powerpoint presentation · 2/13/2017 2 c h a n g e o f c o n d i t i o n & r e s i d e n t m o...
TRANSCRIPT
2/13/2017
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A L E O N A R D O D A V I N C I
G U I D E T O
A S S E S S M E N T A N D
P R O B L E M S O L V I N G
R E S I D E N T H E A LT H S E R V I C E S A N D
C H A N G E O F C O N D I T I O N
C O N S U L T D E V E L O P E D U C A T E C O N S T R U C T
“ S H A P I N G S P A C E A N D S Y S T E M S F O R V I B R A N T A G I N G ”
M A R C H 9 , 2 0 1 7
O R E G O N H E A L T H C A R E A S S O C I A T I O NS P R I N G E X P O C O N F E R E N C E
C Y N T H I A M C D A N I E L M S N R N
E L D E RW I S E I N C
TODAY’S LEARNING OUTCOMES
• Explain the seven principles of da Vincian thinking and how to apply
them in critical thinking and problem solving.
• Discuss how da Vincian thinking helps one to address resident
change of condition assessments and complex care management.
• Explore personal thinking preferences and identify ways to enhance
critical thinking.
Discovery consists of seeing what
everybody has seen and thinking
what nobody has thought.
-Albert Szent-Gyorgyi
Y O U R B R A I N
I S M U C H B E T T E R
T H A N Y O U T H I N K
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C H A N G E O F C O N D I T I O N & R E S I D E N T M O N I T O R I N GT H E R U L E S
THE RULES – 411-054-0040SHORT TERM CHANGE OF CONDITION
• Short term change of condition – Change in health or function that is
expected to resolve or reverse with minimal intervention or in an established
predictable manner.
– Determine and document action or intervention.
– Communicate action or intervention to staff on all shifts.
– Document resident specific interventions and staff instructions as part of
the resident record.
– Minimum of weekly progress notes until the condition is resolved.
THE RULES – 411-054-0040SIGNIFICANT CHANGE OF CONDITION
• Significant change of condition – A major change from the most recent evaluation that
may affect multiple areas of function and/or health. A change that imposes a significant
risk on the resident.
– Evaluate resident
– Nurse referral for assessment and follow up
• Document findings, resident status, and interventions made as a result of the
assessment (and thinking)
– Documentation of change
– Communicate to staff
– Update the service plan
THE RULES – 411-054-0040MONITORING
• Monitor each resident specific to need and service plan.
• Train staff to identify changes in the resident’s physical, emotional, and mental
function.
• Train staff to document and report on the resident’s changes of condition.
• Have a reporting protocol with access to a designated staff person 24 hours a
day who can determine if the resident’s condition requires further action.
• Provide written communication of a resident’s change of condition, and any
required interventions, for caregivers on all shifts.
C H A N G E O F C O N D I T I O N & R E S I D E N T M O N I T O R I N GH O W W E D O I T N O W
G AT HE R
I N F O R M AT I ON
Admit Evaluation
Medication Administration
Record
24 hour report
Interim service plan
Alert charting
Incident reports
Incident report logs
Behavior monitoring
Pain monitoring
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H E R D I N G C AT S
WHAT WE COULD PROBABLY DO MORE OF…
MICHAEL J. GELB (2004)
GELB’S SEVEN DA VINCIAN PRINCIPLES
•Curiositá
•Dimostrazione
•Sensazione
•Sfumato
•Arte/Scienza
•Corporalitá
•Connessione
WHY
LEONARDO?
http://image.slidesharecdn.com/leonardo-da-vinci-ppt-1204527819891627-
4/95/leonardo-da-vinci-ppt-2-728.jpg?cb=1204499021
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http://image.slidesharecdn.com/leonardo-da-vinci-ppt-1204527819891627-
4/95/leonardo-da-vinci-ppt-4-728.jpg?cb=1204499021
Art is an 85 year old former
pilot in the Korean War.
His plane was shot out
from under him twice.
Fiercely independent, he
misses his wife of 54 years.
He loves golf but is not able to
play anymore. Art is having
some challenges with balance
and fell yesterday. He does not like
to wait for care staff to help him.
He is hard of hearing and wears
glasses.
Art
An active 88 year old, Lisa loves to walk and pull weeds in the garden. She needs a walker although she often forgets to use it. She worked as a model and enjoys getting dressed up and going out. Lisa has Alzheimer’s dementia and recently started leaving the community.
Yesterday she was found 10 blocks away and everyone is now concerned for her safety.
The challenge - Lisa always wants to “go.”
CURIOSITÁ
An insatiable
curious approach
to life and an
unrelenting quest
for continuous
learning.
• What is the problem? Are there underlying
issues? What haven’t I considered? What if?
• When did it start? When does it happen?
When doesn’t it happen?
• Who cares about it? Who is affected by it?
Who can solve it?
• How does it happen? How can I get more
information? How can it be changed? How
can I know it’s been solved? How come?
• Where does it happen? Where did it start?
Where else has this happened?
• Why is it important? Why did it start? Why
does it continue? Why, why, why, why, why…
DIMOSTRAZIONE
A commitment to test knowledge through
experience, persistence,
and a willingness to learn
from mistakes.
• Test every idea.
• Don’t take anything for granted.
• Try new approaches to solve old problems.
• Identify evidenced-based resources to support your solution.
• Experiment with hypothesis – “if we implement this intervention, then this is what we expect to happen.”
• Be a Devil’s advocate. Make strong arguments against the solution or invention and then defend your solution.
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SENSAZIONEThe continual
refinement of
the senses,
especially sight,
as the means
to enliven
experience.http://www.nature.com/scientificamerican/journal/v308/n1/images/scientificamerican0113-72-I2.jpg
SYNESTHESIA AT WORK
PR OM OTIN G CR EATIVIT Y, IN N OVATION , AN D IN VOLVEM EN T
DRAW MUSICSHAPE THE
INVISIBLE
MAKE SOUNDS OF COLOR
SFUMATO
“Going up in Smoke”
A willingness to
embrace ambiguity,
paradox, and
uncertainty.
• Curiositá Equals Uncertainty
• Make Friends with Ambiguity
• Cultivate confusion endurance
• Meditate on Mona
• Embody Mona’s smile
• Trust your intuition
ARTESCIENZAThe development
of balance
between art and
science, logic and
imagination.
“Whole-brain”
thinking.
http://assets4.bigthink.com/system/idea_thumbnails/45642/size_1024/rightbrain.jpg?1344535021
- Leonardo da Vinci
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LEFT BRAINED
• I like details
• I am almost always on time
• I rely on logic
• I am skilled at math
• I am organized and disciplined
• I like lists
RIGHT BRAINED
• I am highly imaginative
• I am good at brainstorming
• I love to doodle
• I often say or do the unexpected
• I rely on intuition
• I often lose track of time
U S I N G M I N D
M A P P I N G F O R
P R O B L E M S O L V I N G
CORPORALITÁ
The cultivation of
grace,
ambidexterity,
fitness, and
poise.
DA V I N C I ’S RU L E S
F O R G O O D
H E A LT H• Beware of anger and avoid grievous moods
• Rest your head and keep your mind cheerful
• Be covered well at night
• Exercise moderately
• Pay attention to diet, eat simple
• Keep upright when you rise from the table
• Do not be with the belly upward or the head lowered
• Chew well
• Go to the toilet regularly
•Develop body awareness
•Relearn poise
•Get enough sleep
•Cultivate ambidexterity
•Learn to juggle
CONNESSIONE
A recognition of and
appreciation for the
interconnectedness of
all things and
phenomena.
Systems Thinking.
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http://www.chumans.com/blog/wp-content/uploads/2012/03/Systems-Thinking.jpg
SYSTEMS THINKING
•Taking vast amounts of information and creating lists,
routines, organization, and interventions/solutions.
•Creating systems and recognizing patterns.
•Recognizing the connectedness of everything –
complexity theory.
SYSTEMS THINKING
• Characterized by the fact that there often aren’t simple, linear
solutions to problems – and problems are evaluated in the context of
the whole system.
• It is a basic philosophy of problem solving – it focuses on system
issues rather than immediately observable symptoms.
• Root cause analysis should be conducted from a systems thinking
viewpoint, with knowledge of complex systems phenomena.
• The focus should be on understanding the system rather than
fixating on blame and human error.
N E W S Y S T E M S T H I N K I N G – A L I T T L E F I L M A B O U T A B I G I D E A
https://s-media-cache-ak0.pinimg.com/originals/ec/80/1f/ec801f38094beb2833e56fb35c944e69.gif
THE RIPPLE EFFECT
One small change can have an
enormous impact.
“Reality is made up of circles,
but we see straight lines.”
Peter Senge
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• Curiositá – Am I asking the right questions?
• Dimostrazione – How can I improve my ability to learn from my
mistakes and experiences? How can I develop my independence of
thought?
• Sensazione –What is my plan for sharpening my senses?
• Sfumato – How can I strengthen my ability to hold creative tension to
embrace the major paradoxes of life?
• Arte/Scienza – Am I balancing Art and Science in my problem solving?
• Corporalitá – How can I nurture the balance of body and mind?
• Connessione – How do all the above elements fit
• together? How does everything connect to everything else?
T H A N K YO U !
Cynthia McDaniel MSN RN
Nurse Consultant/Gerontologist
541-419-4036
ElderWise Inc