As nurses, we know every patient is special, but I can think of no greater contribution I can make right now than being a nurse to those who’ve served our country. I work every day with veterans dealing with dementia in my role as the clinical nurse leader for the geriatric extended care line at the Chillicothe Veterans Affairs Medical Center in Ohio.
As a clinical nurse leader with a background in evidence-based practice, I’m always looking for ways to improve the long-term care environment for our veterans with dementia. One idea we arrived at is focused on therapeutic design, which encompasses many things all addressing the senses, thus improving the external environment in a way that can lead to internal healing and peace. Agitation, anxiety, and depression are common in individuals with dementia; we’ve seen how therapeutic design can help alleviate these symptoms.
One tactic we’ve introduced is the use of interactive cats. You may have seen these for sale in stores or online. They have touch sensors in their head, ears, and cheeks and will nuzzle in when petted; these toys purr just like real cats. The point is that through therapeutic design we now have patients with dementia who love to play with these toys; many haven’t been around pets for many years.
We’ve also installed a jukebox in a common area; this music has transformed a sterile setting into one with lively sounds throughout the day. Songs can evoke feelings, bring back fond memories, and bring smiles to faces. As you walk down our main hallway murals brighten the walls and bring color and life. We also have implemented aromatherapy, which is calming and helps patients sleep better as well as reduces their pain.
Importantly, caregivers report that they appreciate the value of sensory-stimulation interventions, which have proven helpful in improving caregiver confidence and reducing distress. Happier patients have also led to a decrease in caregiver burnout rates. This is a stark contrast from how things were before, when veterans who were cognitively impaired would be in a unit with bland colors on the walls, no pictures to look at, and little to remind them of home.
Recently, I had the opportunity to share the lessons I have learned while implementing this innovation with others in the Veterans Affairs system, the largest integrated health care system in the country. The VA is in a unique position to advance, change, and disrupt the way America delivers health care. At the Veterans Health Administration’s Innovation Experience, held in Washington, D.C., I was able to share my experiences and help the entire system understand how we’ve provided better care and support for veterans.
In addition to presenting, I also learned from others, such as Shannon Munro, PhD, who is chair of the national VA nursing research field advisory committee. She serves veterans as a nurse researcher, nurse practitioner, and many other roles. Munro and her team in Salem, Virginia, have significantly reduced the risk of developing hospital-acquired pneumonia by providing consistent oral hygiene during hospital admissions. They named their initiative Hospital-Acquired Pneumonia Prevention by Engaging Nurses (Project HAPPEN); it encourages clinical staff to assist veterans to complete oral care two-to-three times each day. This practice ensures non-ventilated patients receive oral care by providing consistent staff training, educating patients about oral care, and its association with pneumonia, and standardizing oral care supply and distribution. At the Salem VA Medical Center, the incidence of pneumonia decreased by 92% from the baseline in the first year. The intervention has expanded across eight VA hospitals, yielding an estimated cost avoidance of $4.7 million and 21 veteran lives saved to date.
We know our veterans gave their all when they were in active duty. Now, we are glad to work together to ensure we are providing the best in care, as well as the innovations in care, that are needed now and into the future.