Why do we do some of this 'stuff'?

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We do a lot of “stuff” in nursing that makes no sense (both in acute care and long-term care — I'm not singling us out here).  We do a lot of things that waste precious time and are definitely not evidence based.

It's time we drop the “But it's what we've always done around here” mentality and start critically thinking. So let's look at some myth busters associated with falls protocols and then maybe take them out of our equation.

It's a common policy and procedure in many LTC facilities to do frequent “neurochecks” after a fall. However, there are NO studies demonstrating the utility or efficacy of performing regular neurochecks in LTC settings.

I mean no evidence supports observing patients for a fixed period of time after a fall, and there is no regulatory requirement to do such frequent documentation. So why do we do it? Wouldn't it make more sense to observe the resident for changes in behavior or cognitive function?

How about the use of bed and chair alarms? Their use has increased dramatically as most facilities (thank you, Advancing Excellence Campaign) have become restraint-free.

But there are a couple of problems with these alarms. First, there is limited data to support their efficacy in reducing the number of falls in LTC settings. Second, the efficacy of the alarms is dependent on the ability of the staff to have extra sensory perception. Why do I say that? Because unless you are the comic book hero Superman, you can't quickly secure the one resident you are taking care of and fly at preternatural speed and scoop up your resident as his or her butt lifts an inch off the chair or bed BEFORE actually getting up.

Unless the alarms are an effective reminder to the resident to sit back down until assistance comes (which, is VERY rare-and now makes the device a restraint), the alarms just serve to let you know someone has already hit the floor or is Weeble-Wobbling down the hall.

So why waste the money on something that isn't going to work, and in essence is still a restraint? What about having occupational therapy look at a seating and positioning program, or adjustable beds?

Oh, and after six back surgeries, I have to jump on my soapbox about this one: The dreaded body mechanics. This is a “What the Heck were they thinking?” if ever there was one.

No scientific evidence supports the “body mechanics” (“bent knee–straight back”) approach in lifting human beings. Yet, despite this lack of evidence, nursing schools and nursing assistant programs have taught body mechanics manual lifting techniques for more than 100 years. (Makes as much sense as knowing that the sports “cup” was invented in 1874 but the helmet wasn't invented until it became a mandatory piece of equipment in college ball until 1939. Yup, let that one spin around in your mind for a few.  You do the math on how long it took the guys to figure out their brains might also be a valuable part of anatomy worth protecting!)

The purpose of body mechanics manual lifting applies to motionless objects without obstacles such as beds and chairs, not moving human beings, who can be resistant or combative or can lose their balance and drop suddenly. Gee, have you ever had any of your residents be resistant, combative or just, let's say, lose their balance?

So let's start using our heads, be radical, question authority and examine the evidence. And, uh, nothing personal guys, but DON'T think like a ball player!

Just keeping it real!

Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC — a real life long-term care nurse who is also the director of clinical affairs for the American Medical Directors Association. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. She has not starred in her own national television series — yet.

 
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The Real Nurse Jackie

The Real Nurse Jackie is written by Jacqueline Vance, RNC, CDONA/LTC, a 2012 APEX Award of Excellence winner for Blog Writing. Vance is a real life long-term care nurse. A nationally respected nurse educator and past national LTC Nurse Administrator of the Year, she also is an accomplished stand-up comedienne. The opinions supplied here are her own and do not necessarily reflect those of her employer or her professional affiliates.

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