The Importance of Taking Proactive Steps in Skilled Nursing Care

Adequate preparation and continuing education are essential in health care. Amid the hustle and bustle of daily clinical routines, it is important for care professionals and leaders to take a step back and identify areas that would benefit from better or more thorough preparation or additional training and education. The articles in this issue emphasize the benefits of proper preparation in areas of obvious need of attention, such as delirium diagnosis, as well as in less thought of areas. 

Delirium in skilled nursing facility (SNF) patients is underrecognized and linked to poor patient outcomes. Nurses in the skilled nursing setting frequently do not use existing standardized tools for assessing delirium, but the literature suggests they routinely should. Kanah Lewallen, DNP, AGPCNP-BC, GNP-BC, RN, and Philippe Voyer, RN, PhD, conducted a quality improvement pilot in 2 SNFs to evaluate methods for improving the management of delirium in skilled nursing and to evaluate implementation of the new Recognizing Active Delirium As part of your Routine (RADAR) screening too. The study included implementation of a delirium education program and established routine use of the RADAR tool. The authors measured the impact of education on nurse knowledge of delirium in the SNF setting and evaluated the feasibility of using the RADAR screening tool.

Family members of long-term care (LTC) residents near the end of life are often unprepared for the death of a loved one. In addition to the immediate emotional distress accompanying the death, family unpreparedness can lead to increased health costs and an increased risk of poor health outcomes such as complicated or prolonged grief, mood disturbances, sleep disorders, and poor quality of life. Preparedness involves awareness, acceptance, and planning for death across the domains of cognition, affect, and behavior. Kristina Terzakis, BSN, RN, and Meredith A MacKenzie, PhD, RN, CRNP, CNE, review the current literature on what is known about preparedness for death, the assessment of preparedness, and evidence-based interventions to improve preparedness of family caregivers in the LTC setting. 

Finally, in the ECRI Strategies column in this issue, Victor Lane Rose, MBA, NHA, FCPP, CPASRM, explains how facilities should prepare for nursing facility construction or remodeling. Strategies and safety protocols are discussed, such as creating a multidisciplinary safety team, deciding on communication plans that span care staff and construction crews, and prevention of common accidents.