Solutions: Creative Care
An ongoing challenge for geriatric nurses is identifying the full scope of a patient’s capabilities.
Colleen James, a geriatric nurse at The University of Texas Medical Branch at Galveston (UTMB), says that when she enters a patient’s room, a flood of questions races through her head: Is the patient hard of hearing? Does the patient wear glasses? Does the patient use a cane? Is the patient on bedrest? Does the patient have trouble swallowing? Does the patient need help getting out of bed and to the bathroom? Does the patient have dementia?
To help answer these questions, James designed a sign that can be mounted on the side of a patient’s headboard.
The wooden sign includes a series of simple symbols that a nurse can circle to indicate the patient’s capabilities and needs. That way, every caregiver who understands the symbols on the board gains access to critical information in a matter of seconds.
“What I tell my students is that we need to think about how we interact with patients,” James said. “They could have dementia or delirium, but with the board, I will know at an immediate glance what I’m working with.”
At UTMB Health, James coordinates the Nurses Improving Care for Healthsystem Elders (NICHE) program, a national program designed to help hospitals raise the level of care for older adults through nurses and other staff. One of her main goals is to help her young students feel more comfortable with elderly patients.
“I work with nursing students to help them learn how to work with geriatrics—to show them that it is a good area to go into,” James said.
Older Americans are living longer, which means that more medical personnel—nurses, doctors and others—are needed to treat the 65-and-older population.
“In general, the country is way behind on preparing enough geriatricians for today’s older population, much less that of tomorrow,” said Robert Roush, Ed.D., M.P.H., a professor of geriatric medicine at Baylor College of Medicine and director of the Texas Consortium for Geriatrics Education and Care.
In addition, a nursing shortage looms. Although nursing is one of the fastest-growing occupations in the United States, the Bureau of Labor Statistics predicts that 1.2 million nursing job vacancies will arise by 2022.
James is doing her part to bridge the divide between young nurses and elderly patients. She and her students log a lot of hours in the MakerHealth Space at UTMB, where staffers are encouraged to tinker with different materials—everything from zippers and buttons to 3-D printers—to find solutions to on-the-job problems. This is where James built the wooden board.
The space is outfitted with hammers, pliers, cutters and wrenches of all sizes, lined up neatly in rows along the wall. Washers, nails, screws and bolts are organized by size in a bin with several small pull-out drawers. Bigger pieces of equipment are scattered throughout the space.
For a recent project, James and her students sewed zippers, hooks, buttons and bracelets onto over-thehead aprons that patients can take home from the hospital. The aprons are designed to help patients with cognitive impairment—memory loss, confusion or trouble concentrating—due to illness, medication or dementia. Interacting with the different elements on the apron helps stimulate the brain and boost self-esteem.
“We use this as a volunteer opportunity,” James said. “The students are always looking for volunteer hours, and this is something that is also a value add for patients.”
James is now working with Andrew Maxwell-Parish, manager of the space, to create a prototype for a waist apron. They are also collaborating on items for the apron that James considers “guy stuff,” such as fidget toys, nuts and bolts.
The interactive aprons give younger nurses and elderly patients a point of contact.
“It’s a great tool to have the students engaged in a population that I think is underserved,” James said.