HHA Department Integrated

By Annemarie Martin, Patient Services Director

I am pleased to announce that the Home Health Aide Departments for both VNACN and VNAB has been integrated into one department with Elaine Buckley, RN appointed as the Home Health Aide Manager.

Elaine will be responsible for overseeing current staff and workflow processes within the department. She will be spending her time in both the Danvers and Charlestown offices where the departments are currently located. Elaine has been the Home Health Aide and MCH manager for VNAB for close to two years. She will continue with her current responsibilities and is looking forward to working closely with the VNACN staff in her expanded role.

Pharmacy in the Field

By Mary Ambrefe, Clinical Pharmacist

I have been a pharmacist for almost 3 decades and have had the privilege of many home visits before my work with VNA. In recent weeks I have day tripped to Worcester to share joint visits with Anna Azizian, Kari Coughlin, Lindsay Morang, Kristen Cammuso, and Nicole Glasberg, as they continue their work toward becoming heart failure subject matter experts. There are not enough superlatives to share about this intrepid, compassionate and energetic group that are truly on their collective game. I shared visits that were unlike any before, several steeped in extraordinary circumstances. These nurses took me into homes with living conditions that were unimaginable, education challenges that seem insurmountable and socioeconomic barriers, all which compel our undaunted clinicians to think outside of the box.

It was humbling and hope filled to witness the delivery of exceptional care to these most grateful patients and their families.

Negative Wound Therapy Reminders

By Carol Jones, Senior CWOCN
 

To all nurses who apply negative wound therapy, please remember:  A Negative Wound Therapy Consent form MUST be signed the first time you visit to start the therapy. This will include:

1. Teaching how to change the canister
2. How to problem solve the alarm
3. How to contact the company if they can't  do either of the above
4. That they are to remove the therapy and apply a NS moist gauze dressing if they can't get the therapy to work within a 2-hour period.

On admission, all negative wound therapy patients should have ordered:   NS, gauze, and tape to have in the home in case they need to remove the negative wound therapy and apply a dressing.

Nursing DOES NOT go out at night to solve negative wound therapy problems. The patient needs to be able to follow the teaching that you have done with them to solve the alarm, call the company to solve the alarm problem, or remove the dressing and do a NS moist dressing.

Please contact your manager with any questions.

Behavioral Health Program: Charlie's Story

By Janette Keddy, Behavioral Health Clinician

Jon Kabat Zin, creator of the Stress Reduction Clinic and the Center for Mindfulness in Medicine, Health Care, and Society at UMass Medical School said, "You can't stop the waves, but you can learn to surf." This is how I feel about Cognitive Behavioral Therapy (CBT) and I believe I have helped my patient, Charlie, to surf, although we may not see him on the water anytime soon.
 

Charlie started CBT because he wanted someone to talk to regarding his difficulty enjoying his family and frequently getting upset over little things. Charlie was a patient who needed total control over the visit. He insisted on sessions lasting only 40 minutes and would start asking when I would leave almost as soon as I arrived. Initially he would get off topic very easy and it was difficult to focus him back on the exercise at hand.
 

Each week, Charlie warmed up to the idea of the exercises more and more. He successfully made the connection between his thoughts, feelings and behaviors and how this cycle could increase his emotion to a place where he felt out of control. Charlie became able to identify his negative thoughts and make them more positive. He also successfully completed an exposure to an aspect of life that truly angered him and utilized his CBT tools to help him cope with the situation.
 

By the 6th week of therapy, Charlie noted his sleeping had improved. By the end of the 7th week, he was smiling and reporting that he was getting out more. And you may not believe it, but my sessions with Charlie were lasting about 60 minutes and he wasn't asking when I would leave until just after I was getting up to leave or he knew we were nearing the end of session.

We perform three scales at our initial evaluation, below is how Charlie performed at our first evaluation compared to how he performed at discharge.

• Folstein Mini-Mental: 26 at initial compared to 28 at DC
• Geriatric Depression Scale: 16 at initial compared to 10 at DC
• Hamilton Anxiety Scale: 27 at initial compared to 20 at DC

The mini-mental improvement shows how Charlie was able to improve his cognitive ability through CBT likely due to an increase in his ability to focus and concentrate. While Charlie is still rated "mild-depressive" according to the Geriatric Depression Scale, he moved from the high end to the low end (normal is 0-9, mild depressive is 10-19). Charlie's improvement in anxiety moved him from the "moderate to severe" category to the "mild to moderate" category.
 

Most importantly, Charlie felt different. By discharge Charlie was sleeping better, feeling less angry, less depressed, less anxious, getting out of the house more, and enjoying time with his family. I don't believe Charlie will be getting out of the house to surf, but I do believe his work in CBT gave him the gift of control that his wave of emotions was taking away from him.