Encouraging Caregiver Participation in Your Injury Prevention Program

In order to achieve universal participation for your safe lifting and injury prevention program, plan on constantly reminding caregivers to practice safe lifting within the confines of your programs boundaries. Why establish boundaries? We are members of a society conditioned since childhood to obey signs and icons such as One Way street signs, Stop signs, No Smoking signs, and Do Not Enter signs. Each of these signs defines zones or boundaries within which a particular activity is tightly regulated. Most people follow the rules within the boundaries defined by these types of signs. In healthcare, its important to establish facility-wide boundaries or perimeters within which safe lifting practices must be employed at all times. Thats essentially the logic behind the Safe Lifting Environment campaign. This universally recognized symbol can be used by virtually any healthcare facility to post or define perimeters within which safe lifting practices must be employed at all times. While signage alone will not ensure injury prevention, these constant reminders based on societal conditioning are turning out to be a key element in the battle to increase participation and eliminate injuries incurred when caregivers lift and reposition patients. Without defining a perimeter or establishing a conformance zone, individual caregivers are more or less on their own to participate or not, whenever and wherever they see fit. Injury Prevention Programs The healthcare industry is one of the most dangerous occupational workplaces for risk of back injuries to caregivers. Accidents caused by lifting resulting in serious injuries to medical personnel are a major reason for the industrys constantly escalating insurance rates, workers compensation costs, and staff problems. For additional information: Click here for an article discussing injury prevention and the other benefits of safe lifting.

Using Safe Lifting Environment Creating Buy-in with Supporting Documents

Policy Statement Patient Information Checklist: How to determine if your facility qualifies as a Safe Lifting Environment Helpful Hints How to Use the Symbol Merchandise: See Helpful Hint document for ideas on creating buy-in using merchandise Injury Statistics

Creating Buy-in with Graphics Visit the Safe Lifting Environment Section for these items

Flash animation on your Web Site Home Page Static graphic symbol for your Web Site Home Page Drag and Drop symbol for electronic charting (Patient Lift Specific)

.Creating Buy-in with Merchandise

Facility Wide o General Decals at Main and Unit entrances o Lapel Buttons o Place patch on scrubs

Patient Specific o Use symbol on white boards or paper charting o Magnets to indicate type of lift required

Caregivers are people who take care of other adults, often parents or spouses, or children with special medical needs. Some caregivers are family members; others are paid. They help with:

Food shopping and cooking House cleaning Paying bills Giving medicine Going to the toilet, bathing and dressing Eating Providing company and emotional support

Caregiving is hard, and caregivers of chronically ill people often feel stress. They are "on call" 24 hours a day, 7 days a week. If you're caring for someone with mental problems like Alzheimer's disease it can be especially difficult. Support groups can help.
Cultural and geographic differences

The form of elder care provided varies greatly among countries and is changing rapidly. Even within the same country, regional differences exist with respect to the care for the elderly. Traditionally elder care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, elder care is now being provided by state or charitable institutions. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home. Although these changes have affected European and North American countries first, it is now increasingly affecting Asian countries also.[1] According to Family Caregiver Alliance, the majority of family caregivers are women: Many studies have looked at the role of women and family caregiving. Although not all have addressed gender issues and caregiving specifically, the results are still generalizable [sic] to women because they are the majority of informal care providers in this country. Consider: Estimates of the percentage of family or informal caregivers who are women range from 59% to 75%. The average caregiver is age 46, female, married and working outside the home earning an annual income of $35,000. Although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers. [2] In most western countries, elder care facilities are freestanding assisted living facilities, nursing homes, and Continuing care retirement communities (CCRCs).

Improving mobility in the elderly

Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population. Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older adults mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests that limb velocity and core strength may also be important factors in mobility. The family is one of the most important providers for the elderly. In fact, the majority of caregivers for the elderly are often members of their own family, most often a daughter or a granddaughter. Family and friends can provide a home (i.e. have elderly relatives live with them), help with money and meet social needs by visiting, taking them out on trips, etc. One of the major causes of elderly falls is hyponatremia, an electrolyte disturbance when the level of sodium in a person's serum drops below 135 mEq/L. Hyponatremia is the most common electrolyte disorder encountered in the elderly patient population. Studies have shown that older patients are more prone to hyponatremia as a result of multiple factors including physiologic changes associated with aging such as decreases in glomerular filtration rate, a tendency for defective sodium conservation, and increased vasopressin activity. Mild hyponatremia ups the risk of fracture in elderly patients because hyponatremia has been shown to cause subtle neurologic impairment that affects gait and attention, similar to that of moderate alcohol intake.
ABSTRACT

The purpose of this study was to describe adherence to recommended preventive health practices among middle- aged and older male and female family caregivers of individuals receiving home health services. Perceptions of the burden and benefit of caregiving, wellness orientation, social participation, and community resource use by the caregiving dyad (caregiver and care receiver) were also explored using the t test and the X2 test to detect gender differences. A sample of 319 participants 50 and older was recruited from a home health agency in southwestern Pennsylvania to participate in a telephone survey. Results revealed that caregivers had performed 86% of ageand gender-appropriate preventive health practices, but they currently adhered to guidelines for 63% of such behaviors, regardless of gender. Men experienced less burden than women, and were more likely to acknowledge that caregiving made them feel useful and appreciated and gave more meaning to their lives. The study suggests that family caregivers may be as vigilant in their preventive health behavior as the general population, despite their responsibilities. Nurses in contact with middle-aged and older family caregivers are well positioned to encourage health promotion and disease prevention behaviors in this accessible population.

ABOUT THE AUTHORS

Dr. Matthews is Assistant Professor, University of Pittsburgh, School of Nursing. Dr. DunbarJacob is Professor and Dr. Sereika is Associate Professor, University of Pittsburgh, School of Nursing and Graduate School of Public Health. Dr. Schulz is Professor, University of Pittsburgh, School of Medicine. Dr. McDowell is Associate Professor Emeritus, University of Pittsburgh, School of Nursing, Pittsburgh, Pennsylvania. This investigation was supported by National Research Service Award NR06877-03 from the National Institute of Nursing Research and funding from the American Nurses Foundation and the Jewish HealthCare Foundation of Pittsburgh. Written informed consent for participation was obtained from all human subjects, according to a protocol approved by the University of Pittsburgh Institutional Review Board for Biomedical Research. Address correspondence to Judith Tabolt Matthews, PhD, MPH, RN, Assistant Professor, University of Pittsburgh, School of Nursing, 415 Victoria Building, Pittsburgh, PA 15261.

Abstract
This paper outlines the development of a caregiver strain index (CSI) with a sample of spouses, family, friends, and neighbors, aged 22 to 83, who provided varying degrees of care to recently hospitalized hip surgery and heart patients aged 65 and over. Internal consistency (Cronbach's alpha) for the 13-item CSI on 81 cases was .86. Evidence of construct validity was obtained in three areas: ex-patient characteristics; subjective perceptions of the care-taking relationship by caregivers; and emotional health of caregivers. These results indicate that the CSI is a brief, easily administered instrument which identified strain within our sample of informal care providers. Further development of the CSI is being undertaken for predicting specific caregiver populations at risk. This simple index might be usefully included in any interview or assessment package that examines intergenerational relations involving dependency and care.