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Managing sundowning in elderly patients

Many elderly or dementia patients experience a condition known as sundowning, when they experience heightened state of delirium as evening progresses. Sundowning can manifest as hallucinations, restlessness, confusion, and rapid mood swings between agitation, anger, depression, and paranoia. Dr. David Scales of Cambridge Health Alliance recently talked about the challenges that many healthcare personnel have to face when a formerly amiable, lucid patient becomes delirious and inconsolable.

While the causes of sundowning are unknown, organizations such as the Mayo Clinic, and the Alzheimer’s Association have advice on how to reduce its symptoms. The two main recommendations are to help patients find a regular sleep cycle and making them feel comfortable with their surroundings. Some methods include:

• Establishing a predictable daily routine, particularly for bedtimes and waking.

• Getting the patient out during the day and exposed to sunlight. This will help promote sleepiness at bedtime.

• Limiting how much napping a patient does during the day and sugar and caffeine intake in the evening. This will make it easier for patients to fall asleep at a predictable hour.

• Reducing background noise and stimulating activities at night, such as watching TV.

• Leaving a nightlight on to reduce anxiety about being in a dark, unfamiliar room.

• Keeping hearing aids, eyeglasses, dentures, or important personal items nearby and within reach at night to help lower stress.

• Playing familiar/soothing music and placing pictures of loved ones around can make a patient feel more relaxed in unfamiliar surroundings.

Find out what “normal” behavior is for patients both during the day and during sundowning at night by asking their family members. This allows personnel to react more quickly to changes in behavior.

Air seal of ORs compromised by high foot traffic

Johns Hopkins Medicine has released a study showing that OR doors are opened an average of every 2.5 minutes during surgeries, according to a study of 100 knee arthroplasties and 91 hip arthroplasties. The study found that for every 1.5 hours of surgery, doors were held open for an average of 9.6 minutes [9% of the total cut-to-close time.]

Most ORs are slightly pressurized so that air will flow out into the hospital corridor instead of the operating room, which limits the risk of airborne germs entering the OR and causing infections. The Johns Hopkins study, however, shows that in 40% of the reviewed cases, doors were open long enough to depressurize the OR.

“Our findings add to a growing body of evidence of a relatively common practice that could be a potential safety concern, and raises questions about why doors get opened and how we can prevent or minimize the frequency and duration of behaviors that could compromise OR sterility,” says study senior author Stephen Belkoff, Ph.D., M.P.H., an associate professor in the Johns Hopkins University School of Medicine’s Department of Orthopaedic Surgery and the director of the International Center for Orthopaedic Advancement.

Researchers suggested that ensuring ORs are properly stocked with equipment and materials prior to surgery could reduce foot traffic through the OR. They also suggested hospitals conduct their own studies to find out why people exit and enter the OR so frequently.

Are your nurses getting their flu shots?  

More healthcare personnel (HCP) are getting their flu shots, according to a Centers for Disease Control and Prevention (CDC) study, but there are still large gaps in immunization. During the 2014-2015 flu season, 77% of HCPs were vaccinated against the flu, a 14% increase from the previous season. The highest rates of immunization—at 90.4%–was  with HCPs working in hospitals.

While the increase is a positive step, it was also revealed that only 75% of nonclinical personnel had received the vaccine, including food service workers, laundry workers, janitors, housekeeping staff, and maintenance staff. The numbers were even lower for aides and assistants, with only 64% immunized.

The lowest rates for immunization was amongst HCP at long-term care (LTC) facilities, with only 64% of the staff vaccinated against the flu. This is especially troubling given that the elderly living in LTC facilities are more susceptible to serious flu complications. Furthermore, the effectiveness of flu vaccines amongst the elderly is lower than in the rest of the population. One study found that during an LTC flu outbreak, one in four staff members and one in three residents contract the flu.

The CDC calls for  all nurses and staff to be vaccinated at the start of the flu season. When promoting flu vaccines, nurse managers can also encourage their staff to get up to date on other adult vaccines. The CDC recommends that anyone working in a healthcare facility receive:

  • Hepatitis B
  • Flu
  • MMR (Measles, Mumps & Rubella)
  • Varicella (Chickenpox)
  • Tdap (Tetanus, Diphtheria, Pertussis)
  • Meningococcal

The CDC offers promotional material and info on how to promote flu vaccines amongst  healthcare workers.



Rock Your Health: Got the sugar blues?

Depression is predicted to be the second-leading burden on society among all diseases by the year 2020. At the same time, global consumption of refined high glycemic index (GI) foods is steadily rising and there is some evidence that these trends may be related.

A study I recently came across in The American Journal of Clinical Nutrition shows that the incidence of depression in postmenopausal women may be linked to an increased consumption of high glycemic index foods, added sugars, and refined grains (Gangwisch, J., et al. High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative. Am J Clin Nutr doi: 10.3945/ajcn.114.103846).

Now that we are entering what may be termed the Sugar Season, it is a good time to pay attention to this message. Ask yourself these questions: [more]

Free webcast on incident-based nursing peer review

Nursing Peer Review in Action: Experienced Nurses Share Best Practices and Lessons Learned

Thursday, December 3, 2015 at 1:00-2:00 p.m. Eastern

HCPro is hosting a free webcast on December 3 about formal, case-based nursing peer review. Join Sarah Moody, DNP, RN, NEA-BC, and June Marshall, DNP, RN, NEA-BC, for a free 60-minute webcast on how incident-based nursing peer review benefits an organization and elevates nurse practice.

These experienced speakers will clarify the difference between formal, incident-based nursing peer review and the type of review that involves peer evaluation of nurses’ performance. They will demonstrate how incident-based nursing peer review can elevate quality and the professionalism of nursing through sharing case studies and lessons learned.

Moody and Marshall have many years of experience leading nursing peer review committees as incident-based nursing peer review is mandated by the Texas Nursing Practice Act.

For the full agenda and to register for this free webcast, visit

Rock Your Health: Nurse leaders and nurse managers can say no to negativity

At any given time, nurse leaders and nurse managers have a choice: to be negative or to be positive.

Think about it this way. Do you choose to laugh, have fun, and see the bright side of everything? Or do you do the opposite? A positive “can do” attitude is a frame of mind that will serve you well as you go through your day. [more]

Rock Your Health: Nurses can trade in the old for the new

As a nurse manager or nurse leader, are you hanging on to old behaviors that once were useful but now are not?

For example, do you not speak up when you have the opportunity because you think what you have to say is not important, you are not eloquent, or you think you are not good enough.

To overcome this, first write down one old behavior you cling to that isn’t getting you what you want. [more]

Rock Your Health: How nurse managers can remove the roadblocks of life

As a nurse manager or nurse leader, you probably have many unfilled dreams. What is standing in the way of you realizing those dreams? Think about whether this roadblock is a true obstacle or a false belief about yourself. Break it down into small components so you can chip away at it a little bit at a time. You can’t move a large boulder, but you can chisel off small rocks, until you have the strength to push it aside.

Write down one roadblock standing in the way of what you want in life. [more]

Rock Your Health: Living your true passion

If you have lost the passion as a nurse manager or nurse leader, it’s time to ask yourself whether you are willing to challenge the status quo to begin living your passion. Try the below exercise to identify what you love to do.

First, make a list of five things you love to do. Then prioritize your list.

Is priority number one your passion?

How much time do you devote to priority number one? How does it relate to the work you are doing? [more]

Let’s send Kathleen Bartholomew to Oz!

Editor’s note: The below post is authored by Kathleen Bartholomew, RN, MN, who is hoping to represent the profession of nursing as the nurse expert on the Dr. Oz show. Dr. Oz is conducting a nationwide search to find the perfect nurse to join his team and is accepting nominations. Visit the webpage at the bottom of this post to nominate Kathleen.
Kathleen Bartholomew RN
I am on a journey to make healthcare better.

For 15 years I have dedicated my life to empowering nurses and understanding the hidden forces that threaten our identity and potential. What would happen if your patients understood not only their pivotal role in healing, but also the real work of nursing? The trajectory of illness and disease in this country would be radically altered.

As a mother of five children, I have the life experiences that resonate with the general public at a gut level. As an author of five books on the healthcare culture, I have the understanding and expertise to be a voice for this noble profession. And as a seasoned public speaker, I have collected stories from across this nation that poignantly reflect not only nurses’ reality, but the experiences of many of our patients as well.