Traditionally, nursing homes have followed a model of care emphasizing the medical needs of residents. Too often, this approach fails to encompass other factors that contribute to a person’s well-being, including emotional, psycho-social and spiritual needs.
The University of Oklahoma Fran and Earl Ziegler College of Nursing has launched an initiative to meet nursing home residents’ needs in a more holistic way. It starts by asking a simple question: What matters? (story continues below)
“If we don’t ask what matters to nursing home residents, then we don’t know. To a large extent, we have focused on their medical care and overlooked their emotional well-being,” said Diana Sturdevant, Ph.D., R.N., an assistant professor of research in the OU College of Nursing.
Sturdevant and her colleague Teri Round, M.S., R.N., executive director of clinical operations at the college, are introducing Oklahoma nursing homes to the 4Ms Framework. The approach is an outgrowth of the Age-Friendly Health Systems initiative, a designation achieved by OU Medicine last year.
The 4Ms Framework comes from the Institute for Healthcare Improvement, and the OU College of Nursing is among the first in the nation to adapt it to nursing homes from its origin in hospitals. The 4Ms – What Matters, Medications, Mentation and Mobility – are evidence-based elements shown to improve health and well-being by placing nursing home residents at the center of their care.
Asking nursing home residents what matters most to them sets the stage for the other three M’s, Round said. What matters to nursing home residents varies – some want to work toward returning home, while others want to make friends and engage in activities. Others want to plan to attend a special event like a wedding, or be able to interact with their grandchildren. The goal is to align their care according to what matters to them.
“We want to ask them what matters when they first come into the nursing home because that first interaction with the staff sets the stage for their entire stay,” Sturdevant said. “But we also want to integrate that question into their care plan so that we stay in tune with what they want. If we don’t meet their emotional needs, they may get upset or feel lonely, then we may view them as having behavior issues, and the next thing you know, they’re heavily medicated. It can snowball out of control.”
As the second M, medications are important to review for how they affect older adults, especially to ensure that they don’t interfere with their goals. If a person has to be hospitalized, they may be put on medications meant for short-term use, but many residents continue taking them for months or years after returning to the nursing home. In other cases, a nursing home resident may be put on an antipsychotic drug or a sedative that robs them of their quality of life, Sturdevant said.
The third M, mentation, focuses on a resident’s mental health. Older adults can be susceptible to depression, and they should be checked for dementia, Round said. Assessing for delirium is also important because it often goes unrecognized in nursing home residents and, if untreated, can be life-threatening, she said.
Many nursing homes are also addressing mentation by decreasing how many times a night they wake up residents to check on them, Sturdevant said. For years, nursing home providers have awakened residents every two hours, interrupting their sleep, which can increase problems with mental activity and mobility.
The fourth M, mobility, is important for reducing falls and for overall quality of life. Helping residents move around increases their strength, which reduces the likelihood of falls, Sturdevant said. Mobility is also important for people who’ve had a fall because if they don’t get up soon after being treated, they may never walk again.
The OU College of Nursing received a grant of nearly $1 million for the 4Ms initiative. The grant comes from the Civil Money Penalties program, administered by the Oklahoma State Department of Health. When nursing homes are fined, that money goes to the Centers for Medicare and Medicaid Services, and part of it returns to the Oklahoma State Department of Health, where it can only be used for quality improvement projects that directly help residents of nursing homes.
To introduce the 4Ms Framework to nursing homes, the College of Nursing will use its Long-Term Care Leadership Academy, a training program for people at three levels of nursing home employment: administrator and director and assistant director of nursing; RNs and LPNs; and certified nursing assistants.