The senior community where I am employed offers a range of lifestyle options beginning with independent living and advancing to supportive care including personal care, memory care, skilled nursing, and short-term rehabilitation services. More than a decade ago, visionary leaders recognized that aging in place would become the new norm in senior living and embarked on a plan to expand the community in order to support that goal. The position of wellness nurse was created in response to that need.
My years spent in critical care, followed by work as a faith community nurse laid the foundation and provided the skillset that allow me to serve as a wellness nurse for independent living residents. Wellness is defined as a dynamic, lifelong process of growth and change integrating body, mind, and spirit. The program is rooted in the concept of the seven dimensions of wellness that include physical, emotional, spiritual, intellectual, social, and environmental wellness (Miller, 2012). We employ a strengths-based nursing approach and operate under the premise that each individual has an inner-capacity for strengthening and empowering him-/herself to face life's challenges and to make choices that contribute to health and well-being (Gottlieb & Gottlieb, 2013). The staff consists of professional nurses who are governed by the standards of the American Nurses Association (ANA, 2015)Nursing Scope and Standards of Practice, and the ANA Scope and Standards of Practice: Faith Community Nursing (2012).
The day begins at the office by checking on phone messages, emails, and updates on information about residents who have been hospitalized. Team consultation occurs shortly thereafter to keep everyone informed of any resident status changes, followed by a brief morning meeting with department heads in order to maintain open lines of communication. One of the many benefits of a continuing care community is the knowledge that supportive services within a familiar, home setting are readily available.
The independent living community is geographically diverse and includes suites housed in the central healthcare building. Residents of the suites receive a monthly meal plan and easy access to the dining area, chapel, administrative offices, and community hall. Cottages and garden apartments are separate dwellings housed on the perimeter of the campus. The setting allows for the freedom of being in one's own home with the reassurance of being surrounded by a safe, supportive community.
Rounds of the suite and garden apartment residents follow. We've developed a system whereby each resident places a door hanger on the front door in the morning. This enables us to confirm the safety of the resident without being intrusive. The knowledge that a nurse monitors residents on a daily basis gives both residents and families an additional layer of security. The mean age of residents is 84 years and many are managing chronic conditions such as diabetes, cardiac disease, and anticoagulant therapy. The daily routine of the walk-through helps our team consistently monitor changes in an individual's status such as weight loss or gain, or changes in mental status.
Office hours are from 10:30 a.m. to 12:30 p.m., Monday through Saturday. This time is made available to residents for private consultation by appointment or drop-in. Each new resident is given a basic health assessment to determine current and potential needs and consists of history taking, current health issues, medications, vital signs, and social/occupational history. This is also an excellent opportunity to become acquainted with new residents and welcome them to the community. Many relocate from a distance and require references for a new physician, dentist, or hospital. Residents are required to complete an emergency contact form which is kept in a secured location in the administration office. Our community also participates in the File of Life Program in collaboration with local emergency services. Each resident completes an information card which is then placed in a magnetic pocket on his/her refrigerator. Emergency personnel have embraced the program to the extent that they now automatically look for the magnet. The File of Life program has been invaluable; all necessary information is readily available when emergency services are required.
An essential component of the wellness program is exercise. Active engagement with life and high cognitive and physical function all contribute to successful aging. A robust exercise program plays an integral part in the process. The wellness team coordinates exercise programs at various levels including a chair-based stretching & strengthening program, aquatic aerobics, water walking, dance exercise, tai chi, and others. Regular exercise class affords the opportunity to maintain optimal physical function, as well as social engagement and connection, key ingredients in wellness. Today it's supervising a stretching class.
Afternoons are allocated to home visits-on this particular day I'll check in with Mrs. B who lives alone and is dealing with progressive cognitive decline. Through the joint efforts of family and friends, and participation in a memory fitness program she is able to remain in her cottage at this time but is monitored by the wellness team to ensure safety. Next will be a visit with Mrs. W, who has a number of comorbidities including diabetes and rheumatoid arthritis. She is currently dealing with an upper respiratory infection with severe cough. Although she has been examined by her primary care provider and does not require antibiotic therapy, she needs continued encouragement in order to maintain adequate fluid intake and nutrition. I assess her status, make her a cup of tea and toast, and we pray together.
Under the guidelines that have been established, members of the wellness team do not perform "hands on" duties such as dressing changes or injections, traditionally associated with nursing care. It is our responsibility to assess needs and offer the services of nurses and therapists from a certified home healthcare agency of resident's choice. Circumstances can vary from a newly diagnosed condition, to follow-up care after hospital discharge, increased fall risk, or a change in mental status. We maintain a list of home healthcare providers in the area to assist residents and families in the decision-making process. Any agency that is interested in providing services to our residents is interviewed prior to inclusion on the recommended list in order to determine that our missions are in alignment. Periodic resident satisfaction surveys and ongoing feedback from residents who have utilized services are valuable means of assessing the quality of care provided.
The final stop of the day is a family care conference with a resident who had been hospitalized with a hip fracture and is currently undergoing rehab in our skilled nursing unit. Her goal is to return to her apartment when she is safely able to do so. The social worker guides the conversation, various disciplines discuss goals, progress, and plan a home evaluation. My role is to collaborate with the other professionals who are providing care. My presence affirms that her goal is indeed possible and that I will be there to accompany her on that journey.
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