Human Interactions/Independence, Dignity and Choice
Sharp Coronado Hospital
Sleepless in Coronado: Managing Obstructive Sleep Apnea
In managing Obstructive Sleep Apnea (OSA) in the hospital, many patients are at risk due to the high prevalence of undiagnosed cases of OSA. Based on US census results, 10.3 million men and women are in the U. S. with untreated, undiagnosed obstructive sleep apnea (severity level: 15 or more stopped breathing episodes per hour). The 10.3 million individuals with obstructive sleep apnea at the moderate to severe level are 4.5 times as likely to have coronary heart disease, myocardial infarction, and angina as are those without sleep apnea.
At Sharp Coronado Hospital, we screen every patient with a Body Mass Index (BMI) of 30 or greater on admission and offer non-invasive positive pressure therapy to those screened to be at high risk for OSA. Knowing that every patient is different, the non-invasive positive pressure device we chose to offer routinely is an auto-titrating positive airway pressure (APAP) device which senses changes in each patient’s airway and responds accordingly to maintain airway patency and breathing. These devices make it easier to tolerate the treatment by adjusting to the individual needs of each patient.
For those patients who have been diagnosed with OSA and have their own CPAP machine, we allow the use of their personal machines for patient comfort. To further ensure patient safety, all patients who screen positive to be at high risk of OSA are monitored with pulse oximetry for their entire length of stay, even if they refuse treatment. For those patients who refuse therapy, education on OSA is provided by a respiratory care practitioner and follow-up with their family physician for a sleep study is recommended.
Our main goal in managing OSA was to prevent incidences related to coronary heart disease, myocardial infarction, angina, and stroke, which OSA patients are at almost 5 times the risk of having as compared to those without OSA. In addition to pathophysiological changes, sleep is also affected. Patients with OSA snore loudly, choke and gasp for breath multiple times throughout the night which upsets their sleep architecture and often prevents them from getting the quality of sleep they need to feel restored and allow healing processes to be effective.
We include family members in our discussions and education on OSA with our patients to clarify the risks associated with undiagnosed and untreated OSA. To demystify the issues with OSA, we provide patients with education sheets to share with loved ones so an active participation can occur and improve outcomes through social support.
2nd Place-VA Greater Los Angeles
3rd Place-Kadlec Medical Center
Arts Program/Meaningful Activities and Entertainment
Jewish Eldercare Centre
Art Links Lives: An Intergenerational, Intercultural Art Program
For the last three years, Jewish Eldercare Centre has forged ties with a local high school (Pierrefonds Comprehensive) that sees high school students partner up with elderly residents in a unique project that benefits both populations through the process of creating art. Relationships are developed, life lessons are taught and beautiful works of art are created.
The 12 sets of “buddies” work together through the entire school year on an art project based on one of the elderly resident’s cherished memories. Regular visits are scheduled and the participants correspond by e-mail.
Relationships slowly but surely develop as the intergenerational partners open their lives to each other by visiting each other in their home (Jewish Eldercare Centre) and school settings. During the visits, residents share stories of the past which inspire the collective art-making process. The students work on their art at school and bring their artwork in various stages of completion to show their “buddy”.
The pride in their work is evident and smiles abound as each piece is unveiled, and the residents continue to tell their stories. The year-long project culminates in a vernissage (art exhibit) that is open to the entire Jewish Eldercare community. There is a permanent Art Links Lives exhibit on display at Jewish Eldercare Centre for everyone to enjoy on a daily basis.
2nd Place-Valley View Hospital
Nutrition and Nurturing Aspects of Food
Veterans Affairs Medical Center, Battle Creek, MI
Culinary Health On Wheels
The Culinary Health On Wheels (CHOW) program promotes social and physical healing by empowering Veterans through the exchange of information, encourages healing partnerships with caregivers, as well as improving the nutritional value of meals resulting in improved self-management and prevention of conditions such as diabetes, cardiovascular disease and obesity. Prior to the CHOW program, nutritional education was done in an office setting with printed educational handouts and food models.
Formalities break down when you are rubbing elbows in the kitchen and sharing meals engendering a therapeutic alliance different from that which is possible across a desk.
Often Veterans are resistant to dietary change and the thought of trying new foods like soy crumbles, egg substitute, soy milk, flax seed and steel cut oats. However, after preparing the recipes and trying these new foods, most are receptive and incorporate these foods into their home diets. They have also requested that many of the new foods they eat in CHOW classes be made available on the hospital menu
The program is supported by all staff and has been used for cooking demonstrations for employee’s wellness events, and health fairs. This builds employee wellness by increasing knowledge about nutrition and builds employee morale by providing positive human interaction in the workplace.
Spirituality and Diversity
Longmont United Hospital
Longmont United Hospital (LUH) has an extraordinary spiritual care program which exemplifies diversity! Our full-time chaplain and 79 volunteer chaplains, pastors, Stephen Ministers, parish nurses and Clinical Pastoral Education students are truly focused on the Planetree patient-centered experience. Our dedicated volunteer chaplains reflect the religious diversity of Longmont’s community with Christian, Messianic Jew, Buddhist, Catholic, Eckankar, Muslim, Christian Science, Mormon, Greek Orthodox, Seventh Day Adventist, etc. traditions.
With the interdisciplinary team and participation in departmental interdisciplinary rounds, our chaplain provides spiritual presence during Department Rounds and is the leader of the Schwartz Center Rounds, as well as a member of Ethics Committee and Management Meetings. Our remarkable spiritual care program includes weekly Interfaith Communion and religious holiday services, and Blessing of the Hands and Spaces for special occasions including the blessing of the TAILS- Therapy Animals in Loving Service and the Caring Clowns Programs. We support our staff and their families with bereavement services including memorial services, individual and group grief support, and education including a 12-week course on Grief and Loss. A Tea Cart is provided and hosted by the chaplain when a traumatic event or loss happens on the clinical units or in non-clinical areas as needed.
A new and diverse addition to our spirituality program began in 2011 when a new donor came forth from our community and gave our hospital a special gift. The gift was that of a monk from an ashram in India provided by a longtime community member and wise elder, with a deep desire to give a very unique and spiritual gift to his community. Our generous benefactor wanted to learn to meditate from the most experienced teacher he could find. He contacted a swami (monk) he met while on a teaching trip from India and asked him to return permanently to live and teach in Longmont. Our Swami now has a home, Green card, social security card, is signed up for health insurance and is a working member of our community. In late summer of 2011 every Tuesday Swamiji (respectful title for a monk) began teaching classes at the hospital to staff, physicians and community members and every Thursday he teaches Meditation. Every Tuesday and Thursday the hospital conference room is filled with interested students. People of all faith backgrounds attend Swamiji’s lectures and groups and leave his classes with a smile on their face and filled with joy. Swamiji also has provided direct support to patients of the hospital by visiting dying patients and those dealing with challenging and life threatening illnesses. He has had patients receiving chemotherapy attend his hospital lectures in their patient gowns with IV pumps running. He has made home visits to dying patients and also counsels community members one-on-one about relational issues offering his deep healing wisdom in the most helpful and positive ways.
Importance of Family, Friends and Social Support
VA New Jersey Health Care System
Falls Injury Reminder Strategies (FIRST): Transition to Home Environment for Veterans and Caregivers
The Department of Veterans Affairs New Jersey Health Care System (VANJHCS) received a grant for implementation of Falls Injury Reminder Strategies (FIRST): Transition to Home Environment for Veterans and Caregivers in the Home Based Primary Care (HBPC) Program. The majority of Veterans enrolled in HBPC are 65 years or older and likely to experience an annual fall which negatively impacts their ability to remain at home. According to the Centers for Disease Control and Prevention (CDCP), falls are the leading cause of injury death for older adults (those 65 years or older); less than half of older adults talk to their health care providers about falls. Fall incidents are caused by intrinsic (e.g., diseases and medications) and extrinsic (e.g., environmental) factors. The literature about falls focuses heavily on intrinsic factors. The goal of FIRST is to support the desire of Veterans to remain in their home and age in place.
FIRST is an education and onsite intervention for Veterans being cared for in the home environment or transitioning to home care. The grant provided HBPC staff with the knowledge and skills required to help Veterans and family members reduce fall risk and remain in the home environment. The four modules included home modifications for people at risk for falls, people with sensory impairments, people with motor impairments, and people with dementia.
The grant enabled us to assemble caregiver toolkits containing practical items that caregivers can utilize on a daily basis to reduce fall risk such as therapeutic exercise rubber bands to improve strength, balance, and flexibility; non-skid socks; and night lights to increase visibility between the bedroom and bathroom.
2nd Place-Institute Raymond Dewar
Integrative Therapies/Paths to Well-Being
New York-Presbyterian Hospital, Westchester Division
Our work has provided 12 inpatient psychiatric units and several outpatient programs with education and supplies for several integrative practices: aromatherapy, yoga, meditation, breathing exercises and movement. On each of our units, this allows staff to provide these activities for patients at all hours of the day and night. If patients find one of these approaches helpful, we provide them with written information about how to learn more and get involved following discharge.
We surveyed our inpatients and outpatients about their use of integrative practices and found that well over half of our patients use at least one of these approaches. An even larger majority of our patients expressed interest in learning more. Problems they identified as targets for integrative therapies were insomnia, anxiety and stress. A survey of our staff mirrored that of our patients, with a large majority (both clinical and non-clinical staff) currently using integrative approaches and wishing to learn more.
This allows our patients to engage in meaningful, health-promoting activities during times they would otherwise be idle.
2nd Place-Sharp Coronado Hospital
Healthy Communities/Enhancement of Life’s Journey
VA Greater Los Angeles Healthcare System
The Psychosocial Rehabilitation and Recovery Center: “The School for Better Living”
The goal of the Psychosocial Rehabilitation and Recovery Center, otherwise known as “The School for Better Living” (named by the Veterans in the program) is to help veterans with severe mental illness live meaningful lives in the community. The “School” offers classes and individual coaching to help veterans with all aspects of their lives utilizing a holistic approach. The “School” collaborates with mental health programs and primary care in the “care integration” approach for all veterans enrolled in the school. A personal coach, or “Care Integrator” works with veterans on their individual “recovery plan.” The recovery plan is person-centered. It is based on the veteran’s strengths, needs and preferences. The recovery plan is aimed at helping each individual optimize all aspects of their health and live a meaningful life. We utilize a biopsychosocial approach to developing the holistic recovery plan together with the veteran. Once a recovery plan is developed, veterans choose amongst many activities and classes to become involved in. A unique “curriculum” of classes is developed for each “student.” These classes represent a range of cutting edge therapeutic interventions for severe mental illness including evidenced based treatments such as social skills training and cognitive behavior therapy as well as wellness classes that provide a holistic approach for veterans recovering from severe mental illness.
Veterans who graduate this program have amazing recovery stories. We believe that everyone, even the most impaired individual with severe mental illness has strengths that can be used to do something meaningful.
One of the most touching examples that happened recently, is that a gentleman, Veteran A, with severe mental illness—schizophrenia, was recently diagnosed with colorectal cancer. Despite this very serious medical condition, on top of his serious mental condition that has caused him total disability from the military, he is seeking work! He wants to work and more importantly, he wants to help other veterans. Currently he volunteers to help a veteran who is more impaired than he, to navigate the bus and come to the PRRC program. That is called PEER support. The veteran who helps his peer is gaining benefit from that act of kindness himself. We have many examples of veterans who were told that due to their mental illness they could not work or go to school, and now, they are living examples that indeed they can achieve their dreams.
2nd Place-Stamford Hospital
3rd Place-VA San Diego
Patient/Resident Education and Community Access to Information
Sharp Coronado Hospital and Healthcare Center
Ortho! Ortho! Read All About It!
In our ongoing quest to provide patients and families with access to meaningful information, we have initiated the Ortho Daily Newsletter. Patients that are having hip or knee joint replacement surgery receive an ortho newsletter specific to their procedure and activities associated with their day of surgery and recovery process. Many have compared the newsletter to that which one would receive on a cruise ship, a daily itinerary. The newsletter is a different way of receiving information. It’s colorful and bright, motivational, and easy to read. The one page, double-sided, paper is specific to each post-operative day, so that patients receive timely and relevant information. Patients and their Care Partners can focus on the day at hand, organize their schedule, and prepare to be the best they can be through shared decision making in their plan of care. Rather than receiving a plain written page of just words to attempt to educate, this welcoming newsletter entices the patients to read and learn while giving them positive feedback and encouraging them to be an active participant in the scheduling of their goal activities.
Our front desk clerks, because they answer the call lights, were selected to deliver the newsletters each morning. The clerks have the opportunity to make a human interaction with each ortho patient (and Care Partners), by introducing themselves as the person who will be receiving the patient’s calls, and explaining to the patient the purpose of the newsletter. The newsletter includes key take-aways from each department and a daily schedule, so that the patients and families may anticipate therapy times, meal times, and expectations for their day. Rather than waiting for their nurses to come in to initiate the plan of care discussion, the patient upon waking, has information at their fingertips to review at their leisure. During bedside report, patients and nursing team members can review any questions and plan key activities, giving patients the opportunity to discuss the schedule with their Care Partner in an effort to have them present. Because some patients may feel a bit forgetful due to the medications they receive, the ortho newsletter is available to refer back to throughout the day. Since the newsletter is delivered to the bedside, families also have access to this information.
This effort assists in providing a compassionate care experience for our patients and residents because in addition to providing access to information, it encourages the human interaction. When our clerks deliver the newsletter to each patient, the experience is personalized. A smiling face is connected with the voice that answers the call light.
2nd Place-Centre de readaptation Estrie
VA Greater Los Angeles
The VA Greater Los Angeles program introduces patients to integrative health and healing approaches for a variety of commonly-occurring concerns among our patient population. The organization has established a fully integrated, evidence-based mindfulness program designed to introduce these innovative programs to our patient population in a graduated fashion. The three levels of mindfulness care include: An introductory level course, the gold standard for intensive training (Mindfulness Based Stress Reduction – MBSR), and ongoing practice groups including a quarterly silent meditation retreat for MBSR graduates.
The program, with introductory levels, and intensive 8 week mindfulness training, and ongoing retreat practices for our graduates provides a unique opportunity to conduct meaningful research and to assess patient-centered outcomes longitudinally.
Validated standardized questionnaires (PHQ-9, GAD-7, Perceived Stress Scale, SF-12), pre-and post-intervention, are used to assess patients, and after the eight-week intensive MBSR program, patients reported a significant reduction in suicidal ideation, depression scores significantly decreased from the moderately severe range to the sub-clinical mild range, average anxiety scores significantly decreased from the moderately severe range to the mild range, health quality of life significantly increased while patient reports of pain showed a significant decrease.
2nd Place-VA San Diego
Architecture and Interior Design-Large Project
Mercy Medical Center, Cedar Rapids, Iowa
Hall-Perrine Cancer Center
Mercy Medical Center built a thoughtfully designed, patient-centered, state-of-the-art cancer treatment facility – the Hall-Perrine Cancer Center (HPCC). The center opened its doors for service in March of 2012. The design is based on input received from those battling cancer, their families, cancer healthcare professionals and many others, in addition to extensive research and site visits of other leading cancer centers.
Mercy conducted multiple focus groups to collect the input of patients, family members, community members, nursing staff, physicians, and a patient and family advisory council. Caregivers and patients were interviewed separately. The feedback we received played a key role in establishing the features of the environment (colors, materials, lighting, seating and climate control); layout (work flow for nurses and physicians, proximity of resources available and healing gardens); and programming, including food and nutritional services, medical resource center, nurse navigators, salon and fitness center.
Eight site visits were made by HPCC Steering Committee members to other cancer centers to gain expertise from those who have built some of the country’s top facilities.
A wide variety of cancer support services exist in addition to numerous patient-centered amenities and services such as:
Decentralized nursing stations, integrative therapies such as yoga and meditation, display kitchen, gardens, a resource center, children play area, and family gathering areas.
2nd Place-Loch Lomond Villa
Architecture and Interior Design-Small Project
Donald Berman Maimonides Geriatric Centre
Creating a Dining and Sensory room for end of life care
The second floor is quite unique at Donald Berman Maimonides in that the residents are at end-stage Alzheimer’s or other forms of dementia. Most of the residents are in specialized angled wheelchairs. They require help with all activities of daily living. The transformation of the 2nd floor Dining and Sensory room for end of life care had to meet the following three objectives:
1) To divide the space allowing for a more personal and intimate environment thus enabling the staff to be 100% attentive to the residents when feeding and providing a compassionate care experience
2) Make the room multi-functional to accommodate meetings, recreational programs, family visits and other activities
3) Create a room using evidence-based design principles and sustainable design features
2nd Place-VA New Jersey
3rd Place-Mercy Medical Center
Laura Gilpin Kindness Award
Centre de readaptation Estrie
The 2013 Laura Gilpin Kindness award was presented to Centre de readaptation Estrie for the work they did in optimizing and integrating their certification as a Healthy Enterprise into their Planetree structure and processes. This sustainable improvement program allowed the CRE to :
- • enhance the Planetree processes to improve employees’ quality of life through a working environment conducive to satisfaction and personal empowerment;
- • promote active employee participation toward common objectives that seek to improve their working environment, health and well-being;
- • fostering health and well-being projects in the workplace and acquiring healthy life habits;
- • introducing measures that help employees stay in the workplace.