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Annals of Long Term Care
Marianne Smith, PhD, ARNP, BC, Ann Kolanowski, PhD, RN, FAAN, Linda L. Buettner,
PhD, LRT, CTRS, and Kathleen C. Buckwalter, PhD, RN, FAAN
Teamwork: Making It Work
As recommended in the NEST approach, collaboration among disciplines is essential for activity programs and therapies to be successful. The importance of collaboration is underscored by the CMS rules and investigative protocols that interview nurses, nursing assistants, and social workers, as well as activity directors and their staff. Although a wide variety of factors interact to determine outcomes of care, experience and research suggest that successful programs regularly have the full support of the facility administration to form a team, include key staff from all available disciplines to participate in the team, identify a leader who is knowledgeable about dementia and activity involvement, meet on a regular basis, and communicate well with others.
Success also relies on building on the strengths of team members. As activity methods and processes are put in place, the discipline of the team member is less important than the person’s interests and skills. For example, a nurse who is a coin collector may be the ideal person to lead the Coin Collector’s Club; a nursing assistant who plays guitar and sings might organize an evening sing-along; or a social worker who is an early-morning person may be ideally suited to escort the Early Risers Walking Club. Building on staff members’ natural interests and skills is essential to developing and sustaining programs.
Other aspects of teamwork involve helping all staff members appreciate and assist with common aspects of activity involvement, such as helping residents be appropriately dressed and outfitted for the program. For example, wearing sturdy and well-fitting shoes for walking or wearing sunglasses and sunscreen for outdoor activities may be pivotal in the overall success of the program. Staff collaboration also extends to resolving “competing demands” for residents’ time—such as adjusting medication schedules to best accommodate activities (eg, giving as-needed pain medications before or after the activity, adjusting timing to enable full participation), or making appointments to avoid conflicts with scheduled small-group activities.
Another important aspect of teamwork is helping daily staff providers gain needed skills to successfully facilitate activity programs. Although recreation and activity personnel may be available during “business hours” (eg, 9:00 AM to 5:00 PM, Monday through Friday), both scheduled and “as-needed” programs may be needed at all hours of the day, every day of the week. This issue is specifically addressed in the CMS discussion of Care Planning, which notes that activities may occur at any time and are not limited to formal programs provided by activity staff, and that all relevant departments should collaborate to develop and implement an individualized activity program for each resident.3 For example, nursing personnel may benefit from understanding the importance of and strategies for transitioning residents from one activity to another (eg, using the Price Is Right Game before meals, using a Simple Pleasures butterfly to engage a restless resident during personal care). Staff members may also need guidance and assistance to ensure that the residents, not the staff members, conduct the activity. For example, teaching staff caregivers to cue residents to start, demonstrating without “doing” the activity for the person, and providing verbal prompts without dominating conversations is important to activity success.
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