In the following quote, a Social Worker noted a particular odor that prompted her to action We observed that across departments and disciplines, openness and attention to diverse information allowed staff to identify care issues that may otherwise have gone undetected. Here, the CNA was not paying attention to the temperature of the food and risked burning the resident’s mouth by the delay in recognizing the resident’s cues that the food was too hot. Finally she says, “Are the too hot for you?” He jerks his head from side to side and tries to spit them out, but she keeps on giving them to him. : I watch the CNA give the resident steaming grits that look really hot. In contrast to the example above, we found evidence that ignoring or missing resident cues can result in poor care and potentially harm residents, for example in this observation: Further, this example suggests that paying attention can be especially important in caring for residents who cannot communicate their needs or discomforts. This action, allowing the resident periods to stretch and move freely, facilitated tolerance of the chair restraint and averted potential harmful outcomes such as venous stasis or blood clots. : I noticed that he is always trying to get up … he’ll lean up and try to get out of the wheelchair, but he can’t get up.īy paying attention, the CNA understood what the resident was trying to express and she subsequently intervened by periodically taking him for walks. I always go to the CNA … They are the ones that know the resident … They may not know the scientific names but they know what is going on … They see every day from top to bottom.īy paying close attention to a resident’s repetitive behavior while restrained in a wheelchair, a CNA recognized the unspoken desire of the resident to be free from the chair restraint. For instance a Nurse Supervisor (RN) described her reliance on nursing assistants (CNAs) to pay attention to the details of a resident’s condition: ~ It was essential to “knowing the resident” and enabled staff to register subtle resident signals before these could become serious issues. Paying attention in direct care: Several direct care staff said that “paying attention” allowed them to identify and address resident care issues integral to good resident care. The staff described paying attention as needed both in providing direct care and managing staff In this article, we describe paying attention as used by administrators, supervisors, charge nurses, and CNAs with the aim to challenge nursing home leaders to: 1) hone their awareness for paying attention 2) understand the impact that paying attention has on residents and staff, and 3) encourage an environment where all staff members pay better attention.ĭuring the case studies, we observed what staff members termed “paying attention” (and not paying attention), across all levels of staff and departments. In a study of nursing homes, we found that paying attention is critical in providing good resident care and facilitating effective peer and supervisory relationships. Not paying attention, or non-vigilance, has been associated with concerns over patient safety, particularly medication errors and infection control ( Burke, 2003). Because early warning signs of change or danger (whether it is something as simple as recognizing that a resident is chilled and needs a sweater, or as complex as impending stroke), are by definition unexpected, staying “tuned in” and expecting the unexpected is key to fostering resilient and reliable organizational environments ( Coutu 2003). When all staff are paying attention to early or weak signs of potential resident care or staff management issues, information relevant to decision-making can be shared and used before such issues escalate into larger problems. Similar to vigilance, it encompasses staying alert and on guard for the unexpected or unpredictable in order to take necessary and quick action. Using all of our sensory and cognitive resources, paying attention occurs by listening, noticing details, and taking actions that change the course of events. Paying attention to others, our surroundings, and ourselves is a powerful component of “mindful practice” ( Epstein 2003a) and requires an internal discipline that means that nothing is accepted as routine. The difference between highly effective organizations and others “is the sensitivity or mindfulness with which people react to even very weak signs that some kind of change or danger is approaching” ( Coutu 2003, p.86).
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