When dealing with people who have challenging behaviours, the first thing to ask is "Why is it so challenging?" At a training session yesterday, the people were having problems with a lady kicking and hitting. When i asked what time of day, I was told 8.30 in the morning. How come i wasnt surprised? She didnt want to get out of bed at that time of the morning! They then told me she wasnt a morning person. How hard is that to fix?

Always remember. Treat everyone living in residential care as if they are living in their own home and work to their preferences. Then some of this behaviour will stop.

The Nursing Council of NZ says that any person who diminished, demeans or disempowers someone in their care, is culturally unsafe.

How often in your day do you diminish, demean or disempower someone without even realising you are doing it.

Think about your practice and ask yourself, do I do this? Do I not respect the culture of the person I am looking after. Do I not think about the weather when I am putting clothes on them? Do I do things for a person that they can do for themselves, because it is quicker? Do I put them in a wheelchair, rather than get them to walk because it is easier for me? Do I rush past a room because I am too busy to pass the time of day with a person or listen to their concerns? Do I forget to pass on a message I have received for a person and told them a relative has called?

Think about your day and if you have answered yes to any of the above, or something else, then maybe you are culturally unsafe.

Back to my hobby horse. When are caregivers (and that includes Managers & RN's) going to get the fact that a residential facility is the residents home!!

At a recent workshop one of the participants talked about a potential resident who had come in for short stay care where they met all her requirements like breakfast in bed and meals in her room. The lady was really happy so she decided to come in permanently. At this point, the rules changed. She could no longer have breakfast in bed and other meals as she had when she was in for a short stay.

What a let down for the lady? It is a big enough decision to come into care in the first place, to suddenly the rules have changed must have really thrown the lady.

My question was, why did the rules have to be different for a permanent resident to a short stay? Was it to get a bed full? If so, how unethical!

I was told "she needed to socialise". Well, who says she needs to socialise? She had probably lived on her own for some years and didn't socialise at home. Why suddenly does she have to now? She would socialise when, and if, she was ready.

Think about how you are treating your residents. They are, after all, paying your wages. What does it matter if they have their meals in their room. We have to stop running these places like institutions and really think about the people who live there full time - and it isn't management.

Back to the Asian countries. I was speaking to a business man from Singapore on my way back from the Philippines, and talked to him about my observations on the long school day for children in Asian countries. He was telling me that in Singapore they are now realsing it is not good for children to do all study and they are looking at ways for children to have a more integrated learning experience. So perhaps we dont do too badly here in good old Godszone. Especially when we are 3rd in OECD for English and 5th for Maths. We must be doing something right.

Another thing to consider too is, it has been discovered that children under 2 years of age, who do not have a single constant caregiver in their life e.g. just one of many in a Day Care Centre where the caregiver changes regularly, have high cortisole levels. While cortisole has other functions, prolonged high levels of this hormone are known to be a factor in Diabetes and heart Disease. Cortisole is essential for blood glucose metabolism, blood pressure regulation, insulin release for blood sugar maintanence plus immune function and inflammatory responses. Could these factors just be the reason there is an increase in Diabetes and Heart Disease world wide?

To me, no-one has to be a rocket scientist to understand that prolonged exposure to stress, producing high cortisole levels, must have an affect on a person through out there life.

Worth considering isnt it.

Have you ever stopped to think why people from Asian countries seem to be able to work longer hours than we do? Well it has become very apparent to me.

I am currently in the Philippines and coming in to work you see all these little children going off to school at 7am in the morning. The same was in India when I was there 3 years ago. Their school day starts at 7-7.30 am and finishes at 5pm!! In New Zealand, and other countries as well, our school day starts at 9am and finishes around 3pm. We are not conditioned to work long hours.

I have long wondered at the capacity for people from other countries to work long hours and seemingly not get tired. If we had had from the age of 5, had a school day that was 9 hours long minimum, our bodies too would be conditioned to withstand such long days.

On top of this, their class size is around 50 student yet we grumble if we have 30 students claiming it is not conducive to good learning. Who is right? I dont know but what I do know is that they value and prize education as a way forward.

Worth pondering on isnt it?

Are we brought up to be too soft? I dont know, but they certainly seem to cope better with longer hours than we do.

Cross Cultural Communication

We all know how difficult it can be communicating with our own culture, so how must it be for those from a completely different culture? Mis-communication happens all the time. It is especially difficult for our older people and those with hearing loss - I know, I have hearing aids. So if you are going to give the best care you can to the vulnerable in our care, you need to look very carefully as to how you talk to people. Are you sure they understand what you are saying or are they just being polite and nodding their head in agreement just to please you? This goes for everyone.

Now because I am used to having to get people to repeat themselves due to my hearing loss, it is not that way for everyone. So as nurses and managers, you need to coach people who have English as a second language to make sure they know what is being asked and to have the confidence to ask for it to be repeated if they don't. It is no good to complain about the work not being done the way you want it to be done, if you dont invest the time in orientating people to how you want it done - and this includes the way the culture of the people being cared for want to be communicated with. My saying for this month is
"If the team do not know the why behind the what, then the how is superfluous"

I am going to keep this theme going around training. I beats me why registered nurses are only interested in getting the number of hours required to keep their practicing certificate. Shouldnt it be about keeping your education hours up to keep you safe? Caregives are like sponges. they want to learn. How come many registered nurses aren't like them.