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Increasing Nurses' Competency With Geriatric Patients

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   June 08, 2010

A hospital stay often increases confusion and anxiety in patients with Alzheimer's disease or dementia, complicating the care of their primary diagnosis and potentially lengthening their stay. With an aging population, acute care hospitals are seeing more elderly patients, increasing the need for nurses competent in geriatrics and gerontology.

One hospital is focusing on dementia patients' needs through nurse training and environmental changes. Glen Cove hospital in New York, part of the North Shore-Long Island Jewish Health System, now has more nurses qualified in Alzheimer's care than any other acute care facility

The idea to improve care of the Alzheimer's and dementia population came out of a joint meeting with representatives from local nursing homes, says Susan Kwiatek, associate executive director for patient services at Glen Cove. The community hospital serves three nursing homes and several assisted living facilities.

"Average life expectancy has gone up and we're seeing more and more patients who are elderly and have Alzheimer's or dementia. We wanted to create a continuum of care in the best interest of patients," says Kwiatek. "We wanted to ensure a safe and comfortable environment, and also the respect and dignity of our patents."

With the guidance and assistance of the Alzheimer's Foundation of America, the hospital trained its geriatric-unit nurses and patient care associates how to understand and care for Alzheimer's and dementia patients.

Nurses received two days of education on topics ranging from signs and symptoms of Alzheimer's to how to handle those symptoms and they became qualified as dementia care specialists. PCAs received one day of training and became qualified as dementia care providers.

Elaine Evangelou Soto, nurse manager of the geriatric unit, says the behavior of Alzheimer's patients can be challenging to understand or manage if caregivers do not understand the disease. For example, patients tend to be very fixed and repetitive in their actions and thoughts. One technique the staff learned was that giving a patient a stack of towels to fold can be soothing for the patient.

"Once we received education, it made us more aware of what to look for," says Evangelou Soto. "Now we see a calmer patient. We see a patient who isn't as frightened. We are able to focus more on primary diagnoses, rather than on our patient's behavior."

The hospital also made change to the physical environment to benefit their patients. Rooms have been painted a soothing pastel pink and lighting has been made less obtrusive.

Evangelou Soto explains that prior to the training, nurses were always worried about Alzheimer's and dementia patients' tendency to leave their beds and wander. Through education, they came to understand that patients like to feel they're at home and can walk around at will. So the hospital purchased a roam alert system and now patients who are able can walk the unit at will. A wristband device alerts staff when a patient nears an exit or the perimeter of the unit and an alarm sounds if an exit or perimeter is breached.

"It allows patients the freedom to walk around, and nurses don't have to worry that patients will leave the unit," says Kwiatek. "Creating a soothing environment is key. Alzheimer's patients are habitual. If you bring them into an unfamiliar place, it creates a lot of anxiety. So everything we did, all our strategies were to reduce anxiety: Not to have light that was too reflective, not to restrict them from walking because we were afraid they'd leave the unit, giving them activities that are repetitive and make them comfortable. Now it's a calmer and more soothing environment for patients and staff. We provide better care of the patients."

The training and environmental changes required only a small investment by the organization which Kwiatek says will benefit all patients. She wants to expand the training to emergency department staff. "It would be beneficial for them to understand how to interact with Alzheimer's patients and keep them calm," says Kwiatek. "Especially in the hustle and bustle of the day in the emergency room."

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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