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Nursing and You
Volume 1, No. 3, June 1999 - Geriatric Care
The Psycho-Geriatric Nurse: Battling Depression in the Golden Years
We take for granted that in the autumn of our lives, we will gradually become more frail physically. It will become more difficult to see, to hear, to walk, even to iron clothes or operate a table saw. These changes, although there is much we can do to delay them, we see as inevitable. They are expected.
What takes us more by surprise are the failings of our minds. We can look at our bodies objectively, but we rarely do the same with our mental processes. We may remember our grandfather, who remained mentally sharp into his 90's, and expect that the same will be true for us.
As it name suggests, the Baycrest Centre for Geriatric Care in North Toronto specializes in the care of the aged. There is a nursing home, an acute care hospital, and a number of activity programs for seniors. There is also a team dedicated to the mental health of the elderly. Anna Korol, RN, is the head nurse in the hospital's psychiatric unit, while Ruth Hay, RN, is part of a ground-breaking day program which specializes in the treatment of depression.
"The average age in our in-patient unit is 76," says Anna. "There are 20 beds, and the conditions range from schizophrenia to severe bi-polar mood disorder (also known as manic-depression). Many of our patients are concentration camp survivors, and others have been suicidal. The extent of the challenge can be daunting sometimes."
"The key to treating these patients is communication and patience. Even a minor breakthrough can be very rewarding, but often we can achieve much more." Anna gives the example of a woman in her early 70's who came to Baycrest very sick, incommunicative and weighing only 65 pounds. After extensive treatment, her depression resolved, she was once again able to trust staff and family, and she was a much healthier 110 pounds.
Individual analysis and pharmacological treatments are are the predominant therapies on the in-patient unit, but also used is the group, a regular assemblage which includes most of the patients on the unit and the health care team. In Ruth's Day Hospital, the emphasis is on group work, and there are many different groups, focussing on a variety of treatments, from exercise to relaxation, from medication to psychotherapy. The patients learn to support and inspire each other, to cope with their illness even if they can't eliminate it altogether.
While the psychiatric unit operates 24 hours a day like most hospital wards (the day shift has four RNs and one RPN), Ruth's program is nine-to-five. Participants are referred by family physicians, and assessed by the team in a full-day session. They are depressed, but must be communicative, and sincerely interested in being healed.
"Healing is our emphasis," says Ruth, "and preventing recurrence. Depression can come from so many places - physical or other mental ailments, loneliness, bereavement, inactivity. The emphasis in our groups is on talking about our feelings, what matters to us, what we can get excited about. For some, the chance to share these things with others "in the same boat" brings about an immediate relief of their depression. For others, it takes longer, although we have a limit on how long patients can stay with us (a maximum of six months, and four is the norm). For many, it works so well that there's a desire to keep supporting each other, to keep socializing and talking. The Day Hospital operates a large network of follow-up groups."
"I feel very fortunate," says Ruth, "to be able to help others get well, to cope in the world, and to make important changes in their lives."
The psychiatric nurse is part of a multi-disciplinary team which includes a psychiatrist, social worker and occupational therapist. The nurse acts as case manager, playing a large role in initial and ongoing assessment, leading therapy groups and conducting individual therapy, attending patient appointments with psychiatrists, meeting with the family, and ensuring that appropriate community follow-up occurs after the patient leaves Baycrest.
What is the effect of psychiatric nursing on the nurse? "There might be a tendency to let it drain you," says Anna, "especially when you think you've made progress and you come back the next day and have to start all over. But you have to stay focussed on the moment, stay excited. The patients count on that, and I think nurses have a special ability to do that. You have to stay hopeful."
Hope. Sometimes that's a commodity of which the elderly have a low supply. Nurses like Anna Korol and Ruth Hay help bring us together to rekindle it.
What is the College of Nurses of Ontario?
The College of Nurses (CNO) is the regulatory body for nursing in this province. Established by, but at arm's length from, the provincial government, CNO derives its revenues from annual membership fees; it receives no funding from the province. The College decides the criteria for becoming a nurse in Ontario, and the standards of practice to be met to maintain that designation and privilege. No one can practice as a nurse in Ontario, or use the titles "nurse", "registered nurse", or "registered practical nurse", without a valid certificate of registration from the College.
CNO is governed by a 39-member Council, 21 of whom are nurses elected by their peers from across Ontario (14 RNs and 7 RPNs). The other 18 are public members appointed by the provincial government.
Editorial: The Year of the Older Person
For several reasons, it is appropriate that we dedicate one of our early editions of Nursing and You to nursing issues particularly concerned with care of our senior citizens, our older persons.
One reason is that the United Nations has chosen to make 1999 its International Year of the Older Person, celebrating those who have guided our world through a turbulent century. Thanks in large part to medical advances discovered by their own generation, today's seniors form a larger proportion of the population than ever before, and the trend is bound to continue.
This gradual but steady demographic shift has profound implications for the health care system, as we have been discovering in Ontario over the last decade. As the population ages, the challenges in all sectors of health care, in all practice settings, become more acute and more complex. The average client, being older, requires more attention, whether it's from a visiting RPN in the home, or a public health nurse doing all she can to keep seniors active.
With recent cutbacks in nursing staff, the segment of the patient population which has probably suffered the most is our increasing population of seniors. Studies have shown that without nurses' unique holistic approach to care, an approach that considers the spirit as important in wellness and recovery as the body, patients do not recuperate or heal as well.
Health problems, of course, are not exclusive to the elderly. Inevitably, however, a greater proportion of nurses work with the aged, where their special skills are greatly needed and appreciated. The nurses profiled in these pages illustrate the wide range of services Ontario nurses offer to our senior population.
A recent Nursing Task Force in Ontario strongly recommended increasing the numbers of nurses in all sectors of health care, including long-term care and home care, areas largely populated by the elderly. The College of Nurses strongly supported these recommendations, and indications are that the provincial government will follow through on many of them. If so, more nurses and seniors will be brought together, which offers good promise for the health of Ontario.
Petra Cooke, RN
Council President, College of Nurses of Ontario
Margaret Risk, RN
Executive Director, College of Nurses of Ontario
What is a Nurse?
In Ontario, the nursing profession comprises two groups: Registered Nurses (RNs) and Registered Practical Nurses (RPNs). In most ways, the two categories are subject to the same regulatory requirements; the general standards of practice, the complaints and discipline process, the registration process, all are the same. The two main areas of difference are educational requirements and scope of practice. Although all nursing students learn from the same body of nursing knowledge, RNs study it in greater depth and breadth over a longer period of time, and accordingly are able to provide care in more complex situations.
RNs and RPNs are the only categories of nurse we regulate (although there are sub-groups like nurse practitioners or rehabilitation nurses); indeed, they are the only categories of health care provider entitled to call themselves "nurses". Patients should never be afraid to enquire about the credentials of the person providing them with care.
Peterborough: A Community for Seniors
In the city and county of Peterborough, an hour northeast of Greater Toronto, the senior population has increased by 20% since 1981, as compared to 15% for Ontario as a whole. There are a great variety of services catering to this population, from meals on wheels to homemaking services to wheelchair transportation. Three services in which nurses play a key role are: the Community Care Access Centre, staffed almost entirely by nurses; the Health Unit, where nurses develop and operate numerous programs in health promotion; and an independent footcare practice.
Personalizing Care: The Role of the Community Care Access Centre
Ruth (not her real name) is single and almost 80 years old. She's been diagnosed with multiple sclerosis for over 25 years, and lately her condition has slowly and steadily deteriorated. She has no living relatives, but several close friends visit her regularly and help care for her in her one-bedroom apartment.
And the care that's needed is considerable, for Ruth no longer has much control of her body, and has a variety of chronic skin ulcers which require constant monitoring. In addition to her friends, several professional care providers - nurses, therapists, social workers, nutritionists, homemakers - also come by regularly to make sure her needs are met.
Despite her health problems, Ruth is a fiercely independent woman. She often seems to resent needing so much attention and care from others, and she certainly resists any thought of eventually giving up her home to live in a long-term care facility. Bonnie Elliott, RN, who coordinates her care for the Peterborough Community Access Centre (PCAC), admits that Ruth is a challenging case.
"Her condition, combined with her attitude towards care, make her care plan a very complex one," says Bonnie. "But everyone on Ruth's health care team very much admires her stamina and her independent spirit. She's been fighting MS for a long time, and we're honoured to help her continue that fight."
The PCAC is one of 43 Community Care Access Centres responsible for coordinating home care across Ontario. Stephen Kay, RN, is its director. "We have almost 130,000 people in Peterborough City and County, a large percentage of them seniors, and yet there are only six nursing homes with about 960 beds in total. With hospitals keeping patients for shorter periods, that leaves home care."
At any one time, the PCAC has almost 3,000 cases on its plate, spread across a wide geographic area. Not all of them are seniors - in fact, the number of children in home care is also on the rise - but the vast majority of them are. To deal with this workload, the Access Centre employs 30 case managers, all of them nurses, each of whom may be coordinating the care of up to 140 patients at once.
Jane Wilkins has a bachelor's degree in nursing, the level of preparation which most Access Centres are now requiring of their case managers. "Monitoring the quality of care each patient receives is a complex responsibility," she says. "We visit the home initially to assess the nature and level of care required, and make regular visits to ensure it's adequate. We choose the members of the health care team, and meet with them individually and together to keep tabs on progress. We don't actually deliver the care, but it's still very hands-on."
Adds Bonnie Elliott, "The patient is the official client, but the caregivers are the unofficial ones. There are usually a wide variety of them, with a diverse mix of skills and experience. We need to be able to talk with each of them, and give direction, and to deal very quickly with changing conditions."
"Home care, because it's the sector where the patient has the most input, the most control over his or her own care, is a very flexible and complex environment," says Stephen Kay. "We have to be on our toes all the time."
Footcare Key to Senior Independence
"For the elderly, good footcare may mean the difference between being able to remain in their own home, or having to go to a long-term care facility," says Ann Nelson, RN, a Peterborough nurse who has seen a lot of troubled feet in her day. Ann, in fact, has been a footcare nurse in independent practice (i.e. self-employed) for over 15 years (there are many RPNs and RNs employed in foot care across the province).
"Think about it," Ann says. "What other part of your body takes so much constant abuse, day in and day out? For the average person, the feet take about 700 tons of pressure every single day, and if your work keeps you standing or walking a lot, the punishment is going to be a lot worse than that. Over time, your feet are bound to develop problems - 80% of us will have troubles with them sooner or later."
Although Ann and the nurses who work with her see patients with a range of ages and conditions - those in wheelchairs, for instance, or those with diabetes, arthritis or obesity - seniors comprise a major portion of her caseload. The treatments vary widely, from tasks as deceptively simple as clipping toenails (really a fine art, Ann says), to caring for (and hopefully eliminating) ingrown toenails, callouses, or fungus infections. "Nurses bring something special to foot care," says Ann, "a holistic approach that works on the feet as an element of the patient's overall health."
"Some of the more invasive foot treatments, like removing warts or bunions, those things I can't do", she says. "I refer to a specialist for those. But the ability to provide basic footcare is something more and more health care providers are finding they need, and it's not taught as part of a nurse's basic education." (Comprehensive Nursing Footcare Standards were revised by the College of Nurses of Ontario in 1997. All Ontario nurses are obliged to follow them.)
Ann enjoys teaching foot are at a local community college, and she appreciatess the freedom that comes with independent practice. As care for the elderly shifts increasingly into the home setting, footcare will become more crucial, and in an area with as many seniors as Peterborough County, a business like Ann's is bound to grow.
Getting the Message Out Through Theatre
For 16 months now, the Sage Age Players have been performing to rave reviews in a number of venues across Peterborough County. Their show consists of 10 skits, all with a central theme: keeping seniors healthy. "It's an excellent way of getting the word out," says Ann McLeod, RN, a nurse with the Peterborough County and City Health Unit, sponsor of the popular troupe. " Being seniors themselves, the actors are very much in touch with the issues. They raise awareness, they provoke discussion, and they make a difference." A few years back, a Health Unit campaign on the prevention of falls (the number one cause for seniors entering nursing homes) developed a short scripted play called Pills and Spills. When one of the volunteer actors suggested following up the play's success with a permanent troupe, it made a lot of sense. "He'd been with the original Sage Age Players in Perth, so he knew how to get the ball rolling," says Ann. "Now the group has skits on a variety of topics of concern to seniors, not just health matters, everything from consumer scams to the experience of being recently widowed." The Health Unit has many programs designed to keep older adults healthier longer: checking homes for safety, a "continuing to drive" course, exercise programs aimed at preserving strength and flexibility. In carrying out these programs, the nurses of the Unit have a dedicated and talented group of partners.
How Nurses Regulate Themselves: Resolving Complaints Together
According to the Health Professions Procedural Code of the Nursing Act, the College of Nurses of Ontario (CNO) must investigate all written or verbal complaints received about a nurse in Ontario. But a drawn-out, uncomfortable, stressful process can be avoided.
The Participative Resolution Program (PRP) encourages the parties to a complaint - the patient, the nurse, the College and sometimes the facility involved - to actively work together to resolve the concerns that have been raised. The PRP allows each party to propose creative options and solutions, rather than referring the matter to the Complaints Committee (a standing committee of CNO's governing Council) for a decision. The parties resolve the complaint together, enabling the interests of the complainant, the nurse and the College to be met.
Resolutions can take a number of forms: consultation sessions between the nurse and a CNO nursing practice consultant; educational activities by the nurse; policy changes by the employer; sharing of perspectives through face-to-face sessions; a letter of apology to the complainant by the nurse; or, indeed, several of these measures.
A Typical Case
Mrs. M. was hospitalized for hip replacement surgery in a local hospital. Her daughter complained to the College about the actions of a nurse who cared for her mother. There was an incident in which the nurse was rude and threatening in her tone when she spoke to her mother; she also described a situation where the nurse seemed to imply that her mother was mentally incompetent.
An investigation revealed a series of misunderstandings and false assumptions on the part of the nurse, and her physician colleagues, about what Mrs. M. had been told about her upcoming surgery. The nurse assumed the client had information she did not, in fact, possess, and was impatient with her as a result. It was decided to try to resolve the complaint using the PRP process.
The client's daughter said she would like the nurse to meet with her and her mother, and to apologize to her mother for the way in which she had behaved towards her. She also wanted the nurse to receive education to enhance her therapeutic communication skills. Her mother, the client, wanted the nurse to apologize for implying she was not competent. She also wanted closure to this matter, and to restore her positive feelings about going to the local hospital.
The nurse agreed to meet with mother and daughter, to apologize, and to provide the client with the recognition that she was not confused or forgetful. She also agreed to take a course in therapeutic communication at a local university. The meeting took place at the hospital, the mother accepted the nurse's apology, and the parties ended the meeting on a positive note by shaking hands.
A letter including a summary of the resolution of the matter was sent to all parties, and the complainant withdrew her letter of complaint.
For further information on the PRP, call or write the College of Nurses for a copy of the brochure, The Participative Resolution Program... Resolving Complaints Together.
When You Have Concerns About a Nurse
The mission of the College of Nurses of Ontario (CNO) is to "protect the public's right to quality nursing services by providing leadership to the nursing profession in self-regulation". The College fulfils this mission by setting requirements for entry into the profession, registering nurses, and developing and enforcing standards of conduct and practice.
From time to time, concerns may arise about a nurse's conduct or competence. A key element of CNO's responsibility is to investigate all written or verbal complaints received about a nurse, from patients, employers, fellow nurses or members of the public. An investigator gathers all relevant documents, and interviews those people with knowledge of the incidents outlined in the complaint. This information is presented to the Complaints Committee as a written report. The Committee is made up of RNs, RPNs and members of the public. After reviewing the case, the committee determines whether further action is needed. One possibility for the Committee is to refer the complaint to the Participative Resolution Program (see above).
Further action may also take the form of a Discipline Hearing, where both nurse and complainant are represented by legal counsel. If the hearing panel finds the complaint warranted, action taken may range from a verbal caution, to withdrawal of the member's right to practise as a nurse.
Taking Action to Prevent Patient Abuse
As part of its mission to protect the public's right to quality nursing services through regulation of the nursing profession, the College of Nurses of Ontario (CNO) takes very seriously the issue of abuse of patients, by nurses or by any other care provider.
CNO's Standard for the Therapeutic Nurse-Client Relationship, which all Ontario nurses are obliged to follow, is dedicated to creating the best possible health care climate. It gives specific guidelines and rationale for what constitutes acceptable or appropriate behaviour in any situation. Physical, verbal, emotional and sexual abuse, as well as patient neglect, are described and illustrated through numerous examples.
The CNO has a wide-ranging educational program, entitled One is One Too Many, aimed at raising awareness of abusive behaviour among Ontario nurses. The program focuses on helping nurses to recognize warning signs, and on their obligation to speak out about abuse by others.
"Older persons are among the most vulnerable to abuse," says CNO's Executive Director Margaret Risk. "Often, they might fear that reporting abuse will result in a withdrawal of nursing care. But they should never be afraid to speak out. By speaking out, they will probably cause the abusive behaviour to stop immediately, a postive result for them, their fellow patients and the health care team."
For more information about CNO's abuse prevention program, contact us at 1-800-387-5526.
Who's Who in Long-Term Care
In this installment of our series designed to help the public identify the various care providers in different health care settings, we visit a medium-sized, well-established home for the aged in Kitchener.
At Sunnyside Home, a sprawling 263-bed facility with a substantial waiting list, it's hard to tell the players by what they're wearing, at least not by their uniforms. Any one of the rainbow of colours could be worn on any given day by anyone. "We encourage warm colours and comfortable attire, but beyond that it's up to them," says Gail Carlin, RN, Sunnyside's administrator.
Each staff member, however, does have a large round button, with her or his name and designation (RN, RPN, Health Care Aide, etc.). "Our Resident Council wisely advised," says Gail, "that if we were going to have name tags, we might as well make them really big and easy to read, with the designation very clearly marked." (The College of Nurses requires some form of identification, including designation, for all nurses.)
So if you were visiting your aunt at Sunnyside, you could tell whether the person attending her is an RPN (registered practical nurse) or a support worker by peering at the button. An easier way of finding out who's who, though, would simply be to observe what the care provider is doing. "Certainly all of us here at Sunnyside pitch in to help each other when the situation demands," says Gail, "but for the most part the roles are very well defined."
Sunnyside has about 260 paid staff, 115 full time and the rest part-time, supported by over 200 community volunteers. There are laundry workers, food service workers, housekeeping and maintenance staff. There are two social workers, four recreational therapists, a music therapist, a dietician and a chaplain. Also on call to Sunnyside are five physicians as well as physiotherapists, occupational and speech therapists.
The hands-on care providers can be divided into four main groups. On the average day shift at Sunnyside, they are represented as follows:
- Eight Registered Practical Nurses (RPNs);
- Three Registered Nurses (RNs);
- 21 Health Care Aides (HCAs); and
- 12 Resident Support Workers (RSWs).
The RSWs do most of the housekeeping. They change beds, serve food, help with feeding, answer call bells, and transport residents if assistance is required. The HCAs perform most of the physical care of the patients, supervising their bathing, dressing, feeding and many of their day-to-day acvtivities.
The RSWs and HCAs are unregulated; that is, there are no province-wide standards for the care they provide. The nurses, on the other hand, the RPNs and RNs, are provincially regulated by - and accountable to - the College of Nurses of Ontario.
At Sunnyside, the RPNs administer medications, change dressings, and perform most of the routine nursing treatment. They share the documentation and charting with the RNs. The RNs, for the most part, are clinical supervisors; during their shift, however, they will see each and every one of the 80 or 90 residents for whom they are responsible. The nursing managers, the Director of Care, and in Sunnyside's case, the Administrator, are all RNs as well.
The RNs participate in hands-on care when the treatment required is particularly complex. For the most part, however, they are responsible for initial and ongoing assessment, for coordination of the care plan for individual patients, and for the documentation of care.
Despite the delineation of tasks, however, all of the care providers at Sunnyside may be called upon to participate in conferences about care. The music therapist, the chaplain, the HCA, the RPN or RN - if she or he has ideas to contribute about a particular resident, that contribution is taken very seriously.
"Everyone here has skills and perspectives to add," says Gail. "Blending all of them successfully, and involving residents and their families in care planning, is what translates to a high quality of service and care. That's what we aim for."
What is Nursing?
The goal of nursing is to restore, maintain and advance the health of the patient. It is both a "science" and an "art". The science is the application of nursing knowledge and the technical aspects of the practice. The art is the establishment of a caring relationship through which the nurse applies nursing knowledge and uses judgement in a compassionate manner. Both focus on the whole person, not just a particular health problem.
Nurses can play many different roles - clinical practitioner, administrator, teacher, researcher - in many different settings - hospitals, long-term care facilities, patients' homes, clinics, industry, or classrooms, to name just a few. They care for patients at all stages of the life cycle and in all states of health, from normal functioning to crisis.
In Ontario, the nursing profession is comprised of two groups: Registered Nurses (RNs) and Registered Practical Nurses (RPNs). The two categories are subject to the same regulatory requirements; the general standards of practice, the complaints and discipline process, the registration process, all are the same. The two main areas of difference are educational requirements and scope of practice. Although all nursing students learn from the same body of nursing knowledge, RNs study it in greater depth and breadth over a longer period of time, and accordingly are able to provide care in more complex situations.
RNs and RPNs are the only categories of nurse we regulate (although there are sub-groups like nurse practitioners); indeed, they are the only categories of health care provider entitled to call themselves "nurses". Patients should never be afraid to enquire about the credentials of the person providing them with care.
Diary: Reflections of a Registered Practical Nurse in Long-Term Care
Debbie Adams, RPN, has worked at Rainy Crest Home for the Aged in Fort Frances for 16 years. In this diary, she reflects on some of the issues she encounters in her work.
Imagine not being able to take care of yourself, due to some physical or mental affliction that has prevented you from living within the comforts of your own home. Don't ever say, "Oh, that will never happen to me," because one day, you may find yourself in the same circumstances as some of the residents currently living at the Rainy Crest Home for the Aged.
During my 16 years of working as a Registered Practical Nurse, I've witnessed many residents who continued to be lonesome for their home environment, and others who more easily accepted Rainy Crest as their new home. All become my primary focus from the moment I begin my shift. They are the reason for my employment at Rainy Crest, and I feel it's my responsibility as a nurse to make them feel as comfortable as possible.
My day begins by reviewing the report from the previous shift, updating me on the status of the residents for whom I'm responsible that day. This is followed by the preparation and distribution of medications, which is when I interact most closely with the residents. Today I leaned down to one resident who was looking despondently into space, and asked, "What's the matter?"
"I want somebody to talk to," she replied. "I'm lonely." I knelt beside her and began to engage in small talk, and the end result was to make her laugh. More important than that... she had forgotten all about being lonely. My reward for that moment was seeing the happy expression upon her face, and knowing that I had played a small part in making her day just a little bit more enjoyable.
Charting is started as the medications are distributed, and a multitude of treatments are implemented, such as wound care and dressing changes. Throughout the day, with the assistance of the Health Care Aides, I am busy with lifting and shifting of residents, feeding, bathing, as well as any unexpected occurences that may arise.
On any given shift, I care for 84 residents. Of course I do not do this by myself. My co-workers and I work together, and we function like a well-oiled machine. Teamwork allows us to use our time most efficiently, and gives us the flexibility to respond to residents needing immediate attention. My response to one such resident will give you a very good picture of how we need to communicate with residents.
That day, I went chasing after a male resident who had wandered out of the building. I caught up to him and asked, "Sir, why did you stray out of the Home?" He told me, "I have no children, no wife, and all of my friends have died. How would you feel if no one came to visit you? I think just be better off dead! You don't know how it feels to be old and all alone."
I smiled at him and took his hand. "You are wrong, sir, you have many friends here who love and care for you. If you left us, we'd all be sad! The first day you came here, you made me laugh so hard. Don't you remember when I was getting you ready for bed and I said, 'Would you like me to put your pajamas on?' You came back quick as anything, 'Why, sure you can, but only if you can fit into them.' "Well, the resident and I started laughing at that memory, and he said, "You're right, I guess I have made a few friends here." Before long, I had him settled back in his room.
Some days I feel sad because I am not able to spend the amount of quality time I feel I should with the residents due to the shortage of staff. It can almost seem as though the residents are on conveyor belts, and my co-workers and I are attending to them in a "blink of an eye". It's during the most chaotic moments that I have to sustain a sense of humour in order to balance out the rest of my day.
At bed check one evening, I discovered a female resident trying to climb into bed with another resident. I quietly said, "Ma'am, that's not your bed. Come on now, and I'll bring you back to your room." She was a tiny woman who wouldn't hurt a fly, but she wasn't about to be coaxed out of that bed! She began punching and kicking me, and her arms were flying everywhere. It took a lot of patience and persistence, but finally, through gently talking with her, I managed to get her back to her room and into her own bed. She looked at me angrily and said, "I'm not going to forget this, my dear", as she furiously yanked the covers up over her head.
I took a deep breath and tried to think how I would feel if I were her, if for reasons I had no control over, all those things I once loved and took for granted were slipping away from me. I knew that, really, she wasn't fighting me, she was fighting her situation, and I had to admire her for that.
Administering personal care at Rainy Crest is very complicated. It's not just giving the residents what they need for their bodies, it's trying to make them feel at home and happy and cared for. I could never think of, or refer to, the residents as though they were "just a number". They are people who deserve to be treated with respect, and they are the reason I am here.
Contact Us
For further information about any aspect of nursing regulation in Ontario, including how to express a concern about a nurse's conduct or practice, please contact:
College of Nurses of Ontario
101 Davenport Road
Toronto, Ontario, M5R 3P1
cno@cnomail.org
Telephone: 416-928-0900 or Toll Free 1-800-387-5526
Fax: 416-928-9841
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