus of learning. Plan a change of pace every minutes during a lecture.

There is also a chemical component to treating depression in women who have a co-occurring disorder. At Sierra Tucson, there are programs to treat addiction; mood disorders, like depression and anxiety; trauma; eating disorders; and pain, as chronic pain and chronic depression often co-exist. Menzie advises clinicians to really look carefully at the medications patients take and not just those for mental health.

What are the side effects and what are the contraindications? Certain anxiety medications are short acting. Patient education is important with medication management.

Nurses can coach patients how to manage the side effects and teach them it sometimes takes a few weeks for the full effects of the drugs to take hold. Of course, there is much more to being a director of nursing at a residential mental health treatment facility. Nurses provide patient care, and she supervises approximately members of the clinical team, which includes nurses, and clinical technicians, and she assists other professionals in managing patient issues.

Menzie provides clinical supervision and continually teaches her team how to manage and communicate with difficult patients. She has hired nurses with a wide range of past experiences-med-surg, OB-GYN, home health, and psych, among others. Collaboration with other disciplines, both scheduled and a spontaneous, is an important part of treatment at the facilities. Similar situations arise at Sierra Tucson.

When dealing with difficult patients, she moderates case conferences where healthcare professionals from various disciplines share their input. Crotty argues passionately for the inclusion of nursing in the treatment plan for women with depression.

Menzie echoes those sentiments about the power of nursing in the mental health setting. It keeps you on your toes mentally, physically, emotionally and spiritually. Nurses are on the front lines of psychological care more often than many people realize. Coping Mechanisms Dating back to her days as a med-surg nurse, Menzie has had a career-long interest in the pyscho-social issues patients face. Team Players Of course, there is much more to being a director of nursing at a residential mental health treatment facility.

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We used a semi-structured instrument to interview 26 HCAs and undertook content analysis. We focussed on 3 key aspects: role perception, burdening factors, and disease conception. Results: Most HCAs said their new role provided them with personal and professional enrichment, and they were interested in improving patient-communication skills.

They saw their major function as interacting with the patient and considered support for the family physician to be of less importance. Even so, some saw their role as a communication facilitator between family physician and patient. Burdening factors implementing the new tasks were the increased workload, the work environment, and difficulties interacting with depressed patients. HCAs' disease conception of depression was heterogeneous.

There are special considerations when treating female patients. Sierra Tucson has both co-ed and all-female residential lodges. The staff is deliberate about the living situation for each patient, making sure it is the best fit for their recovery.

Patients with a co-occurring disorder also require special precautions. When a patient is first admitted, often only one co-occurring issue, like substance abuse, is evident. Through their daily assessments, nurses are on the lookout for incidences of other disorders, and can recommend a treatment reassessment.

There is also a chemical component to treating depression in women who have a co-occurring disorder. At Sierra Tucson, there are programs to treat addiction; mood disorders, like depression and anxiety; trauma; eating disorders; and pain, as chronic pain and chronic depression often co-exist. Menzie advises clinicians to really look carefully at the medications patients take and not just those for mental health.

What are the side effects and what are the contraindications? Certain anxiety medications are short acting. Patient education is important with medication management. Nurses can coach patients how to manage the side effects and teach them it sometimes takes a few weeks for the full effects of the drugs to take hold. Of course, there is much more to being a director of nursing at a residential mental health treatment facility. Nurses provide patient care, and she supervises approximately members of the clinical team, which includes nurses, and clinical technicians, and she assists other professionals in managing patient issues.

Menzie provides clinical supervision and continually teaches her team how to manage and communicate with difficult patients. She has hired nurses with a wide range of past experiences-med-surg, OB-GYN, home health, and psych, among others. Collaboration with other disciplines, both scheduled and a spontaneous, is an important part of treatment at the facilities. Similar situations arise at Sierra Tucson.

When dealing with difficult patients, she moderates case conferences where healthcare professionals from various disciplines share their input.

Crotty argues passionately for the inclusion of nursing in the treatment plan for women with depression. Menzie echoes those sentiments about the power of nursing in the mental health setting. It keeps you on your toes mentally, physically, emotionally and spiritually.

Nurses are on the front lines of psychological care more often than many people realize. Coping Mechanisms Dating back to her days as a med-surg nurse, Menzie has had a career-long interest in the pyscho-social issues patients face. Team Players Of course, there is much more to being a director of nursing at a residential mental health treatment facility.