Thursday, August 18, 2016

What is Hospital Delirium?

Hospital Delirium
by Guest Blogger Johanna Thomas, Trinitas Elder Life Clinician

A few years ago I visited my 89 year old father in law at the hospital after his hip replacement surgery.  Having been told that the surgery went well and that he was even joking with the nurses, I was surprised to find him acting a little “off”.  He insisted on getting dressed even though we repeatedly told him he was staying for a few days.  Minutes later he tried to tip the dietary associate because he thought we were at a restaurant.  This might not sound alarming for someone who just had hip surgery but I informed the nurse that he was "not his usual self".  When I got home that evening, the hospital staff informed us that my father in law, usually a very pleasant man, had become somewhat restless, angry, and was trying to leave.  For safety, he was restrained and required additional staff supervision for the remainder of the night.  
This is not an uncommon scenario for a hospitalized older patient.  Hospital Acquired Delirium (HAD) is an under recognized but very serious condition.  A person experiencing acute confusion could become disoriented, have bizarre thoughts and ideas, or might experience hallucinations.  Older patients have a higher risk for experiencing delirium.  Dehydration, infection, and/or a side effect of a medication can all be reasons why an otherwise “sharp as a tack” elder could become delirious during hospitalization.  It is important to remember that, unlike dementia, delirium is reversible.  With a few simple steps, caregivers can help in the prevention or reduction of delirium. 

          The Healthcare Foundation of New Jersey (HFNJ) understands the importance of using proven and cost-effective measures to prevent or reduce the onset of delirium, and in 2013 HFNJ awarded Trinitas Regional Medical Center with its first Delirium Prevention Initiative grant.  Trinitas subsequently adapted the Hospital Elder Life Program (H.E.L.P.) model founded by Dr. Sharon Inouye, a pioneer in delirium research and prevention.  The original program allows volunteers to feed patients.  Although our volunteers do not feed patients, they provide bedside companionship during mealtimes to encourage the importance of nutrition.   
        H.E.L.P. consists of an interdisciplinary team and specially trained volunteers who perform daily protocols with patients 65 years and older.  Daily orientation visits, feeding encouragement during mealtimes, bedside therapeutic activities, and non-pharmacological sleep protocols (such as hand massages and soothing music) are part of the structured therapies offered by the HELP volunteers. 
 
Our H.E.L.P. patients are also offered music from the Medical Library’s World Music Collection.  The collection of world music has been well received, as noted on their surveys, by many of our patients who have been able to listen to music from their native country.  
 
We have a diverse group of volunteers that consists of college students, graduate students, working adults and retirees.  Most recently, we have added a few highly qualified high school students to our program. 
 
At home, family and caregivers of at-risk elders can also aide in preventing their loved one from experiencing acute confusion.  The Hospital Elder Life Program website offers tips to help reduce the risk of delirium.  Some include:
  • Prepare a “medical information sheet” listing all allergies, names and phone numbers of physicians, the name of the patient’s usual pharmacy and all known medical conditions. Also, be sure all pertinent medical records have been forwarded to the doctors who will be caring for the patient
  • Bring glasses, hearing aids (with fresh batteries), and dentures to the hospital. Older persons do better if they can see, hear and eat
  • Bring in a few familiar objects from home. Things such as family photos, a favorite  comforter or blanket for the bed, rosary beads, a beloved book and relaxation tapes can be quite comforting
·    Help orient the patient throughout the day. Speak in a calm, reassuring tone of voice, and tell the patient where he is and why he is there
·    Stay with the hospitalized patient as much as possible. During an acute episode of delirium, relatives should try to arrange shifts so someone can be present around the clock
For more information on the delirium prevention, please visit: http://www.hospitalelderlifeprogram.org
 
        If you would like to be a part of our enthusiastic and rewarding H.E.L.P. Team at Trinitas RMC, please visit http://trinitashospital.org/volunteer_services.htm and click on “links to application form”. 
 
You may also contact Johanna Thomas, Elder Life Clinician or Diana Noboa, Elder Life Assistant at (908-994-5620). 
 


Friday, July 15, 2016

Trinitas Veterans Program: Project Pride


Project Pride
 
What is it?
Trinitas' Project Pride for Veterans, which has been in existence for a little over a year, was the brain child of Trinitas Regional Medical Center and the VA clinic, co-located at Trinitas, Elizabeth, N.J.
 
What does it do?
The goal of Project Pride is to provide group and individual therapy for veterans and their families. 
 
A 2013 study by the United States Department of Veterans Affairs found: suicides from 1999 to 2010 showed that roughly 22 veterans were committing suicide per day -- or one every 65 minutes! Some sources even suggest that this rate may be undercounting suicides.
 
How does it work?
To provide these services, a soldier (Reservist) was hired along with a Licensed Social Worker.  In addition, we also have a prescriber that is an Air Force veteran.
 
Results:
While the VA thought they would be able to give at least 100 referrals, unfortunately that did not happen. However, not to be deterred, Project Pride started friendly visits to hospitalized veterans to determine if there was anything they might need or if there was any way the program could help them.
 
Although the program hoped to help more, they are still happy to report about 13 veterans are engaged in treatment and currently have no wait time for services for veterans.
 Taletha Surujnath (left), an advanced practice nurse and Air Force veteran
and Linda Reynolds (right), LSW and Director
 
Conclusion:
Unfortunately,  funding will cease in September 2016. This loss of funding will impact its ability to visit another campus --but the good news is the program will continue to offer therapy.
 
For more information about this program please contact:
Linda Reynolds MA, LCSW,
Director, Adult Outpatient Unit
Trinitas Regional Medical Center
908-994-7278

Tuesday, June 7, 2016

Why We Offer a Standing Computer Station: "Sitting is the New Smoking"

One Medical Library's Approach to Encourage Patron Wellness
    
            Thanks to a small grant from the Trinitas Health Foundation, the Medical Library was able to incorporate a new standing desk computer station in early June 2016. 
            There were several reasons why this type of desk station was introduced into the library: customer demand for an additional computer, space limitations, and health benefits.  Yes, health benefits!  

             Dr. James Levine, director of the Mayo Clinic-Arizona State University Obesity Solutions Initiative and inventor of the treadmill desk, who has been studying the adverse effects of increasingly sedentary lifestyles for years, concluded, “Sitting is more dangerous than smoking, kills more people than HIV and is more treacherous than parachuting. We are sitting ourselves to death.” In fact, Levine is credited with coining the phrase, “sitting is the new smoking.”  The reason this is so dangerous is because when you sit for long periods, sluggish blood flow can set the stage for a blood clot to form.  

              A recent study of more than 100,000 men and women also supported this conclusion.  It found those who sat for more than six hours a day were more likely to have died from cardiovascular disease over the course of the 14-year study than those who sat for less than three hours a day. This held true even among those who exercised regularly!

              "Overall, current evidence suggests that both standing and treadmill desks may be effective in improving overall health considering both physiological and mental health components," stated an article from Preventive Magazine.

              Digging deeper, there are a myriad of reasons why standing for a bit of time instead of sitting is better for you: 
  1. A standing workstation could increase HDL cholesterol: the "good" cholesterol
  2. 18 participants in one study who used a standing desk for three months lost some weight
  3. Seven studies of standing desks, totaling 220 participants, found they had very little impact on typical work tasks (typing).  In one telling study, employees using a sit-stand workstation for four hours a day during on work week had no significant difference number of characters typed per minute or typing errors made when standing compared to sitting. 
  4. In one seven-week study using a standing desk use, participants not only reported less fatigue, tension, confusion, and depression, but more vigor, energy, focus, and happiness. Even more significant, when they returned to their seated desks, their overall mood returned to baseline levels.

One of our hospital employees trying out the Library's new standing station.


             
             By the way, this idea isn't exactly new. While they may not have had studies backing up their preference to stand up while working, Leonardo da Vinci, Benjamin Franklin, Thomas Jefferson Winston Churchill, Ernest Hemingway, and even Donald Rumsfeld all reportedly used stand-up desks.
            
             The win here is that standing more might help you live longer-- and also improve your mood in the process. At our Medical Library, we are excited to offer our new standing station, and knowing we are doing our part to contribute to wellness.

update: 7/25/16
"Sedentary time at very high levels is associated with a higher risk of cardiovascular disease independent of other well-established risk factors, including low physical activity and high body-mass index." Dr Ambarish Pandey (University of Texas Southwestern Medical Center, Dallas) and colleagues conducted a meta-analysis of nine prospective cohort studies published before July 6, 2015 covering 720,425 participants (mean age 54.5, 57.1% women) and 25,769 unique cardiovascular events. Median follow-up came to 11 years.

The meta-analysis was published online July 13, 2016 in JAMA Cardiology
 
references:
 
 
 
 
 
 



Tuesday, May 31, 2016

Brain Attack!

May is Stroke Awareness Month!

      Did you know that a stroke is sometimes called a "brain attack"? It occurs when blood flow to an area in your brain is cut off.  When this happens, brain cells are deprived of the oxygen and glucose needed to survive, and die. If a stroke is not caught early, permanent brain damage or even death can result. Stroke is the #5 cause of death and the leading cause of disability in the USA.

     Treatment targets factors that put you at risk, such as high blood pressure, diabetes, and high cholesterol.  Still, it takes more than that to prevent a stroke. You also have an important role to play in preventing stroke, too! Why? Because only you can make lifestyle changes to help lower your risk.

      So, what are some things you can do? Try to follow the Life's Simple 7 tips from the American Heart Association and the American Stroke Association:

1) Manage and control blood pressure: Lowering your systolic blood pressure (bp) number (top) by 10 or your diastolic number (bottom) by 5 can cut your risk of stroke death by half

2) Control cholesterol: By controlling your cholesterol, you are giving your arteries a chance to remain clear of blockages

3) Reduce blood sugar: High levels of blood sugar over time can lead to diabetes, which increases your risk for having a stroke

4) Get active! Increase walking time has been associated with reduced stroke risk. 30 minutes a day, 5xs a week is an easy goal to improve your heart and brain health, plus it helps to prevent stroke

5) Eat better: A healthy diet is one of your best weapons for fighting stroke! Adding more fruits and vegetables into your diet, and reducing sodium intake to less than 1,500 mg per day is a great start towards healthier eating

6) Lose weight: Nearly 70% of American adults are overweight or obese! Obesity increases your risk for stroke so losing weight can help lower your blood pressure and reduce the burden on your heart, lungs, blood vessels and bones

7) Stop smoking: If you smoke, your risk for stroke is 2-4xs higher  than for nonsmokers or even those who have quit for more than 10 years!

See how much you know about stroke by taking our Medical Library's health literacy quiz, now available in both English and Spanish versions:
http://www.trinitasrmc.org/library_health_literacy.htm
http://www.trinitasrmc.org/library_health_literacy_spanish.htm



It is important to know the common symptoms of stroke so you recognize what may be happening to yourself,  your loved ones or others.


If you are located in N.J. and your community or organization would like to learn more about stroke, please contact:
Terry Finamore RN BSN MS
Stroke Coordinator

Trinitas Regional Medical Center
Elizabeth, N.J.
908 994 8787 (phone)


Many thanks to Terry Finamore who helped with this post.









   

 



Friday, April 22, 2016

A Hospital Program Designed to HELP (Hospital Elder Life Program)

Addressing the Generational Divide… Saying YES to HELP
by Johanna Thomas, Guest Blogger
 
The Trinitas Hospital Elder Life Program (HELP) recently invited high school students from the Youth Enrichment Services (Y.E.S.) program of our New Point Campus, Elizabeth, New Jersey, to do arts and crafts with our elderly patients.
Under the supervision of the Johanna Thomas, Elderlife Clinician; Diana Naboa, Elder Life Assistant, and Cristina Pineros, Clinician, the students guided patients in a “Memory Box” craft.   The students and patients also engaged in conversation with the patients during the project.  These interactions were not only stimulating for our patients but also enriched the students understanding about social responsibility and helping those less fortunate then themselves.  This collaboration proved to be important for mutual growth in providing assistance and help to others. 
 
This is the third collaboration between HELP and the Y.E.S. program.  Patients and families were very pleased to have young students visit their older loved ones.  In addition, it was really a great multigenerational project that also was a great collaboration between campuses.
             Here are some of the comments and feedback from patients and families:
*       I liked it.  The girls were very good.  Enthused patient
      *       I liked them.  (the students) –Satisfied patient

 *       Picture was fun. –Intrigued patient
*       I felt good.  The girl is very mature and intelligent. –Wise patient
*       (The boys) were very proper.  They considered me.  –Distinguished patient
*       Very kind, they keep you busy. –Engaged patient 
*       Thank you so much.  It was nice. -patient
        The girl is very intelligent. –patient’s family
 
 
For more information about the Trinitas Hospital Elder Life Program (HELP) please contact:

Johanna Thomas, Elder Life Intervention Clinician
Hospital Elder Life Program (HELP)
Trinitas Regional Medical Center
9 south
225 Williamson Street
Elizabeth, NJ  07207
908-994-5620      
  
If you are interested in volunteering with this program or at the hospital, please contact:
Lisa Liss, Director of Volunteers
 
 
 Update:
May 11, 2016
Many thanks to Kean University! Their book drive supported the HELP program and our patients will enjoy reading new books due to their generosity. Pictured are HELP program staff, volunteers, the Volunteer Director and Library Director.


waiting for the book delivery
a full book cart for our patients!
 
 
 
 
 


Wednesday, March 30, 2016

The Trinitas Library's Health Literacy Quiz Games: 2016 Update

How much do you think you know about Alzheimer's, prediabetes, stroke, heart attack or even commonly used medical terms you've heard on tv or the doctor's office? Take a minute to test yourself with our health literacy quizzes and find out!
The Trinitas Library offers a fun, private and easy way to test your knowledge about health care related topics -- and hopefully learn some new information at the same time!
 
How it began:
In 2010, the Medical Library with the support of a clinical advisory team, created health quizzes to study the effectiveness of using quiz games to improve consumer health literacy. This research study funded partly by a grant from the National Library of Medicine/NIH/NN/LM/MAR and was given Institutional Review Board (IRB) status. Our health literacy outreach effort was recognized with an MLA Hospital Library's Section Award in Research in 2010. The project concluded with great success in 2011, and due to their popularity, they remained live.
 
The results?
To date, well over 8,000 people world wide have played our health quizzes on both sites. Over 88% of players have indicated they will use the information they learned by taking the health quizzes for their future health care decisions!
 
More quizzes!
We are happy to report, that in response to requests, we've expanded the health topics since the initial study.  In 2014 we added Alzheimer's.  For 2016, we've created a quiz about prediabetes and it is in the pipeline to be posted on the website shortly. In the meantime, you can access the English version's direct link if you don't want to wait: https://www.surveymonkey.com/r/RZHDLRS
 
Redesign coming soon:
For our Spanish speaking community, we are proud to announce we've redesigned the pathway linking our health quizzes from the hospital's main visitor page http://www.trinitas.org for a more streamlined experience, and will be on the website very soon. These are just some of the updates we've been working on as we continue our mission to help you learn about health topics in a fun way in the privacy of your own home or mobile device. Visitors may also access the health quizzes from the library's main website http://www.trinitashospital.org/medical_library.htm.

But, you don't have to wait until we've put the finishing touches on our website. If you like, you can you can access the E-Salud prediabetes health quiz right now: https://es.surveymonkey.com/r/JWZGF3Q
 
Outreach in virtual reality:
For those who enjoy gaming on a more advanced, immersive level, we continue to remain active in the virtual world of Second Life (SL), and are hosted by the University of Sheffield's Infolit ischool
Smaller traveling exhibits are hosted around SL for wider outreach , such as at a virtual Senior Center.
 
Health literacy:
Anyone can experience health literacy issues. It crosses every demographic, and does not matter how educated you are, how much money you make or how old you are. The bottom line is when you are not able to understand what your health care provider has told you or how to read a prescription bottle, manage your chronic illness or even know how to navigate the health care system, this affects every aspect of your ability to get well.
 
So, how much do you know about our health topics? Find out by playing a few quizzes. Whether you participate through the library's website or in a virtual world setting, in English or Spanish, what you learn may possibly save a life -- including your own!


 

Tuesday, March 8, 2016

Just Move! (You Know You Want To)


Spring means Getting Out and Moving!
By Guest Blogger for March issue: Jim Dunleavy PT DPT MS, Director, Rehabilitation Services

One issue with a New Year’s resolution of getting fit is that the weather many times does not cooperate. However, come Spring it is the time to “Get Moving. "

From starting a daily walking program to getting into serious training for a marathon, this is a prime time of year to get moving.  Here are some things you should consider before you start:

1.      Assessment of your current health status. Be sure you do not have any conditions that might limit your ability to increase your daily activity. Talk to your Doctor about exercise and its impact on high blood pressure, Diabetes or other breathing or heart issue. If there are issues, here at the Health and Rehabilitation Center we have programs that can get you moving safely again.

2.      Be realistic. Once cleared medically, that does not mean you immediately go out and run as you did when you were a child. You need to build up any activity, even walking programs, in order to not hurt your joints and muscles. Our staff here at the center can help you determine what is best for you and the correct intensity.

3.      Every Exercise is not the same. There are exercises that are designed to increase muscle strength. Other types of exercise build up your cardiac and breathing stamina. As assessment by a physical therapist or a member of our fitness center team can determine what deficits you have and design a program that meets your body’s specific needs

4.      You are what you eat. No exercise program alone will meet your fitness, weight loss goals. You have to take a serious look at both the amount of food you eat and how much of each food group are you eating.

5.      Variety is the Spice of Life. Many people stop exercising because they do the same thing, every day, over and over again. They get bored. I advise my patients to mix it up a bit. There are many ways to get heart healthy from walking to a group exercise class. If you have strength goals, there are many types of resistance programs available. Also programs like Pilates or Yoga are also considerations in changing up your fitness program

The above are some the most important things to consider when starting and maintaining an exercise program. Most people do need help and the #Trinitas Health and Rehabilitation Center  is here to help you feel better, have more energy and feel fit for many years to come so…..Get Moving!
 
Pictured: Trinitas Physical Therapy & Fitness Center
 
For more information you can go to: http://www.moveforwardpt.com/Tips