A couple of weeks ago, I had the opportunity to attend the national conference of the Green House Project. The Green House movement is an initiative to truly transform the lives of older adults by creating living environments that are truly home, that focus on enabling people to live meaningful lives regardless of age, disease or disability.
One of the presentations I sat in on at the conference focused on the use of restraints. We are very proud of the fact that we have completely eliminated alarms and restraints in the long term care setting and were sharing our methodology and results. Director of Nursing, Eric Riguerra, gave a great presentation on our approach and success. The second speaker was a woman who is also a Director of Nursing in a long term care facility and she, too, told the story of their journey to a restraint and alarm free environment.
When she finished her formal presentation she said “And now for the rest of the story.” She shared with us a medical odyssey that she had experienced within the last year. Seemingly out of nowhere, she developed a staph infection that spread to her brain. By the time it was diagnosed, not only did she need surgery but the neurosurgeons were telling her that “it was likely too late.” As a 49-year-old woman with a young family, this was not only devastating, but also shocking.
She did survive the surgery and woke up in the Intensive Care Unit on a ventilator. She was heavily sedated and could not communicate but she heard everything around her. She tried, as people do, to pull out the ventilator tubes and so her wrists were placed in restraints. Then, as she moved, alarms would go off and she would become agitated, resulted in restraints placed around her ankles as well.
Her husband, despite his lack of medical background, realized that the more the alarms went off, the more agitated she became and the more she struggled against the restraints. The hospital staff, to their credit, realized this and addressed it and, finally, she was able to be extubated from the ventilator. She told us that every time she heard an alarm she thought it was her alarm clock and that she needed to get up and go to work. Hence the struggle and the agitation.
Her story has stuck with me as I am sure it has with everyone else who heard it. Not only does it underline and underscore our commitment to being alarm and restraint free, but it reminds us that there is, so often, more than meets the eye. When we interpret someone’s reaction or behavior at face value, especially someone who cannot communicate with us in a conventional manner, we are as likely to be wrong as we are to be right.
Looking beyond the surface, developing a real understanding of the other person, thinking past the outward manifestations of behavior are not just important lessons for all of us who work with older adults but important lessons for all of us as human beings.