Kansas State UniversityCenter on Aging January 2007 PEAK Project Newsletter Resources (WEBSITE) Kansas Culture Change Coalition www.kansasculturechangecoalition.org (BOOK) Caring for Patients from Different Cultures 3rd edition, Geri-Ann Galanti, 2004 What happens when a Cherokee patient summons a medicine man to the nursing home or hospital? Why do Asian patients rarely ask for pain medication, while Mediterranean patients seem to seek relief for the slightest discomfort? If the goal of the American medical system is to provide optimal care for all patients, health care providers must understand cultural differences that create conflicts and misunderstandings and can result in inferior medical care. This book contains over 200 case studies illustrating cross-cultural misunderstanding and culturally competent health care. Chapters cover a diverse range of topics including end of life, traditional medicine, mental health, pain, religion and multicultural staff issues. (BOOK) Death & Dying, Life and Living 5th edition, Charles Corr, Donna Corr, Clyde Nabe, 2006 This guide offers insight into ways of coping with the issues surrounding death, dying and bereavement. The authors offer practical guidelines for communicating with those coping with life-threatening illnesses, dying, and/or bereavement regardless of their culture, religion, or stage of life. MOVIE REVIEW Late Life Depression: Depression in the Elderly The later years can be a time of loss of companionship, health, independence, and perhaps a loss of hope. As many as one in five older Americans suffer from symptoms of major depression, which can sometimes lead to suicide. In this video, three elderly people tell stories of how they have coped with their major depression, offering their experience and advice. Aquarius Health Care Videos, 28 minutes, 2004 www.aquariusproductions.com. The Journey Toward Culture Change Continues Advisory Group Resources We are currently featuring the 2006 PEAK award winners. We have included two more stories in this issue. Dooley Center in Atchison The grand essentials of happiness are something to do, something to love, and something to hope for. Allan K. Chalmers The Dooley Center is part of the Mount St. Scholastica Monastery. The center was created for the Benedictine Sisters of this monastery with strong input from sisters who were still active in the monastery and sisters who retired at the center. The unique situation of most residents was that they came from the monastery where they had lived and worked for many years before being admitted to the nursing home. The monastery is connected to the home not only physically, but it is also strongly linked with the home's sisters through close interpersonal relationships. The Companion Sister Program connects each sister living at the home with a monastery sister. This program enforces sisters' connection to the monastery activities and provides them with regular companionship and assistance with special needs. Barbara Stec, the Dooley Center administrator, said that the change started with discussions about the need for construction about eight years ago. She thought that physical changes should be incorporated with transformative changes. The first step that she made was visiting Meadowlark Hills, which was followed by many discussions with the monastery sisters and the Dooley Center sisters, through Resident Council. Stec underlines the fact that "there always has been community here." She wanted to embrace a monastic culture better; help the sisters feel more deeply that they are still a part of the monastery. What she soon discovered was that the home already had many features of culture change before the implementation of further changes. Staff members were encouraged to continue doing what they were doing - spending time with the residents, meeting their individual needs and building strong relationships with each other. All changes were discussed with the sisters who were voting for or against each project. The sisters looked at existing innovative models of care for feedback and ideas. Decisions considered benefits for the majority, and many compromises were made to reach this benchmark. Barbara stated that occasionally staff members continue to demonstrate resistance toward some of the innovations. The resistance is usually caused by stress that results in a decreased comfort level. The changes are hardest on nurses who are still not sure how a new model works, and sometimes see everything as overwhelming. Administration believes in open communication and involvement of staff in decision making. The guiding principle is keeping the goal in mind: Dooley Center is a resident-centered home with staff involved in decisions pertaining to the home, the residents and themselves. Barbara plans to provide more educational programs and more information on culture change to staff members this year. She has taken several staff members to conferences, and intends to continue doing so. More staff will have the opportunity to visit other facilities and familiarize themselves with different models of care. More educational sessions are planned with a focus on culture change training. Barbara notes that staff members are always nicely surprised when other people recognize the home in which they work. It validates the notion that their efforts pay off and are appreciated in the nursing home industry. Staff members' input in residents' care plans is an element reflecting growing staff empowerment through decisions that affect residents' care. Barbara reports better outcomes for residents' personal care, as well as better results with staff retention and turnover rates. Staff members work a 12-hour shift. This results in fewer people needing to be involved in the care of residents. It also ensures continuity of care and consistency of staff working with the same residents. Barbara notes that some of the nurses and CNAs have been working at the Dooley Center for many years. This could be explained partly by the values and lifestyles sisters represent that enhance relationship and community building. One of the benefits of the Dooley Center environment and its unique residents is that "things are done slower." Small changes occur more readily. One of the most recent changes is the reconstruction of the home. Each sister moved to a private room. The dining room was renovated to reflect community living. Soon after, the clinic, activity room, massage therapy room, and chaplain's room went through renovations. Kitchenettes were added, and more areas for socializing were created. The extra area helps when pre-school children and other visitors visit residents. These and other efforts contributed to the Dooley Center's success, and resulted in the home receiving a 2006 PEAK award. The awards gave the residents and staff incentive to work even harder on improving their model of person-centered care. Medicalodge of Eureka Changes at the Medicalodge of Eureka started with the "FISH" or "Fresh Ideas Start Here" philosophy. It is a set of simple interconnected principles that, when applied in a working place, bring many positive outcomes. Peggy Hackett, the home's administrator, loved the FISH idea and wanted the whole staff to be hooked on it. It has worked, and when one walks through the building it is easy to see the philosophy reflected in pictures, gadgets, and many other creative visual forms in staff offices. These all symbolize the staff mindset on how to work with residents. FISH principles are congruent with culture change values. FISH identifies four values: 1. Be there (focus on people's needs) 2. Play (having fun with new ideas that in turn produces more creativity) 3. Make their day (genuine interest in others) 4. Choose your attitude (awareness of how your attitude affects others) Peggy was the first staff member to be educated about the principles of culture change through training sessions. She shared what she learned with the rest of the staff. PEAK website resources were used to familiarize staff with the new concept of care. Dietary staff members were critical in demonstrating the effectiveness of the change, and getting the staff to support the change. After the success of the open dining for residents and staff, other aspects of culture change were somewhat easier to implement. Whenever staff members are resistant in trying something new, Peggy encourages them to try it for 90 days. Continuous discussions with staff help modify ideas according to residents' needs and staff comfort level. Peggy chose payday as a day for regular educational sessions. Each session is recorded and shared with night staff members. Surveys from staff are often used to gain feedback while Resident Council serves as another discussion platform. Residents and families receive a monthly newsletter that informs them about the Eureka home life. Survey forms lay around for families to pick up and use for comments. My Inner View staff satisfaction surveys provide the opportunity for anonymous feedback, and assists in establishing goals and tracking turnover. Each team is responsible for care plans for the residents in its neighborhood. Each wing has the director of activities on board. Families truly appreciate permanent staff assignment and the fact that they always know who to ask for answers. Staff consistency also has resulted in higher morale. The changes implemented in the Medicalodge of Eureka earned the site a 2006 PEAK award. The effects of the changes help staff be motivated "to do even more." Seeing the residents have choices, having most residents in private rooms, and increased socialization are the best rewards for staff. Staff will keep working on innovations to strengthen a person-centered model to improve residents' quality of life and increase staff empowerment, not for awards, but for a better life both for the residents and for staff members. The only people in the world who can change things are those who can sell ideas. Lois Wyse