Geriatric Nursing: Caring for Older Adults

Podcast Transcript

Carol Pehotsky (00:05):

With any luck, we'll all have the privilege to reach advanced stage. With that, will likely come the need for specialized nursing care. Our guests today specialize in geriatric nursing, and they'll share more with us about this rewarding and interesting field. Hi, and welcome to Nurse Essentials, a Cleveland Clinic Podcast where we discuss all things nursing. From patient care, to advancing your career, to navigating tough, on the job issues. We're so glad you're here. I'm your host, Carol Pehotsky, Associate Chief Nursing Officer of Surgical Services Nursing.

(00:43):

Welcome back everyone. Today we have two special guests with us to talk about, nursing care for our older patients. And I'm very fortunate in my family, longevity tends to be the theme. So, it is very important for me to take care of myself. I have one grandmother who lived to 95 and the other grandmother lived to 103. So, we had, we had the big birthday party at 80, and then the big birthday party at 90, and then the big birthday party at 100. (laughs). And then every time I saw her after that, because she lived in another state, every time I'd hug her bye, she said, "Well, maybe I'll see yah." (laughs). And there we have it. And bless her heart.

(01:19):

Having said that though, the very first patient I got, my very first nursing clinical, was an older lady in a specialty bed. Now, this is 20 years ago, but the bed was huge. It was loud. She, in my estimation, you know, had some tissue loss and I was terrified. I didn't want to hurt her. She could not see or hear very well. And although I'd spent time with grandmothers of an older age, I didn't know what to do. And I was co- convinced even touching her was going to hurt her.

(01:47):

Very fortunate for me, one of my nursing school classmates, had already had several years working as a nurse's aide in one of our Cleveland Clinic Hospitals. "Come on, Carol, I got you." And we went in together and really just showed me the way of life, deliver the care that you would want to be delivered in such a gentle way. And just getting over that first hurdle and then I was fine. What a gift to me. And wouldn't we all want that for ourselves as that first nursing student experience, or for any of our nurses that really have that moment where we would want somebody to take us by the hand? Or, when we get to that place, if we're fortunate to live that long.

(02:22):

So, I'm so honored today to be joined by Julie Simon and Jennifer Katlen. They're both Clinical Nurse Specialists with us here at Cleveland Clinic, and they both have a passion for caring for the older adult. Welcome ladies. We're so glad to have you.

Julie Simon (02:34):

Thank you, Carol.

Jennifer Katlen (02:35):

Thanks for having us.

Carol Pehotsky (02:36):

So, first we'd love to hear from you a little bit about your backgrounds and why you're so passionate about caring for our older adult population. Who wants to go first? Julie, can I pick on you first?

Julie Simon (02:45):

Sure. (laughs). So, my background has been, is starting out in med-surg type areas. Medicine, a lot of the renal failure, kidney failure, GI bleeds, those kinds of patients.

Carol Pehotsky (02:46):

(laughs). Yeah.

Julie Simon (02:57):

In combination with each other can be pretty rough-

Carol Pehotsky (02:59):

Mm-hmm.

Julie Simon (02:59):

... in a lot of older patients as well.

Carol Pehotsky (03:01):

Mm-hmm.

Julie Simon (03:01):

So, as far as the passion for caring for older patients, I also have been blessed with, family who's definitely got some longevity.

Carol Pehotsky (03:01):

Mm-hmm.

Julie Simon (03:10):

So, great aunts, actually they were great, great aunts for me.

Carol Pehotsky (03:13):

Oh, wow.

Julie Simon (03:13):

So, she reached 103 as well.

Carol Pehotsky (03:15):

Yeah.

Julie Simon (03:16):

Um, grandmother who was, mm, we just... This is our first birthday without her yesterday-

Carol Pehotsky (03:21):

Aww, grandma.

Julie Simon (03:21):

... so, it would've been her 100th.

Carol Pehotsky (03:21):

Aww.

Julie Simon (03:23):

So, she made it to 99. But always s- surrounded by family who was very interesting.

Carol Pehotsky (03:29):

Mm-hmm.

Julie Simon (03:29):

You know, you love doing things with them.

Carol Pehotsky (03:30):

Mm-hmm.

Julie Simon (03:31):

And so that interaction with the family that is in the older generation, I think was so valuable.

Carol Pehotsky (03:37):

Mm-hmm. Mm-hmm.

Julie Simon (03:37):

And it just brings that personalization to it.

Carol Pehotsky (03:38):

Mm-hmm.

Julie Simon (03:41):

And so, every time I see someone in that bed-

Carol Pehotsky (03:41):

(laughs).

Jennifer Katlen (03:41):

Yeah.

Julie Simon (03:43):

... then, you know, who is that? That's my grandmother.

Carol Pehotsky (03:45):

Hmm. Mm-Hmm.

Julie Simon (03:45):

I would, you know, that's my grandfather.

Carol Pehotsky (03:46):

Mm-hmm.

Julie Simon (03:46):

That's my, and that's the care that I would want given.

Carol Pehotsky (03:49):

There you go. All right, Jennifer, how about you? Welcome.

Jennifer Katlen (03:52):

Thanks. So, I've been a nurse for almost 20 years now, and a clinical nurse specialist for about 10.

Carol Pehotsky (03:53):

Great.

Jennifer Katlen (03:59):

And when I first started out nursing, I really wanted to work in pediatric cardiology.

Carol Pehotsky (04:05):

Okay. (laughs). All right.

Jennifer Katlen (04:05):

So completely opposite. I ended up working in adult cardiology.

Carol Pehotsky (04:09):

Okay.

Jennifer Katlen (04:10):

And of course, you know, our older adult population is a lot of that's specialty population.

Carol Pehotsky (04:17):

Mm-hmm. Mm-hmm.

Jennifer Katlen (04:17):

So, whether I wanted to or not, here I was with these patients.

Carol Pehotsky (04:20):

(laughs).

Jennifer Katlen (04:21):

And I too have a family with a lot of longevity. Great Uncle Jay was 106.

Carol Pehotsky (04:26):

Oh my gosh. (laughs).

Jennifer Katlen (04:27):

My great grandma was 102 and my grandma 99.

Carol Pehotsky (04:27):

Wow.

Jennifer Katlen (04:31):

But I think for me, I never really thought of them as being patients, because they were very healthy-

Carol Pehotsky (04:36):

Right. Yeah.

Jennifer Katlen (04:37):

... up until the time that they passed away. So, I didn't think of them in that way. But I really enjoyed connecting with my older adult patients in the hospital. Even in the ICU-

Carol Pehotsky (04:48):

Mm-hmm.

Jennifer Katlen (04:48):

... um, once people were able to talk and converse-

Carol Pehotsky (04:52):

Mm-hmm. Mm-hmm.

Jennifer Katlen (04:52):

... I found them very interesting. And they always wanted to connect with me too as a person and not just as a nurse.

Carol Pehotsky (04:58):

Mm-hmm.

Jennifer Katlen (04:58):

So, I found that really valuable.

Carol Pehotsky (05:00):

Well, and to let our audience in on a little conversation we were having before the mics were live, you know, ta- talking to Julie and Jennifer about, you know, sometimes in the cafeteria you have, you have a table where you, you're talking about, information sharing with the public and, (laughs), you were, you were telling us Julie about, the 95-year-old who said, "Geriatric patients. Who's that for?"

Julie Simon (05:21):

Hmm. Right? Right?

Carol Pehotsky (05:22):

And so, as we all get, hopefully we have the privilege of getting older-

Julie Simon (05:25):

Right.

Carol Pehotsky (05:25):

... it isn't necessarily something that we see in ourselves.

Julie Simon (05:29):

No. Mm-mm.

Carol Pehotsky (05:30):

But that need is there. So, can you both walk us through, you know, there are certainly physiological changes that we need to acknowledge and, and how do we acknowledge that in this patient population? It's not just physiological changes, but what else should we look for in assessing for?

Julie Simon (05:42):

You've mentioned the physiological changes. Um, I think of it, you know, you know, muscle mass is different versus body fat, things like that affect medications, how much hydration we keep on board.

Carol Pehotsky (05:53):

Hmm.

Julie Simon (05:53):

All those affect both how much patients drink, how much medications are absorbed-

Carol Pehotsky (05:58):

Hmm.

Julie Simon (05:58):

... all those kinds of factors. But then, beyond the physiological changes, the social changes, right? And so, sometimes I think of myself and how I think of myself, I don't think of myself necessarily super different than I used to when I'm younger, right?

Carol Pehotsky (06:12):

Sure. (laughs).

Julie Simon (06:14):

And, and so, I don't imagine that changing for me.

Carol Pehotsky (06:18):

(laughs). Get older, I guess.

Julie Simon (06:18):

[inaudible 00:06:18] is I get, I, right? But, as you progress through age, then there's other things to deal with. And so is it a loss of, function or is it a loss of spouse or-

Carol Pehotsky (06:18):

Mm-hmm.

Julie Simon (06:28):

... you know, things that are social that go along with that as you age. And so, taking those into account and the effect they may have on depression or other things that come up then in care.

Carol Pehotsky (06:37):

Mm-hmm. And, uh, anything else we should be thinking about in terms of the psychological or with that social factor, uh, Jennifer, that we should be thinking about for our older population?

Jennifer Katlen (06:47):

Uh, I tend to be concerned about my patients and if they're lonely-

Carol Pehotsky (06:50):

Hmm.

Jennifer Katlen (06:50):

... or maybe a little depressed. And again, what Julie said about, you know, losing some of those family members. And I think back to my grandmother who was 99, she was the last one to live from, you know, all of her family-

Carol Pehotsky (06:51):

Yeah.

Jennifer Katlen (07:03):

... and how kind of sad she must have been from that.

Carol Pehotsky (07:04):

Mm-hmm.

Jennifer Katlen (07:07):

And, uh, you know, I take time to spend time with my patients because I recognize that those times when they're in the hospital, even just for a blood draw-

Carol Pehotsky (07:17):

Mm-hmm.

Jennifer Katlen (07:18):

... maybe the only time that they're getting out and seeing other people.

Carol Pehotsky (07:21):

Sure.

Jennifer Katlen (07:21):

So, taking that time to make connections with people is really important.

Carol Pehotsky (07:25):

Sure. So, listen to their audiences. I, I think about, (laughs), you know, way back when, when I was a nursing student, right?

Julie Simon (07:25):

Mm-hmm.

Carol Pehotsky (07:31):

You know, you have one patient, maybe you have two patients. And, you know, I remember, "Gosh, that patient in room X, Y, Z-

Julie Simon (07:38):

I love nursing students, because they have those talk with you about, right?

Carol Pehotsky (07:43):

Right. Talked and talked and talked but for you have time, right?

Julie Simon (07:43):

Yes.

Carol Pehotsky (07:44):

Yeah.

Julie Simon (07:44):

So, I always encourage them to, (laughs), to be in those rooms. Absolutely.

Carol Pehotsky (07:48):

Yeah. And yeah, so think about what you can give that patient because, to, to both of your points, that, you have time, what a precious gift you can give to your patients as a student.

Julie Simon (07:57):

Mm-hmm. I think there's a, uh, another element too as well, because, often, sometimes they're faced with loss of independence, right?

Carol Pehotsky (07:57):

Hmm. Mm-hmm.

Julie Simon (08:05):

And so, with that sort of fear of losing independence, will that patient necessarily disclose to you that they are feeling like they may not be thinking quite normally as they usually do? Or they feel like they might be a little confused. And that, that's often, they might recognize that themselves, but would they tell us, because what does that mean? Right?

Carol Pehotsky (08:05):

Sure.

Julie Simon (08:27):

And so just kind of, gaining that trust and making... because we need to know, we need to figure out why that is, right?

Carol Pehotsky (08:32):

Right.

Julie Simon (08:32):

And so, if we can help with that, then, it's something that we need to make sure we find out.

Carol Pehotsky (08:38):

Yeah. You're not just having a conversation with that patient while you're passing medications, like, you're building that trust and maybe you're going to get to learn something more about them.

Julie Simon (08:46):

Right. Right.

Carol Pehotsky (08:47):

Fantastic. So, we know there's lots of misperceptions out there.

Julie Simon (08:48):

Mm-hmm.

Carol Pehotsky (08:50):

Let's talk a little bit more about that. How we as nurses, wherever we're in our journey of nursing need, need to be aware of those biases and fight them.

Julie Simon (09:00):

So, I think that we have a lot of biases even in our media in America, you know, how older adults are portrayed, always frequently confused and not always in the best of health. Um, so that's something that we combat with some of the classes that we teach in aging sensitivity, as well as, you know, just perceptions. Think of the la- o- last person that you took care of, or think of an older adult and what do you think of? Is it a positive-

Carol Pehotsky (09:00):

Mm-hmm.

Julie Simon (09:27):

... thought or is it not a positive thought?

Carol Pehotsky (09:30):

Mm-hmm.

Julie Simon (09:30):

And then, just to put people in the shoes of the patient, right? And gain some empathy as to those perceptions and then work to address them. So, when you're caring for your patients, are you looking at the patient or sometimes the gaze sort of shifts towards the family?

Carol Pehotsky (09:48):

Mm.

Julie Simon (09:48):

And so, keeping that patient as the focus of the conversation. And I've experienced that personally with my own family that I've gone to the, you know, to the office with. And so, I'm always redirecting back to, (laughing)-

Carol Pehotsky (09:48):

Yeah, sure.

Julie Simon (09:48):

... you know-

Carol Pehotsky (09:48):

Yeah.

Julie Simon (10:04):

... the, to the patient-

Carol Pehotsky (10:04):

Mm-hmm.

Julie Simon (10:05):

... because they are perfectly capable of addressing their concerns. I'm just there for a second set of ears sometimes-

Carol Pehotsky (10:05):

Right.

Julie Simon (10:12):

... as I would also ask for a second, uh, set of ears for myself-

Carol Pehotsky (10:15):

Right.

Julie Simon (10:15):

... because it's just a lot to take in.

Carol Pehotsky (10:17):

As a concerned family member, not because the person I'm with can't-

Julie Simon (10:21):

Mm-hmm.

Carol Pehotsky (10:21):

... speak for themselves.

Julie Simon (10:22):

Right.

Carol Pehotsky (10:22):

Yes, for sure. Jennifer, what else can you add for us about that? There's a lot to talk about misperceptions. (laughs).

Jennifer Katlen (10:28):

Well, I frequently teach an aging sensitivity course as well.

Carol Pehotsky (10:28):

Oh, okay.

Jennifer Katlen (10:32):

And it's always interesting to hear what people have to say, when you ask them, "You know, what's the first word that kind of comes to your mind-

Carol Pehotsky (10:39):

Oh, sure. (laughs).

Jennifer Katlen (10:39):

... when you think of your older patients?"

Carol Pehotsky (10:40):

That's a good exercise.

Jennifer Katlen (10:41):

And I go back to, you know, myself.

Carol Pehotsky (10:41):

Mm-hmm.

Jennifer Katlen (10:44):

When I was that nurse, and I, I am right there with all of these-

Carol Pehotsky (10:47):

Mm-hmm.

Jennifer Katlen (10:47):

... b- uh, nurses and caregivers I'm teaching, because usually the words they're giving us have a negative connotation.

Carol Pehotsky (10:53):

Yeah.

Jennifer Katlen (10:54):

And they'll say things like, weak, frail, grumpy, slow. And as we explore that a little bit, you know, and talk about it, that, it's really easy for caregivers to kind of have that idea in their head because, we're at work every day and we're seeing people kind of at their weakest, most vulnerable.

Carol Pehotsky (11:15):

Mm-hmm.

Jennifer Katlen (11:15):

And none of us are very good when we're sick.

Carol Pehotsky (11:19):

Yeah. (laughs).

Jennifer Katlen (11:19):

And definitely not our older adult patients either. So, we start to see all of our older adult patients in that same way.

Carol Pehotsky (11:19):

Mm-hmm.

Jennifer Katlen (11:26):

And forget that there are people like, you know, my grandparents or my own parents who are in their 80s and are, you know, very active and living a very active lifestyle.

(11:35):

So, it's important to kind of remind ourselves and remind each other, that that is the norm.

Carol Pehotsky (11:41):

Mm-hmm. Yeah.

Jennifer Katlen (11:41):

What we're seeing in the hospital is not the norm, we need to shift our perceptions. And then I think it's a little bit easier for us to start thinking, what do I need to do to get them back to that place?

Carol Pehotsky (11:54):

Right.

Jennifer Katlen (11:55):

Because we always point out, you put the most active person in a hospital gown and some yellow socks-

Carol Pehotsky (12:02):

(laughs). Yeah.

Jennifer Katlen (12:03):

... in the bed, and you're going to go right to that, they're slow, they're frail, they're grumpy.

Carol Pehotsky (12:07):

Yes.

Jennifer Katlen (12:08):

And not that they're, you know, running the community center near their house or golfing three times a week.

Carol Pehotsky (12:15):

Right.

Jennifer Katlen (12:15):

So, it's important to kind of reset our perceptions of older adults.

Carol Pehotsky (12:19):

Yeah. If any one of us is in excruciating pain, we're, we're not going to be at our best independent of our age.

Jennifer Katlen (12:24):

Correct.

Carol Pehotsky (12:25):

Right. Yeah. All right. So, here's your homework everybody. (laughs). Be thinking about, do that own exercise in your own head, like-

Julie Simon (12:31):

Mm-hmm.

Carol Pehotsky (12:31):

... when, when you think about somebody who's older, and again, the older I get, the further away that older adult is, right? (laughing).

Jennifer Katlen (12:37):

Yeah. Absolutely.

Carol Pehotsky (12:39):

That, that bar keeps moving anyway. (laughs). So, so I, going back to the example I shared where, yeah, again, when I was in that moment, I, I would've used the word frail.

Jennifer Katlen (12:50):

Mm-hmm.

Carol Pehotsky (12:50):

This, this was a woman who, who had been probably in skilled nursing for a long time, and had some contractures, had tissue loss. I was convinced I was going to hurt her. And again, I was very fortunate that I had this colleague come up and really help me figure out a way to be gentle, but to deliver the care I needed to deliver.

(13:06):

So, what can we all be doing differently? Again, thankfully I quickly figured out a way to do that, but to shepherd each other through that, delivering sensitive, comfortable, supportive care, to our patients who are older.

Jennifer Katlen (13:23):

Well, I think it's first very important to make sure that we're not making any assumptions about the patient.

Carol Pehotsky (13:23):

Sure. Yeah.

Jennifer Katlen (13:29):

We want to make sure that we're taking a look at their history-

Carol Pehotsky (13:33):

Mm-hmm.

Jennifer Katlen (13:34):

... and it's very important to make sure we're getting them back to their baseline-

Carol Pehotsky (13:34):

Sure.

Jennifer Katlen (13:37):

... or keeping them at baseline.

Carol Pehotsky (13:37):

Yeah. Yeah.

Jennifer Katlen (13:39):

We definitely don't want to send someone home worse than when they got to us.

Julie Simon (13:43):

Right. And especially if her baseline is already as challenging as it is that you're describing. So, any loss of what she already has there as her base is going to be a challenge. So, just maintaining those things.

Carol Pehotsky (13:58):

Well, I think it all comes back to, how would you want to be treated? Right? And, you know-

Julie Simon (14:01):

Mm-hmm.

Carol Pehotsky (14:01):

... she's still can hear; she can still talk. It's-

Julie Simon (14:01):

That's right.

Carol Pehotsky (14:03):

... you know, it's, it's, don't pretend she's not there.

Julie Simon (14:06):

Absolutely.

Carol Pehotsky (14:07):

Have a conversation. "Are you in pain? Let's, let's get you comfortable first, let's get you some medication. We do need to turn you to protect your skin, but-

Julie Simon (14:16):

Right. Explaining what you're doing as you go along.

Carol Pehotsky (14:19):

Exactly. "He- help us. Help you along the way."

Julie Simon (14:19):

Mm-hmm. Right.

Carol Pehotsky (14:19):

Right.

Julie Simon (14:21):

And then if something is bothering you, tell me what bothers you so that I can work around that a little bit.

Carol Pehotsky (14:26):

Yeah. Yeah. Yeah. Throughout our, wherever we work in nursing, right? We need to be assessing all of our patients for risk of abuse. Certainly, that can look a little bit different in the older adult population. Can you talk through how that might show up in our patients who are older?

Julie Simon (14:40):

Particularly in patients with high care needs, for example, Dementia, Alzheimer's, those kinds of patients, it's often from caregivers or family members. It's a lot of strain and stress to be a full-time caregiver.

Carol Pehotsky (14:55):

Sure.

Julie Simon (14:55):

And so, it does become a challenge. And so often we need to be looking for, you know, signs of neglect. So, are they getting enough food or are they being cleaned up if they need to be cleaned up? Those kinds of things. And the things that come with that if they're not-

Carol Pehotsky (14:55):

Sure.

Julie Simon (15:10):

... so, pressure injuries.

Carol Pehotsky (15:12):

Mm-hmm.

Julie Simon (15:12):

Or we would call them bed sores and, just making sure we're looking out for those as well as, sort of a self-neglect.

Carol Pehotsky (15:12):

Mm.

Julie Simon (15:20):

So, again, going along with that independence, right? That you want to maintain. Sometimes we put ourselves in not the best situations.

Carol Pehotsky (15:28):

Sure.

Julie Simon (15:29):

That aren't the safest. And to really watch out for those and make sure that they have the resources that they need to be able to stay in their home if they would like-

Carol Pehotsky (15:37):

Mm-hmm.

Julie Simon (15:37):

... or to go to assisted living or a skilled nursing facility if they're needed. And sometimes that's a hard transition.

Carol Pehotsky (15:44):

Sure. And obviously we wouldn't be looking into anybody's financials, (laughs), but would there be any things that a patient might say to us where we might be worried that there might be some form of economic abuse or some other neglectable situations going on beyond the physical?

Jennifer Katlen (15:58):

I haven't had that happen to me personally.

Carol Pehotsky (16:00):

Mm-hmm.

Jennifer Katlen (16:01):

But with any patient, if they're talking about their family members wanting their check-

Carol Pehotsky (16:07):

Mm.

Jennifer Katlen (16:07):

... or them not being able to make purchases on their own without permission from their family-

Carol Pehotsky (16:08):

Sure. Mm-hmm.

Jennifer Katlen (16:13):

... are all signs that they could be taken advantage of by their family.

Julie Simon (16:18):

I think there's a lot of scams now too.

Carol Pehotsky (16:21):

Wow. Gosh. Yeah.

Julie Simon (16:21):

And that's a big focus, right?

Carol Pehotsky (16:22):

Oh, yeah.

Julie Simon (16:22):

So, there's, there's big groups kind of focusing on that now as well. Um, so just avoiding those phone calls that are trying-

Carol Pehotsky (16:23):

Oh my gosh.

Julie Simon (16:30):

... to get the money from your mother or grandmother-

Carol Pehotsky (16:30):

Yeah.

Julie Simon (16:33):

... or whoever it may be is also-

Carol Pehotsky (16:34):

Or on the internet as well.

Julie Simon (16:34):

Right. Internet, yeah.

Carol Pehotsky (16:36):

And texting is internet and, and-

Julie Simon (16:38):

Don't click on that.

Carol Pehotsky (16:39):

Right. (laughing).

Julie Simon (16:40):

Please don't answer that phone call.

Carol Pehotsky (16:41):

(laughing). But it's, it's a good point. And, you know, some of the older adults in my life, then, then it almost, it makes them so scared of their devices. It's like, it's-

Julie Simon (16:51):

Because they're tricky. It's not obvious.

Carol Pehotsky (16:52):

... it's finding that balance or helping them, like, here are some resources you can trust.

Julie Simon (16:57):

Right.

Carol Pehotsky (16:57):

To feel educated, to feel safe around that. And, and here, between myself and other family members, like, if you don't know, here's, here's who you can call, and we will-

Julie Simon (16:58):

Right.

Carol Pehotsky (17:07):

... help you get those things. But it, it's a good point. It's a very scary situation that they find themselves in.

Julie Simon (17:13):

Right.

Carol Pehotsky (17:13):

And they don't want to do the wrong thing.

Julie Simon (17:15):

But finance is now a mandated reporter as well.

Carol Pehotsky (17:17):

Oh, okay. I didn't know that. Okay. Oh.

Julie Simon (17:17):

So, in addition to nurses, financial advisors and, you know, other groups that deal with money are also now among mandated reporters.

Carol Pehotsky (17:26):

Oh, that's great to learn.

Julie Simon (17:27):

Mm-hmm.

Carol Pehotsky (17:27):

Fantastic. So, we were talking a little bit beforehand too, that there are age-friendly metrics now.

Julie Simon (17:28):

Mm-hmm.

Carol Pehotsky (17:32):

That really helps us all focus around, really making sure that we're doing the right thing by older adults. Can you talk us through a little bit more about what that is and why it's so important?

Julie Simon (17:42):

So there has been a focus on the four Ms for a while now.

Carol Pehotsky (17:46):

Mm-hmm.

Julie Simon (17:46):

So, through the Johnny Hartford Foundation and the IHI, looking at what matters most to patients.

Carol Pehotsky (17:47):

Mm-hmm.

Julie Simon (17:52):

Because that should really drive-

Carol Pehotsky (17:54):

Any of our care. Yeah. (laughs).

Julie Simon (17:55):

... our, you know, our care, right?

Carol Pehotsky (17:56):

Right?

Julie Simon (17:56):

So, what is important to them? And then, from there, looking at, okay, so, does this medication that we think that you should take, really support what is important to you?

Carol Pehotsky (17:56):

Hmm.

Julie Simon (18:08):

Or is that going to take away from something that's really important to you?

Carol Pehotsky (18:08):

Mm-hmm.

Julie Simon (18:12):

And then looking at mobility and maintaining that is a huge one. And mentation, again, looking and assessing for delirium and cognitive impairments. So those are the four MS. And there will be coming soon some metrics from CMS, related to age friendly. So, those will be things that will encourage hospitals to look at the four Ms.

Carol Pehotsky (18:37):

(laughs).

Julie Simon (18:38):

And make sure that we are assessing those.

Carol Pehotsky (18:40):

Very good. So, we're very fortunate here at Cleveland Clinic to have a geriatric resource nurse program. Can you ladies talk to us a little bit more about what that is, how it was created, and how we sustain that here?

Julie Simon (18:52):

We do, and it's a great program. We do that as part of our niche membership.

Carol Pehotsky (18:57):

Okay.

Julie Simon (18:57):

So, it is just training nurses to have more of a focus and knowledge base related to care of older adults.

Carol Pehotsky (19:04):

Mm-hmm.

Julie Simon (19:05):

And so, we do give them a couple days' worth of additional education.

Carol Pehotsky (19:09):

Oh great.

Julie Simon (19:09):

And then, we meet with them, you know, every month.

Carol Pehotsky (19:13):

Oh, wonderful. Mm-hmm.

Julie Simon (19:13):

And go ahead and have meetings and continue to grow that knowledge for them. And we request that they share that information with their peers.

Carol Pehotsky (19:21):

Mm-hmm. Mm-hmm.

Julie Simon (19:21):

Take that back to their units and affect more than themselves.

Carol Pehotsky (19:25):

Sure.

Julie Simon (19:25):

And then also do some rounding on some patients.

Carol Pehotsky (19:29):

Mm-hmm.

Julie Simon (19:29):

And in the moment, education at the bedside to affect better care for patients.

Carol Pehotsky (19:35):

Wonderful. And how do we sustain that? You know, nurses are so busy, how are, how are we making sure that they are able to access that information?

Jennifer Katlen (19:42):

Well, fortunately we are able to offer things virtually now.

Carol Pehotsky (19:42):

Okay.

Jennifer Katlen (19:47):

So, at our local hospitals, we have some in-person meetings.

Carol Pehotsky (19:47):

Mm-hmm.

Jennifer Katlen (19:51):

And we can round together as a group.

Carol Pehotsky (19:53):

Oh, wonderful.

Jennifer Katlen (19:54):

And that helps us reinforce those strategies with each other. And we can also join the systemwide geriatric resource nurse group-

Carol Pehotsky (20:04):

Great.

Jennifer Katlen (20:04):

... virtually.

Carol Pehotsky (20:05):

Mm-hmm.

Jennifer Katlen (20:05):

And that way we can share best practices with each other as well.

Carol Pehotsky (20:09):

Oh, wonderful.

Jennifer Katlen (20:09):

So, you know, there are things that we learned since COVID. We used to be primarily all in-person when we did teaching and education, and we've branched out a little bit since-

Carol Pehotsky (20:19):

Wonderful.

Jennifer Katlen (20:19):

... to offer things virtually as well.

Carol Pehotsky (20:21):

That's fantastic. So, let's say I'm a nurse listening from outside Cleveland Clinic and I'd like to learn more about geriatric nursing. What would you recommend?

Julie Simon (20:30):

So, looking for continuing education contact hours related to geriatric care.

Carol Pehotsky (20:30):

Mm-hmm. Mm-hmm.

Julie Simon (20:36):

I think that there's not always a lot of those-

Carol Pehotsky (20:36):

Hmm.

Julie Simon (20:38):

... and to really focus and kind of look at, geriatric specific care is something that you sort of have to seek out-

Carol Pehotsky (20:39):

Hmm.

Julie Simon (20:46):

... and then to get certified-

Carol Pehotsky (20:47):

Oh, wonderful.

Julie Simon (20:48):

... in geriatrics.

Carol Pehotsky (20:49):

Okay.

Julie Simon (20:49):

So, go ahead and, you know, you do have to care for older adults for a certain amount of time to do that, obviously.

Carol Pehotsky (20:54):

(laughs). Sure. Yeah. Yep.

Julie Simon (20:55):

And to get a certain amount of education, but then to demonstrate your expertise by getting certified in geriatrics.

Carol Pehotsky (21:02):

Wonderful. Tell us a little bit about the importance of building trust in caring for older patients, please.

Jennifer Katlen (21:09):

Yeah. So, we want to make sure that we're building a trusting environment with our patients. And sometimes that occurs in the hospital and sometimes outside of the hospital.

Carol Pehotsky (21:09):

Mm-hmm.

Jennifer Katlen (21:18):

And I encourage you, if you're interested in working with older adults, to seek out opportunities maybe in your community to work with-

Carol Pehotsky (21:18):

Sure, yeah.

Jennifer Katlen (21:24):

... our older adults. Whether that's a community health fair-

Carol Pehotsky (21:28):

Mm-hmm.

Jennifer Katlen (21:29):

... or I work at our mobile food pantry at my hospital.

Carol Pehotsky (21:29):

Oh, yes. Yeah.

Jennifer Katlen (21:33):

And that provides a lot of good connection points.

Carol Pehotsky (21:35):

Sure.

Jennifer Katlen (21:35):

And Julie has some great ideas for building a trusting environment in the hospital setting.

Julie Simon (21:40):

Right. So, beyond that experience, which I think is helpful-

Carol Pehotsky (21:44):

Mm-hmm.

Julie Simon (21:44):

... two, make sure that the scenario is set up for good communication in the first place.

Carol Pehotsky (21:49):

Okay.

Julie Simon (21:49):

So, does the patient have their glasses on? Do they have their hearing aids on?

Carol Pehotsky (21:52):

Yeah. It seems so simple, but. (laughs). Yeah. Oh, man, yeah. Right.

Julie Simon (21:56):

Is the IV pump going off? You know, sitting next to you and the neighbor has their TV blaring. So-

Carol Pehotsky (21:56):

Yeah.

Julie Simon (22:00):

... can we look at the environment, address it a little bit so they can have conversations with us in the first place? And then, you know, beyond that, it, it prevents so many different things like delirium as we mentioned before. But-

Carol Pehotsky (22:01):

Sure.

Julie Simon (22:13):

... then, you have that good setup, come down to eye level, sit down with your patient-

Carol Pehotsky (22:18):

Mm-hmm.

Julie Simon (22:18):

... and then have your conversation. Because it just, it's communicating respect, and I have the time for you to see what is your concern.

Carol Pehotsky (22:27):

Right. And you can actually see me-

Julie Simon (22:28):

I can. Yeah. Yeah.

Carol Pehotsky (22:28):

... and you can hear me. (laughs). Yes.

Julie Simon (22:30):

If you take off my glasses and I would be in big trouble. (laughs).

Carol Pehotsky (22:30):

Same. Right? Yeah.

Julie Simon (22:33):

That was in the hospital.

Carol Pehotsky (22:34):

Yes.

Jennifer Katlen (22:34):

Yeah. I remember a time when we used to send everything home with the patient when they were admitted because we didn't want to lose their glasses-

Carol Pehotsky (22:35):

Right? Yeah.

Julie Simon (22:35):

Right.

Jennifer Katlen (22:41):

... their hearing aids, et cetera. And I think back to that and I'm like, "Oh no, what were we doing?" (laughs).

Carol Pehotsky (22:47):

Right.

Jennifer Katlen (22:47):

You know?

Carol Pehotsky (22:48):

Yeah.

Jennifer Katlen (22:48):

And did you-

Carol Pehotsky (22:49):

Well, you know better, you do better, right?

Jennifer Katlen (22:50):

Yes.

Carol Pehotsky (22:50):

Geez. Yeah.

Jennifer Katlen (22:51):

And it's important, again, not to make assumptions here-

Carol Pehotsky (22:54):

Mm-hmm.

Jennifer Katlen (22:55):

... because, sometimes patients have hearing aids in their ears, and they're not on, or the batteries are dead.

Carol Pehotsky (23:02):

Hmm. Right. Yeah.

Jennifer Katlen (23:02):

So, it's really important to ask them, "How do you charge these hearing aids? Do you need the charger box?"

Carol Pehotsky (23:08):

Sure.

Jennifer Katlen (23:08):

"Do you need family to bring in batteries?"

Carol Pehotsky (23:10):

Yeah.

Jennifer Katlen (23:10):

And don't assume, just because they're sitting in their ears for the last four days, that they're functioning.

Carol Pehotsky (23:14):

That they're actually working. Yeah.

Julie Simon (23:15):

Maybe it's just more of an earplug, you know?

Jennifer Katlen (23:17):

Yeah.

Carol Pehotsky (23:17):

(laughing). Yeah.

Jennifer Katlen (23:17):

Yeah.

Julie Simon (23:18):

If it's not helping at hindering.

Carol Pehotsky (23:20):

Right. Yeah, that's right. Well ladies, this has been super helpful. Thank you. We'd now like to flip to the speed round and let our listeners get to know a little bit more about you as the amazing human beings you are. So, I know you're busy, busy, busy ladies, but it's finally time to unwind. I'm going to pick on Jennifer first. What do you do for you to relax and recharge?

Jennifer Katlen (23:42):

I really try to get some time in my craft room.

Carol Pehotsky (23:46):

Ooh. All right.

Jennifer Katlen (23:46):

And I like-

Carol Pehotsky (23:47):

What are we making?

Jennifer Katlen (23:49):

I have a cricket-

Carol Pehotsky (23:50):

Ooh.

Jennifer Katlen (23:50):

... so, I create a lot of paper crafts.

Carol Pehotsky (23:52):

Nice.

Jennifer Katlen (23:52):

Some I do ceramics, painting, just, whatever kind of strikes my fancy.

Carol Pehotsky (23:57):

Cool. All right. All right. Julie, what are you doing for you?

Julie Simon (24:00):

(laughs). So, I enjoy going on walks.

Carol Pehotsky (24:04):

Okay.

Julie Simon (24:04):

Especially through town and, you know, just taking my kids with me. And if I can get them out of the house and let's go, you know-

Carol Pehotsky (24:05):

(laughs).

Julie Simon (24:12):

... they get their activity in, but sometimes you don't sit at your desk. So, it's nice to just take everybody and go out on a walk.

Carol Pehotsky (24:19):

Wonderful. Well, thank you so much for joining me today.

Jennifer Katlen (24:19):

Thank you.

Julie Simon (24:22):

Thank you.

Carol Pehotsky (24:27):

As always, thanks so much for joining us for today's discussion. Don't miss out. Subscribe to hear new episodes wherever you get your podcasts. And remember, we want to hear from you. Do you have ideas for future podcasts or want to share your stories? Email us at nurseessentials@ccf.org. To learn more about Nursing at Cleveland Clinic, please check us out at clevelandclinic.org/nursing.

(24:54):

Until next time, take care of yourselves and take care of each other.

(25:01):

The information in this podcast is for educational and entertainment purposes only and does not constitute medical or legal advice. Consult your local state boards of nursing for any specific practice questions.