Volunteer Reference Manual

Volunteer Reference Materials
WelcometoNYPsVolunteerReferenceManual.Inthesepages,youwillfindavariety ofinformation,tips,resources,andcontactnumbersdesignedtohelpyoubemore successfulasavolunteerinthehospital. Onceagain,thankyoufortime.
NewYorkPresbyterianHospital2011
Contents
CONTENTS..................................................................................................................................2 FIRSTFLOOR............................................................................................................................6
VolunteersBasics.............................................................................................................................6 VolunteerProfessionalism:TenHospitalityStandards ......................................................................................... 6 HIPAA ..............................................................................................................................................7 WhatisHIPAA?..................................................................................................................................................... 7 WhatYouCanDotoProtectPatientConfidentialityandInformation................................................................. 7 Whatshouldntyoudo/HIPAAViolations ............................................................................................................. 7 Remember............................................................................................................................................................ 7
SECONDFLOOR ........................................................................................................................9
ShiftChecklistofTypicalVolunteerActivities...................................................................................9 Arrival.................................................................................................................................................................... 9 GettingStarted..................................................................................................................................................... 9 ConductingPatientVisits...................................................................................................................................... 9 ProvideSupport&Assistance............................................................................................................................... 9 Pain/ComfortAssessment................................................................................................................................ 10 AssessPatientSatisfaction.................................................................................................................................. 10 Environment....................................................................................................................................................... 10 DocumentandDebrief/EndingShift................................................................................................................. 10 QuestionsforNurse(priortoworkingwithpatients).....................................................................11 Introduceyourself.............................................................................................................................................. 11 MayIpayafriendlyvisit?................................................................................................................................ 11 MayIwalkwiththem?.................................................................................................................................... 11 MayIengagethepatientinRangeofMotion(ROM)exercises?.................................................................... 11 MayIofferlightmassage?.............................................................................................................................. 11 IsthereanythingelseIneedtoknowaboutthispatient?.............................................................................. 11
Imhereforfourhours,willyoutellmeaboutanyotherpatientsyourecommendvisiting?and/orLetme knowifyouneedanyhelp................................................................................................................................ 11
EnteringaPatientsRoom..............................................................................................................12 OptimizeYourInitialSuccessandPositiontoListen.......................................................................................... 12 TipsonBeingaGoodListener ........................................................................................................13 QuestionstoAskYourselfWhenCommunicatingWithaPatient:..................................................................... 13 UseClarifyingResponses.................................................................................................................................... 13 TheAimoftheClarifyingResponse.................................................................................................................... 13 ClarifyingResponseExamples............................................................................................................................ 13 UseOpenEndedQuestions................................................................................................................................ 13 OpenendQuestionExamples............................................................................................................................ 13 BasicExerciseProgramforPatients................................................................................................14 ArmLifts.............................................................................................................................................................. 14
NewYorkPresbyterianHospital2011 2
ButtocksSqueezes.............................................................................................................................................. 14 AnklePumps....................................................................................................................................................... 14 HeelSlides ........................................................................................................................................................... 14 KneeLiftsinSittingPosition............................................................................................................................... 14 LegKicks.............................................................................................................................................................. 14
RecreationalActivities ....................................................................................................................15 TalkingActivities................................................................................................................................................. 15 RelaxationthroughVisualization........................................................................................................................ 15 Meals.............................................................................................................................................17 GuidelinesforDysphagiaDiets........................................................................................................................... 17 Adequacy............................................................................................................................................................ 17 Foods.................................................................................................................................................................. 17 DefinitionsofLevelsofFood.............................................................................................................................. 17 Liquids................................................................................................................................................................. 18 SuggestionsforPatientsWhileEating................................................................................................................ 18 DietTypes......................................................................................................................................20 ExampleFoodsbyType...................................................................................................................................... 20 DysphagiaDietSampleMenus........................................................................................................................... 28 Challenges......................................................................................................................................30 YourOwnReflections......................................................................................................................................... 30 DifficultConversations...................................................................................................................31 TheRoleofSocialWork...................................................................................................................................... 31 EmotionalReactions........................................................................................................................................... 31 PatientCopingStrategies................................................................................................................................... 31 WhatcanyoudoasaVolunteer?....................................................................................................................... 32 ObjectivesinListening........................................................................................................................................ 32 GuidelinesforListening...................................................................................................................................... 33 TherapeuticInterventions.................................................................................................................................. 33 JustBeingThere.................................................................................................................................................. 34 SupportSystems................................................................................................................................................. 34 PhrasesforSuccess........................................................................................................................35 Howtoapproachanurseandaskaboutpatients.............................................................................................. 35 Approachingnurseduringorafteravisit........................................................................................................... 35 Greetingorintroductionwiththepatient.......................................................................................................... 35 Mobility............................................................................................................................................................... 37 MealAssistance.................................................................................................................................................. 37 Patientiscrying ................................................................................................................................................... 37 Patientisinpainorhasdiscomfort.................................................................................................................... 38 Patientiscomplaining ......................................................................................................................................... 38 Returningtoapatientsroomafterlookingintoasituationorjustasecondvisit........................................... 38 Patienthasfamilymembersvisiting................................................................................................................... 38 PatientRequests................................................................................................................................................. 39 Leaving/Goodbye................................................................................................................................................ 39 Patientbeginstodiscloseinformationtheydonotwantsharedwithanyoneelse.......................................... 40 Dischargeiscancelledandfamilyhascomeintopickthemup......................................................................... 40
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THIRDFLOOR.........................................................................................................................41
Geriatrics.......................................................................................................................................41 Oncology........................................................................................................................................42 NancysFriends/TheNancyKlauberForestFoundation................................................................................... 42 NancysFriendsDVDcollectionandLibrary....................................................................................................... 42 AdditionalResources.......................................................................................................................................... 43 Neurology......................................................................................................................................44 BrainAneurysm.................................................................................................................................................. 44 BrainTumor........................................................................................................................................................ 45 CerebralAneurysm=BrainAneurysm................................................................................................................ 46 Craniopharyngioma............................................................................................................................................ 47 CSFLeak=SpontaneousCerebrospinalFluidLeak............................................................................................. 48 GuillainBarreSyndrome..................................................................................................................................... 49 Headache=Cephalalgia...................................................................................................................................... 50 HeadTrauma=TraumaticBrainInjury=IntracranialInjury.............................................................................. 51 HerniatedDisc.................................................................................................................................................... 54 Hydrocephalus.................................................................................................................................................... 55 Meningioma........................................................................................................................................................ 56 Meningitis........................................................................................................................................................... 57 MyastheniaGravis=MG ..................................................................................................................................... 58 MultipleSclerosis(MS)....................................................................................................................................... 59 Parkinson'sDisease ............................................................................................................................................. 60 Pneumocephalus................................................................................................................................................ 61 Seizure=Epilepsy............................................................................................................................................... 62 SkullbasedTumor.............................................................................................................................................. 63 SpinalStenosis (Seealsocervical,thoracic,orlumbarstenosis).................................................................... 64 Spondylolisthesis................................................................................................................................................ 65 Stroke=CerebrovascularAccidentorCVA......................................................................................................... 66 TrigeminalNeuralgia=TicDouloureux=Prosopalgia........................................................................................ 67 Resources .......................................................................................................................................68 Facilities.............................................................................................................................................................. 68 PatientRelated................................................................................................................................................... 68 WorkforceHealthandSafetyDepartment......................................................................................................... 68 DogVisits............................................................................................................................................................ 68 SpiritualNeeds/PastoralCare........................................................................................................................... 68 Food/Nutrition.................................................................................................................................................. 68 Newspaper/GiftShop....................................................................................................................................... 69 ComfortZoneforCaregivers.............................................................................................................................. 69 ErrandSolutions ..................................................................................................... Error!Bookmarknotdefined. HaircutNeeds..................................................................................................................................................... 69 ExerciseBooklet.................................................................................................................................................. 69 PatientLibrary.................................................................................................................................................... 69 TV/Phone.......................................................................................................................................................... 69 BuildingServices(roomtemp) ............................................................................................................................ 69 PatientServices................................................................................................................................................... 69 Security............................................................................................................................................................... 69
APPENDIX.................................................................................................................................70
CONFIDENTIALITYSTATEMENT.......................................................................................................70 EvaluationofVolunteerServices....................................................................................................71 FeedbackOnYourVolunteers........................................................................................................72
FIRSTFLOOR
VolunteersBasics
VolunteerProfessionalism:TenHospitalityStandards
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Smilewithyourface&yourvoice Greetallyoumeet Neversayno,offeralternatives FollowuponEverything Speakfirst,listen,speaklast AguestconcernisYOURconcern Makeitpersonalusetheguestsname EscortguestsDonotpoint Anticipateneedsandtakeaction Applyallhospitalitystandardstocolleagues
HIPAA
WhatisHIPAA?
ThefirstnationalprivacylawthatcoverseverypatientintheUnitedStates. ThislawwentintoeffectApril14th,2003anditincludesseverefinesfor anyonecaughtviolatingpatientprivacy. TheHIPAAprivacylawsareinadditiontotheexistingPatientsBillofRights, whichispostedthroughouttheHospital.
WhatYouCanDotoProtectPatientConfidentialityandInformation
Neveraccessapatientsinformationunlessthereisaclinicalorbusiness need. Nevercall/pagepatientsinsuchawayastorevealtheirhealthissues(e.g. PatientSmith,pleasereturntothedialysisunit) Neverleavehealthinformationunattendedinanareawhereothersmay inappropriatelyseeand/orremoveit. Ifyouareavolunteerwhohasaccesstoacomputer: Besuretoobtainapersonalpasswordtosignin Neverleaveacomputerwithoutsigningoff Neversharecomputerpasswordswithanyone Positioncomputerscreenssothatvisitorsorpeoplewalkingby cannotviewinformation
Whatshouldntyoudo/HIPAAViolations
YouhearthatacelebrityisintheHospitalandyoutrytosneakapeekatthe paperorelectronicrecord. Youdiscusspatientinformationonanelevator,inalobby,thecafeteria,or otherpubliclocationortoanindividualnotinvolvedinthepatientscare. Youknowthatoneofyourfamilymembers,neighbors,friendsorfellow volunteersisapatientandkeepothers(notinvolvedinthecare)uptodate.
Remember
Assuringpatientprivacyandconfidentialityisaserviceexcellenceinitiative. BeHIPAAaware Thinkpatientconfidentiality WhenpatientinformationisrequestedaskWhydoyouneedthis information? Accessonlyinformationyouneedtodoyourjob Helpeducateothers
CompliancewithHIPAAregulationsisnotjustalaw,itisthewaywedo business.
SECONDFLOOR
ShiftChecklistofTypicalVolunteerActivities
Arrival
SignintothecomputerattheVolunteerOffice(RoomJ144). Changeintouniformsmock;buttonentirely;makesureyourIDisvisible. Lockyourvaluablesandpickupamealcard(thegreencardsinplastic sleeve). Proceedtotheunit.
GettingStarted
ConsulttheVolunteerBinderatNursingStationandsignin. Obtainacopyofthelatestcensusfromthebinderorclerk. Checkthebinderforanymessagesandnotesfromthecoordinator. Readnotesfromthepreviousvolunteersanddetermineappropriatevisits. Beforevisitinganypatients,youMUSTtalktotheirnurse.(Refertoorcopy thelatestNursingAssignmentSheetpostedbytheUnitClerk.) IntroduceyourselftotheNurseandaskforanyreferrals. Determineifyoucanconductmeals,walkingand/orrangeofmotions withallofthepatients. Placebinderbackandinitiatevisits.
Note: Do not take binder into patient rooms. This is an infection prevention issue.
ConductingPatientVisits
Knockondoororthewall(forpatientsinbedB) Greetthepatientbyname,CHECKPATIENTIDENTIFIER,introduceyourself usingtheID,stateyourpositionasavolunteer,andstartaconversation.
ProvideSupport&Assistance
GeneralAssistance:gettingthemsupplies,toiletryitems,etc Emotionalsupport:buildingrapport,activelistening,deepconversations FeedingAssistance:full;partial;encouragement/accompaniment MobilizationAssistance:(WalkinganddoingROMs) RecreationActivities:crossword/Sudoku,puzzles,newspapersfromgiftshop Buildabridgeandbringnaturalclosuretovisit;smileandsaygoodbye. IsthereanythingIcandoforyoubeforeIleave? ExplaintheVideoOnDemandPatientEducationService
Pain/ComfortAssessment
Areyouinanypain?(Informthenurse.) Areyoucomfortableinbed?Doyouneedtoberepositioned? Howisthetemperatureintheroom?(Informclerkiftoohotorcold.) Doesthepatientneedablanket/pillow?
AssessPatientSatisfaction
Arethereanyneedsthatyouhavethatthestaffisntaddressing? DoyouhaveanycomplaintsorissuesIcanhelptoresolve? Remindthemaboutfreepatientservices.
Environment
Istheorientationboardupdated? Placethecallbellarenearby;checkthatallcards/pictures/decorationsare wherepatientcansee them;placethetelephone/waterpitcher(refill) withinpatientsreach Bringtraytablecloserandorganize/declutterit. C\learawayclutterandtrashatbedsideandcheckifthepatienthasall suppliesneeded(tissues,lotion,etc.)
DocumentandDebrief/EndingShift
Documentallinteractionsandactivitiesinthebinder.Thisiscriticalto promotingsuccessfulhealthcaredelivery. Document/Communicateconcernstosupervisor(ifonsite)andthenursing staff. Signout/CheckoutintheVolunteerOffice. Smile&feelgoodaboutyourself.Youvejustmadeadifference.
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QuestionsforNurse(priortoworkingwithpatients)
Introduceyourself
Hi,MynameisFIRSTNAME.Iamavolunteer. IsitOKformetosee/visitwithpatientFULLNAME?
MayIpayafriendlyvisit?
Isthereanythingspecificthatwouldbehelpfultoknow? Arethereanyisolationprecautions(contact/droplet/respiratory)Ishouldbe madeawareof? Anyproblemswithforgetfulnessorattention?
MayIwalkwiththem?
Dotheyhaveanyassistivedevices(e.g.,walker)? Dotheyhaveanyconnections(e.g.,IVorOxygen)?
MayIengagethepatientinRangeofMotion(ROM)exercises?
IsthereanypartofthebodyIshouldavoidforanyreason?
MayIofferlightmassage?
Doanypatientsneedmealassistance? Whattypeofdietareontheyon?
IsthereanythingelseIneedtoknowaboutthispatient? Imhereforfourhours,willyoutellmeaboutanyotherpatientsyourecommend visiting?and/orLetmeknowifyouneedanyhelp.
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EnteringaPatientsRoom
OptimizeYourInitialSuccessandPositiontoListen
Trythesequestionsforconversationstarters.
BackgroundandUpbringing
AreyoufromNewYork? Wheredidyougrowup? Mostmemorablemomentfromchildhood? Anysiblings?
Family
Doyouhavefamilyinthearea? Howdidyoumeetyoursignificantother? Doyouhavechildrenorgrandchildren? Doyouhaveanypets?
Travel
Whatsyourfavoriteplacetovisit? Wherehaveyoutraveled? HaveyoueverlivedoutsideoftheUS? Doyouspeakanyotherlanguages?
Entertainment
FavoriteTVshows? Celebritygossip? Whatmoviehaveyouwatchedmorethanonce? Whatareyourfavoritebooksormagazines? Whatsonyourreadinglist?
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TipsonBeingaGoodListener
QuestionstoAskYourselfWhenCommunicatingWithaPatient:
Canthepatienthearyou?(Dotheyhaveanysensoryneeds)? Doesthepatientunderstandwhatyouaresaying(arethereanylanguage barriers,dementiaorchangeinmentalstatus)? Doyouappearunhurriedandinterestedinwhatthepatienthastosay?
UseClarifyingResponses
Clarifyingresponsesareatypeofreflectiveresponse.Whenclarifyingresponsesare used,thefocusremainsonthepatient,whilethelistenerprobesforadditional information.
TheAimoftheClarifyingResponse
Toacknowledgeandexpressthepatientsfeelings Toencouragethepatienttoexpandfurtheronthecurrenttopic
ClarifyingResponseExamples
Itsoundstomelikeyouare(angry/upset/sad)isthatright? Tellmemore Howdidthatmakeyoufeel? Whathappenednext?
UseOpenEndedQuestions
Openendedquestionsgivethepatientawiderangeofoptionsonhowtorespond. Patientscannotuseonewordresponses,suchasyes,no,fine,orgood,toanswerthese questions.
OpenendQuestionExamples
Tellmeaboutyourfamily. Whattypesofactivitiesdoyouliketodowhenyouarehome? Yousounddown.Howareyoufeeling?
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Basic cExerciseProgramfor f Patients

Note: N youca anprintthisoutandleav veitattheb bedsideforp patientuse.Theseexerc cises were w develop pedbytheNewYork N Pre esbyterianPh hysicalThera apyDepartm ment
Arm mLifts
1. 2. 3. 4. 5. 6. Beginwithyourarmscr rossedonyour rlap. u overheadto omakeaY. Slowlyraiseyourarmsup Breathein nasyougoup. Breatheout o whenyourarmscomedo own. Returntostartingpositi ion. mes. Dotentim
Butt tocksSquee ezes

1. 2. 3. 4. 5. Lieonyou urback. Squeezebuttocks b together. Holdforfive f seconds. Dotentim mes. Remembe ertobreathe.
Ank klePumps
1. 2. 3. Lieonyou urback. Movefoo otupanddown nslowly. Dotentim meswitheachfoot.
Hee elSlides
1. 2. 3. 4. 5. Lieonyou urbackwithyo ourlegsstraigh ht. Startbend dingyourknee eandslowly. Slideyour rheeluptowardsyourbutto ocks. Returntothestartingposition. meswitheachleg. Dotentim
KneeLiftsinSittingPositi ion
1. 2. 3. 4. 5. Sitwithyo ourfeetonthe efloor. Liftyourleftkneeupan ndloweritslow wly. r kneeupand a loweritslo owly. Liftyourright Continueliftingonekne eeupandthen ntheother. meswitheachleg. Dotentim
LegKicks
1. 2. 3. 4. 5. Sitwithyo ourfeetonthe efloor. Slowlykic ckonefootout t. Returntostartposition. ckotherfootout. Slowlykic Dotentim meswitheachleg.
NewYorkPr resbyterianHospital2011
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Recre eationalActivities A
Talk kingActiviti ies
Tohearexam mplesofreminiscingchec ckoutwww w.storycorps. .net,whereListeningis san Act A ofLove.
Rela axationthro oughVisualization

Youcanhelppatientsuse evisualizatio ontechnique estolessentheirpainand/oranxiet ty. htheseexerc ciseandpracticethems sothatyouw willfeelmor recomfortab ble Readthrough when w guiding gapatientth hroughtheprocess. p Benonjudgm mental,nonclinging. c You umaynotice efeelingsass sociatedwithcertain houghtsand dimages;eitherpositiveemotionalr reactions(at ttraction,de esire, th ex xcitement)or o negative(aversion, ( fe ear,anxiety)orneutral(noreactions satall).Notice th heseaswellwhentheyarise a andsim mplyacceptthemrather rthangettin ngcaughtup pin th hem.Seethe emalldissol lveanddisap ppearbylett tingthemgo o.Wecometorealizeth heir im mpermanent tandtransie entnaturein nthemind,a andeventua allyregainth hefreedomt to work w withthe eminourow wntime,whenwererea ady,withgre eaterclarity yandconfide ence. In ncreasingou urcomfortzo onewiththe emultimatellyhelpsusto oseethemmoreclearly y.
Visualization V nExercise:TheSun
Visualize V your rselfonthebeach b atdawnthe se eaisalmostmotionlessasthelastbright b stars fa adeawayfeel f thefresh hnessandth hepurityof th heairwatc chthewater thestarsthedark sk kytakesom metimetoexperience e th hesilence beforesunrise e,thestillne essfilledwith hall possibilitiesslowly,thedarknessme eltsandthe olorschange etheskyov verthehoriz zon co becomesred thegolden nThenthesun's s first ra aysreachyo ouandyouwatchitslow wly em mergingfrom mthewater r. With W halfthesun'sdiskvisibleandth hereststillb elowthehorizonyouseethatits re eflectioninthe t wateriscreatingapathofgolde enshimmerin nglightlead dingfromyo ouall th hewaytoits sveryheart The Th temperat tureofthewater w ispleasantandyo oudecideto ogoinslow wlywith jo oyyoustart ttoswiminthegoldenradianceyo r oufeelthelig ightfilledwa atertouching yo ourbodyyo ouexperienc ceyourselffloating fl effor rtlesslyandm movingplea asurablyinth he se ea The Th moreyou uswimtowa ardthesun,the t lessawa areyouareo ofthewater, ,andthemo ore th helightarou undyouincre easesyoufeel f envelope edinabenef eficent,golde enlightwhic ch
NewYorkPr resbyterianHospital2011 15
permeatesyo oucompletel lyyourbod dyisbathing gnowinthevitalityofth hesunyour r fe eelingsarepervaded p byitswarmth yourmindiisilluminate edbyitslight. Note: N thisexe ercisedoesn nthavetobeatthebea ach.Youcan nuseanylow wstress lo ocation.
FocusedBre eathing
Si itorliedown ninacomfo ortableposit tion.Placeyo our ri ighthandon nthemiddleofyourches standyourlleft handonyour rlowerbelly. . Close C yourey yes. Taking T afewmomentsto osettlein Bringyouraw warenesstothefeelingof o yourhand dsin ontactwithyourbody. co Li ingeringinthatfeelingfor f afewmo omentsof si ilence Beginnoticing gthroughyo ourhandsth hefeelingof fyour bodybreathin ngjustasitis i inthisvery ymoment,a andinthene extmoment. Rememberth hatthereisno n rightway, y,orwrongw waytobreat th.Allyouar redoingis payingattent tion.Donttr rytoalteror rchangewh hatyouaref feeling.Rath her,allow yo ourselftoba arewitnessto t thebreath hthatisalre eadyarisingintheprese entmomentas yo ouexperienc ceit. Continue C sens singyourbre eathinthisway w asbestyoucanforafewminut tesofsilence e.
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Meals
GuidelinesforDysphagiaDiets
Patientswithdysphagiaordifficultyswallowingareatriskforaspiration.Aspiration occurswhenfoodparticlesorliquidentertheairway.ThegoaloftheDysphagiaDietis toreducetheriskofaspirationbyprovidingfoodinaccordancewiththepatientsability toswallowandtomeettheirnutritionalneeds.Itincludesthreelevelsoffoodand threeconsistenciesofliquid;additionallythereareinstanceswhennoliquidsare allowed.
Adequacy
Thedysphagiadiet,whencarefullyplanned,willprovideadequatenutrients.However, intakemaybelimitedduetodecreasedappetiteorincreasedtimerequiredtoeat. Therefore,supplementationmaybenecessarytoconsistentlymeet100%ofthe RecommendedDietaryAllowances. Levels of Food: I Pureed II Mechanically Altered III Advanced Mechanical Consistencies of Liquid: Honey-thick Nectar-thick Thin
Foods OverallTypesofFoodstoAvoid
Stickyfoodssuchaspeanutbutter,creamcheese Stringyfibrousfoodssuchascitrusfruit,asparagus,celery Crumblyfoodssuchascornmuffins,crackers,drycake Foodswithsmallpitssuchasolives,cherries,grapes Hardfoodssuchasrawvegetables,somefruits(apples),bagels
DefinitionsofLevelsofFood
Pureedfoodsaresmooth,creamy,cohesive,eventexturedfoodsthatrequireno chewing.Pureedfoodscanbepreparedbyusingablenderorafoodprocessor.Foods shouldbepureeduntilsmoothandthickenedtopuddingconsistency(seebelowfor thickeners). MechanicallyAlteredfoodsshouldbesoftandcookeduntiltheyareforktender.In general,theyaremoist,cohesive,requiresomechewingability,andarecutintosmall pieces(lessthaninch).
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AdvancedMechanicalfoodsincludeallfoodsexcepthard,sticky,orcrunchyfoods. Adequatechewingabilityisrequired.Thesefoodsstillneedtobemoist. NOTE:Level2MechanicallyAlteredDietincludesLevel1PureedFoods.Level3 AdvancedMechanicalDietincludesbothLevel1PureedandLevel2Mechanically Alteredfoods.
Liquids
Thedysphagiadietwillincludeaspecificfoodtextureandliquidconsistency.For example,youmayneedaLevel1PureedDietwithnectarthickliquidsoraLevel2 MechanicallyAlteredDietwithhoneythickliquids.Thinliquidsarefamiliarbeverages suchaswater,tea,coffee,soda,juiceandbroth.Italsoincludesfoodsthatareliquidat roomtemperatureorbodytemperaturesuchassherbet,gelatinandicecream.
ThickenedLiquids
Prethickenedbeveragesofvariousflavors,includingwater,juice,milk,teaandcoffee, arecommerciallyavailable. Commercialthickeners,whicharestarchbased,canbeusedtothickenjuice,milk,soup, coffee,andpureedfoodstoensuresafeswallowingandincreasethevarietyoffoods andbeveragesconsumed.Starchbasedthickenersallowforthemostfluidtobe releasedduringdigestion.Commercialthickenerscanbepurchasedoverthecounter fromthepharmacy. Commonfoodsusedtothickenliquidsandpureedfoodsare:driedinfantcereal,potato flakes,pureedvegetablesandfruits,breadcrumbs,cornstarch,flour,andtofu. Cornstarchandflourrequireheattothicken. Pleasecontactyourdietitianforadditionalresourcestoobtainthickenersandpre thickenedbeverages.
SuggestionsforPatientsWhileEating
Sitinaquietenvironmentandavoidtalkingduringmealssoyoucan concentrateoneating. Eatsittinguprightata90degreeangleduringmeals. Remainuprightaftereatingforatleast30minutes. Takesmallbitesoffoodandsipsofbeverages. Keepyourchindownatanaturallevelwhileswallowing.Donottiltyour headback. Clearmouthofanyresidueaftereatingwithatoothbrushoraswab. Clearthroatafterswallowing. Alternateeatingsolidsanddrinkingliquidswhiledining.
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FollowanyotherfeedinginstructionsgiventoyoubyyourSpeechTherapist orOccupationalTherapist.
This information is brief and general. It should not be the only source of your information on this health care topic. It is not to be used or relied on for diagnosis or treatment. It does not take the place of instructions from your doctor. Talk to your health care providers before making a health caredecision.
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DietTypes
ExampleFoodsbyType
LEVEL 1: PUREED
FOOD GROUP FOODS TO CHOOSE FOODS TO EXCLUDE
Breads, cereals, potato, pasta, rice, and other starches (6-11 servings a day) 1 serving = 1 slice bread, cup cooked cereal, 1/3 cup pasta/rice
Commercial pureed bread mixes, pregelled or slurried breads that are gelled through entire thickness. Pureed potatoes with gravy, butter, margarine, or sour cream. Smooth, homogenous, cooked cereals such as farina-type cereals. Should have a puddinglike consistency. Well-cooked pasta, noodles, or rice that have been pureed in a blender to smooth, homogenous consistency. Moist polenta.
All other breads, rolls, crackers, biscuits, pancakes, waffles, French toast, muffins, and bread dressing. All other potatoes, plain mashed potatoes. All dry cereals and any cooked cereals with lumps, seeds, chunks, including oatmeal. Non-pureed pasta, noodles, or rice. Dry polenta
Vegetables (3-5 servings/day) 1 serving = cup
Pureed vegetables without chunks, lumps, pulp, or seeds. Tomato paste or sauce without chunks, lumps, or seeds. Tomato or vegetable juices (thickened if on nectar or honeythick liquids)
All other vegetables that have not been pureed or with chunks, lumps, pulp, or seeds. Tomato sauce with seeds, thin tomato juice.
Pureed fruits or well-mashed fresh Fruit bananas (2-4 servings/day) 1 serving = 1 piece or cup of Fruit juices without pulp, seeds or chunks (thickened if on nectar or fruit or fruit juice honey-thick liquids)
Whole fruits (fresh, frozen, canned, or dried). Fresh juices with pulp, seeds, or chunks.
Dairy-milk, yogurt, cheese (2-3 servings/day) 1 serving = 1 c milk or yogurt, 1 oz cheese
Smooth yogurt without nuts, seeds or whole or small soft pieces of fruit. Milk (thickened if on nectar or honey-thick liquids)
Yogurt with nuts, seeds, or whole or soft pieces of fruit. Cheese or cottage cheese.

LEVEL 1: PUREED continued

Meat, poultry, fish, beans, legumes, eggs, nuts, meat substitutes (2-3 servings/day) 1 serving = 2-3 oz or 1 c beans
Pureed meats, fish, or poultry. Liverwurst Pureed eggs. Souffls that are smooth and homogenous. Hummus or other pureed legume/bean spread. Pureed tofu.
Whole or ground meats, fish, or poultry. Non-pureed fried, scrambled, or hard-cooked eggs. Non-pureed lentils or legumes. Peanut butter, unless pureed into foods correctly. All nuts & seeds Soups that have chunks, lumps, and particles.
Soups (May need to be thickened if on nectar or honey-thick liquids.)
Soups that have been pureed completely in a blender or strained of skins, seeds, and lumps (thickened if on nectar or honeythick liquids). Any smooth, homogenous beverages without lumps, chunks, or pulp (thickened if on nectar or honey-thick liquids). Butter, margarine, strained gravy, sour cream, mayonnaise, whipped cream cheese, whipped topping. Smooth sauces such as white sauce, cheese sauce or hollandaise sauce (may need to be thickened if on nectar or honey-thick liquids).
Beverages
Any beverages with lumps, chunks, seeds, or pulp.
Fats and Oils (use sparingly) 1 serving = 1 teaspoon
All fats with coarse or chunky additives-such as whipped cream cheese with vegetables or salmon.
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Sweets/Desserts
Smooth puddings, custards, yogurt, souffls, flan and pureed desserts.
Cookies, cakes, pies, pastry, textured puddings, bread or rice pudding, and fruit yogurt. All candies including caramels or licorice. These foods are considered thin liquids and should be avoided if thin liquids are restricted: Frozen malts, milk shakes, frozen yogurt, eggnog, nutritional supplements, ice cream, sherbet, frozen juice bars, regular or sugarfree gelatin, or any foods that become thin liquids at either room (70F) or body temperature (98F).
LEVEL 1: PUREED continued

Miscellaneous
Sugar, artificial sweeteners, salt, finely ground pepper, herbs and spices. Honey, smooth jellies. Ketchup, mustard, BBQ sauce and other smooth sauces.
Coarsely ground pepper, herbs, and spices. Chunky fruit preserves and jams with seeds. Seeds, nuts, sticky foods.
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LEVEL 2: MECHANICALLY ALTERED

Breads, cereals, potato, pasta, rice, and other starches (6-11 servings a day) 1 serving = 1 slice bread, cup cooked cereal, 1/3 cup pasta/rice Cereals may have cup milk or just enough milk to moisten if thin liquids are restricted. The moisture should be well-blended into food.
Cooked cereals with little texture, including oatmeal. Soft pancakes, well-moistened with syrup or sauce. Commercial pureed bread mixes, pregelled or slurried breads that are gelled through entire thickness. Well-cooked, moistened, boiled, baked or mashed potatoes. Wellcooked, shredded hash brown potatoes that are not crisp. All potatoes need to be moist and in sauces. Moist polenta. Well-cooked noodles or pasta in sauce of appropriate consistency if on thickened liquids. Spaetzel or soft dumplings that have been moistened with butter or gravy.
Very coarse, dry, or cooked cereals that may contain seeds, nuts, dried fruits or coconut. All other breads. Potato skins and chips. Fried or french-fried potatoes. Rice.
All soft, well-cooked vegetables, except those on Exclude list. Vegetables should be less than inch thick and easily mashed with a fork. Soft, drained, canned or cooked fruits without seeds or skin. Fresh soft/ripe banana. Fruit juices without pulp, seeds, or chunks (thickened if on nectar or honey-thick liquids).
Cooked corn and peas. Broccoli, cabbage, brussels sprouts, asparagus, or other fibrous, nontender or rubbery cooked vegetables. Fresh, frozen, or dried fruits. Cooked fruit with skin or seeds.
Fruit (2-4 servings/day) 1 serving = 1 piece or cup of fruit or fruit juice
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LEVEL 2: MECHANICALLY ALTERED continued

Soft, moist cheese (mozzarella, Dairy- milk, yogurt, cheese meunster, monterey, jack cheese) (2-3 servings/day) and cheese spreads. Yogurt with 1 serving = 1 c milk or yogurt, small soft chunks of fruits 1 oz cheese Thinly sliced cheese and soft cheese cubes. Cottage cheese. Milk (thickened if on nectar or honey-thick liquids).
Crumbly or hard cheese (blue cheese, feta and cheddar). Yogurt with nuts.
Meat, poultry, fish, beans, Moistened ground or cooked meat, poultry, fish or tender meat. eggs, nuts, meat substitutes May be served with gravy or (2-3 servings /day) sauce. Moist meatballs, meat loaf, 1 serving = 2-3 oz or 1 cup of or fish loaf. beans Pieces should not exceed inch thick cubes and should be tender. All meats or protein substitutes should be served with sauces, or moistened to help maintain cohesiveness.
Casseroles without rice. Moist macaroni and cheese, wellcooked pasta with meat sauce, tuna-noodle casserole, and soft, moist lasagna. Smooth quiche without large chunks. Protein salads such as tuna or egg without large chunks, celery or onion. Poached, scrambled, or softcooked eggs. Egg yolks should be moist, but not runny (Cook eggs to 160F or use pasteurized eggs for safety). Souffls may have small soft chunks. Tofu. Well-cooked, slightly mashed, moist legumes such as baked beans. Soups with easy-to-chew or easySoups to-swallow meats or vegetables (May need to be thickened if on (particle sizes in soups should be nectar or honey-thick liquids.) less than inch thick). Soups may need to be thickened if on nectar or honey-thick liquids.
Dry meats, tough meats (such as bacon, sausage, hot dogs, and bratwurst). Dry casseroles or casseroles with rice or large chunks. Peanut butter. Hard-cooked or crisp fried eggs. Sandwiches. Pizza.
Soups with large chunks of meat and vegetables. Soups with rice, corn, and peas.
LEVEL 2: MECHANICALLY ALTERED continued

Beverages
Foods to Choose All beverages with minimal amounts of texture, pulp, and chunks (thickened if on nectar or honey-thick liquids).
Foods to Exclude All others.
Fats and Oils (use sparingly) 1 serving = 1 teaspoon
Butter, margarine, cream for cereal (depending on liquid consistency recommendations), gravy, cream sauces, mayonnaise, salad dressings, cream cheese, cheese spreads with soft additives, sour cream, sour cream dips with soft additives, and whipped toppings. Soft, moist cakes with icing or pregelled and slurried cakes and cookies or soft, moist cookies that have been dunked in milk, coffee, or other liquid. Pudding, custard. Soft fruit pies with bottom crust only. Crisps and cobblers without seeds or nuts and with soft breading or crumb mixture. Drained canned fruit pears and peaches. Soft smooth chocolate bars that are easily chewed.
All fats with coarse or chunky additives.
Sweets/Desserts
Dry, coarse cakes and cookies. Rice or bread pudding. Anything with nuts, seeds, coconut, pineapple, or dried fruit. Chewy candies such as caramel and licorice. These foods are considered thin liquids and should be avoided if thin liquids are restricted: Frozen malts, milk shakes, frozen yogurt, eggnog, nutritional supplements, ice cream, sherbet, frozen fruit bars, regular or sugarfree gelatin or any foods that become thin liquid at either room (70F) or body temperature (98F). Seeds, nuts, coconuts, and sticky foods.
Miscellaneous
Jams and preserves without seeds, jelly. Sauces, salsas that have small tender chunks less than inch thick.
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LEVEL 3: MECHANICALLY ADVANCED

Breads, cereals, potato, pasta, rice, and other starches (6-11 servings a day) 1 serving = 1 slice bread, cup cooked cereal, 1/3 cup pasta/rice, 3oz potato Cereals may have cup milk or just enough milk to moisten if thin liquids are restricted. The moisture should be well-blended into food.
Any well-moistened breads, biscuits, muffins, pancakes, waffles without nuts and seeds. Add adequate syrup, jelly, margarine, butter, etc., to moisten well. All well-moistened cereals. All potatoes and other starches including rice, wild rice, moist bread dressing, and tender, fried potatoes. All cooked, tender vegetables, except corn.
Dry bread, toast, crackers Tough, crusty breads such as French bread or baguettes Dry bread dressing. Coarse or dry cereals such as shredded wheat, bran cereals, muesi or granola. Tough, crisp-fried potatoes. Potato skins.
All raw vegetables. Cooked corn. Non-tender or rubbery cooked vegetables. Difficult-to-chew fresh fruits such as apples or pears. Stringy, high-pulp fruits such as papaya, pineapple, or mango. Fresh fruits that have skins or peels that are difficult to chew (grapes). Uncooked dried fruits such as prunes and apricots. Fruit leather, fruit roll-ups, and fruit snacks.
All canned and cooked fruits. Fruit (2-4 servings/day) Soft, peeled fresh fruits such as 1 serving = 1 piece or cup of peaches, nectarines, kiwi, fruit or fruit juice mangos, cantaloupe, honeydew (without seeds). Soft berries with small seeds such as strawberries. Watermelon without seeds (only if you can have thin liquids). Fruit juices without pulp, seeds, or chunks (thickened if on nectar or honey-thick liquids). Yogurt without nuts and seeds. Dairy- milk, yogurt, cheese (2-3 servings/day) All cheeses. 1 serving = 1 c milk or yogurt, 1 Milk (thickened if on nectar or oz cheese honey-thick liquids).
Yogurt with nuts or seeds.
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LEVEL 3: MECHANICALLY ADVANCED continued

Meat, poultry, fish, beans, eggs, nuts, meat substitutes (2-3 servings /day) 1 serving = 2-3 oz or 1 cup of beans
Thin-sliced, tender, or ground meats and poultry. Well-moistened fish. Eggs prepared any style. Casseroles with small chunks of meat, ground meats, or tender meats. Tofu. Cooked beans.
Tough, dry meats and poultry. Dry fish or fish with bones. Peanut butter.
Soups (May need to be thickened if on nectar or honey-thick liquids.)
All soup except those on the exclude list. Strained corn or clam chowder. (Need to be thickened if on nectar or honey-thick liquids.)
Soups with tough meats. Corn or clam chowders. Soups that have large chunks of meat or vegetables (greater than 1 inch thick). Liquids of inappropriate consistencies. All fats with coarse, difficult-to-chew, or chunky additives such as creamcheese spread with nuts or pineapple. Dry cakes, cookies that are chewy or very dry. Anything with nuts, seeds, dry fruits, coconut, or pineapple. Chewy caramel or taffy-type caramel. These foods are considered thin liquids and should be avoided if thin liquids are restricted: Frozen malts, milk shakes, frozen yogurt, eggnog, nutritional supplements, ice cream, sherbet, frozen juice bars, regular or sugarfree gelatin or any foods that become thin liquids at either room (70F) or body temperature (98F).
Beverages Fats and Oils (use sparingly) 1 serving = 1 teaspoon Sweets/Desserts
Any beverages (thickened if on nectar or honey-thick liquids). All other fats except those on the exclude list.
All others except those on Avoid list. Soft chocolate.
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Miscellaneous
All seasonings and sweeteners. All sauces of appropriate thickness. Jams, jellies, honey, preserves.
Nuts, seeds, and coconuts. Any other sticky or hard foods.
DysphagiaDietSampleMenus
DYSPHAGIA DIET LEVEL 1 PUREED DYSPHAGIA DIET LEVEL 2 MECHANICALLY ALTERED DYSPHAGIA DIET LEVEL 3 ADVANCED MECHANICAL
Breakfast
cup apple sauce 1 cup farina 1 cup vanilla yogurt 2 packs sugar 8 oz milk (appropriate consistency)
Breakfast
1 medium fresh ripe banana 1 cup yogurt soft pancakes moistened with syrup 1 pat butter 1 soft cooked egg 8 oz milk (appropriate consistency)
Breakfast
1 medium ripe banana 2 French toast with syrup 1 scrambled egg 1 pat butter 1 cup yogurt 8 oz milk (appropriate consistency)
Lunch
1 cup mashed potato with gravy 1 pat butter 2 oz thickened pureed beef cup thickened pureed veggies cup chocolate pudding 1 cup creamed soup (appropriate consistency) 1 medium well-mashed ripe banana 8 oz beverage (appropriate consistency)
Lunch
1 medium baked potato(no skin) w/ cheese sauce 2 oz ground beef moistened with gravy 1 cup soft cooked cut vegetables inch thick pieces 1 cup split pea soup (appropriate consistency) cup drained canned peaches 8 oz beverage (appropriate consistency)
Lunch
1 medium baked potato (no skin) with shredded cheese 1 pat butter 3 oz fish fillet with sauce/gravy cup soft cooked vegetables 1 cup chicken noodle soup (appropriate consistency) 1 cup ripe cubed melon 8 oz beverage (appropriate consistency)
Dinner
1 cup mashed sweet potato 1 pat butter 3 oz thickened pureed chicken cup thickened pureed veggies 1 cup creamed soup (appropriate consistency) cup thickened pureed peach
Dinner
1 cup well cooked pasta with meat sauce cup soft cooked cut vegetables inch thick pieces 1 cup cream of mushroom soup (appropriate consistency) 1 slice moist cake with icing 8 oz beverage (appropriate
Dinner
1 cup cooked rice 3 oz thinly sliced beef or chicken with sauce cup soft cooked vegetables 1 cup vegetable soup (appropriate consistency) 1 slice moist pound cake (NO
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8 oz beverage (appropriate consistency)
consistency)
nuts or seeds) 8 oz beverage (appropriate consistency)
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Challenges
YourOwnReflections EarlyExperiencesInfluencingReactionstoLoss
Ourearlyexperienceswithlossleaveuswithmessages,feelings,fears,andattitudeswe will carry throughout life. To manage this influence of our unconscious and conscious reactionstopastexperiences,itisimportanttorecognizeandstateexplicitlyhowthese experienceshaveinfluencedusandourlifestyles. Thinkaboutyourearliestlossrelatedexperience: Whendiditoccur?Whowasinvolved?Whathappened? Whatwereyourreactions,positiveandnegative? Whatwereyouadvisedtodo,andwhatdidyoudo,tocopewiththe experience? Howdidyourexperienceinfluencethefeelingsandattitudesaboutlossthat youmaintaincurrently?
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DifficultConversations
TheRoleofSocialWork
Patients in the hospital are cared for using a multi-disciplinary approach to treatment, meaning that practitioners from a range of educational and professional backgrounds such as physicians, nurses, physical and occupational therapists, and nutritionists work together to provide the best and most comprehensive care possible for each patient. Social workers act as members of this multi-disciplinary team and provide a biopsychosocial approach to assessment and treatment. Simply put, social workers look at the whole patient, while also considering influence of the many systems of which they are a part their family, their culture, their community, etc. Social workers use this information to provide supportive emotional counseling and education to patients and families, and to help develop and implement a post-discharge plan of care that takes all these factors social, medical, emotional, physical into account and will optimize the patients quality of life post-hospitalization. As a volunteer, you too will be providing support to patients and their families while they are in the hospital; however your role is very different from that of the social worker.
EmotionalReactions
Planned or not, being admitted to the hospital is an extremely stressful experience. Patients and their families are forced to cope with a great deal of uncertainty as they go through the process of diagnosis and treatment, and this can bring up a lot of strong emotions such as anger, fear, sadness and grief. As a volunteer, it is important to let a patient talk about these feelings even though they may be difficult for you to hear. Being able to freely discuss emotions can help a patient feel safer, calmer and more in control. You may encounter a situation in which a patients anger or other negative emotions seem to be directed at you. It is important to remember that more often than not the feelings being expressed are due to the patients illness and hospitalization, and not because of something you have done or said.
PatientCopingStrategies
When confronted with a lot of strong, negative emotions, people will often use coping strategies to help them deal with what they are feeling. These are important because they act as a buffer, giving the patient both time and space to come to terms with what is happening to them. It is important not to try and challenge or correct what the patient may be thinking or feeling. Instead you can offer them a safe place to talk, and work through their emotions whatever they may be.
Some of the most common coping strategies used by patients who are dealing with a difficult illness or hospitalization: The first and most commonly used coping mechanism is denial. Patients who are using denial will often say things like, this isnt happening to me or I know the doctor is going to find a way to cure me even when the diagnosis is terminal. Denial gives the patient a sense of control. Other times, patients might try to rationalize their situation, for example by believing that their illness was somehow intentionally given to them by a higher power as a challenge or test for them to overcome. Finding a larger or deeper meaning in an illness may provide the patient with a sense of order and purpose in an otherwise confusing and frightening situation. Patients may also find a sense of comfort and safety by allowing others to take care of them. By regressing to what is seen as a safer place, such as childhood, a patient can feel protected and cared for as they try to work through what is happening to them. Anger is also a very commonly used coping mechanism. When used as a coping mechanism, anger can help a patient feel as if they have a degree of control over what they believe to be an uncontrollable situation. A patient may also react to a hospitalization or difficult diagnosis by actively seeking out as much information as possible, a coping mechanism called intellectualization. The gathering of knowledge can help give the patient a sense of control over their illness and helps them to better make sense of what is happening to them. In each of these cases, the coping mechanism used helps the patient to make sense of and emotionally cope with what is happening to them. If you recognize a coping mechanism being used by a patient, dont try to challenge their way of thinking; instead allow them to talk, and when you respond focus on what and how they are feeling, rather than whether or not what they are feeling is right.
WhatcanyoudoasaVolunteer?
As a volunteer, one of your primary goals is to make the patient feel more comfortable. When you meet with a patient, you want to first build a trusting relationship with those you visit. Do what you say and do not make promises you cant keep. Becoming someone the patient can rely on to do what you say, to speak openly with them and allow them to do the same can go a long way towards making them feel less anxious.
ObjectivesinListening
One of the most important things you can do as a volunteer is to listen. Often times, because of the hospitals fast-paced environment, patients can feel alone, or that their voices are not being heard. By sitting with a patient and allowing him
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or her to guide the conversation and tell their story, you can help them feel more at ease. If a patient seems somewhat reluctant to talk, a simple way to encourage them is to ask open ended questions. These are questions that require more than a simple, one-word answer. If you are trying to begin a conversation with a patient, using open ended questions such as How can I help you? as opposed to a closed ended question like Can I help you? can not only make things easier for you but can also help the patient feel they have permission to speak freely about what is important to them.
GuidelinesforListening
Listening is an active process, and how you listen is just as important as taking the time to listen in the first place. Looking interested in what a person has to say, expressing empathy for the feelings they express, and remaining nonjudgmental about the opinions they express can all help the person who is speaking feel that they are not only being heard, but also understood.
TherapeuticInterventions
When listening to a patient, keep in mind that sometimes what you dont say speaks more loudly than any words can. Body language is something all people unconsciously pick up on and can communicate a lot about what you are thinking or feeling. For example, if someone is listening to you speak with their arms folded tightly across their chest, would you feel that they were interested or empathetic to what you had to say? Would you feel differently if they were sitting with their hands folded loosely in their lap? One of the simplest things you can do to convey interest when you visit a patient is to sit instead of standing when you talk with them. By sitting, you show your interest and commitment to the conversation, and patients will feel as if you have spent more time talking with them than if you had spoken with them while standing. The acronym SOLER gives an easy way to remember some of the cardinal rules of physical listening. Non-verbal cues such as nodding your head or leaning in closer can go a long way toward making a patient feel that what they have to say is important to you. Sometimes, a response as simple as, Really? or Tell me more, is all it takes to reassure the patient that they are being heard. If you find yourself uncertain of how to respond to something a patient has told you, sometimes one of these minimal encouragers can be a good way to keep the conversation going.
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JustBeingThere
And sometimes, you dont have to say anything at all. While it can be uncomfortable at times, silence can sometimes convey both acceptance and support more powerfully than any words could. Dont feel like you always have to say something in response to what a patient has said; sometimes the simple act of physically being with the patient and sharing that moment with them is enough to make them feel that they are not alone.
SupportSystems
Hospitalization, no matter the reason or the outcome, is a very stressful experience not only for the patient but for their family members and loved ones as well. As a volunteer it is important to know that there are several support systems in place to help patients and their families through this difficult time. If a patient seems to be depressed, or has questions about what will happen to them post-hospitalization, they might benefit from seeing the social worker. If you learn that a patient often finds comfort through their church or temple, or through prayer you might consider asking them if they would like to be visited by one of the hospitals chaplains. It is also important to remember that these services are available to support you as a volunteer as well. The work you do is important but can be emotionally draining or raise a lot of questions. You should always feel free to talk with the charge nurse, patient care manager, social worker, or your volunteer coordinator about and questions or concerns you may have. By taking care of yourself, you are ensuring that you will be able to give your best to your patients.
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PhrasesforSuccess
Asavolunteeryouarelikelytoencountervarioussituationsthatwillrequireyouto handleconversationsskillfullyandeffectively.Reviewthevarioussituationsand practicetheexamplephrases.
Howtoapproachanurseandaskaboutpatients
Hi.MynameisSallyandImavolunteer.Doyouhaveamomenttodiscuss yourpatientswithme? IsitOKifIvisitthefollowingthepatients? DoyouhaveanypatientsIcanwalkand/ordorangeofmotionwith? Aretheyhookeduptoanything?DoweneedtodisconnecttheIVor changetoaportableoxygentank? Ifwalking,dotheyuseanassistivedevice?Whatkind? Ifrangeofmotion,dotheyhaveanylimitationsorshouldIavoidanypartof thebody? Doanyofyourpatientsneedhelpwiththeirmeals?Whattypeofdietare theyon?Dotheyhaveanyphysicallimitations? IsthereanyoneIshouldvisitfirstwhoneedsimmediateassistance? IsthereanyoneIshouldnotvisitforanyreason? Isthereanyonewhoneedshelpmovingroomsorbeingdischarged?
Approachingnurseduringorafteravisit
Hiagain.IwasjustvisitingMs.Xandshehassomeconcernsabout(state theconcernorcomplaint). Excuseme.Mr.Tishavingsomepain. (SeePainissuesbelowandshareanswerswithnurse.) Note:alwaysreturntothepatientwithanupdate. HiMr.T.Ijustspokewithnurse.Shewillbeinmomentarilytoassistyou.
Greetingorintroductionwiththepatient Introducingnameandroleofvolunteer
Hi.MynameisSallyandImavolunteerhereatthehospital. Hi,Ms.X.MynameisSallyandImavolunteer. Imheretohelpmakeyourstaymorepleasant. Imheretohelpmakeyourstayascomfortableaspossible.
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CheckingID
MayIseeyourIDbandsoIcanmakesureImtalkingtotherightperson? WouldyoumindreadingyourIDbandtomesoIcanmakesureImtalking totherightperson?
TurningdownthevolumeonTV
MayIturndowntheTVsowecanheareachotherbetter? DoyoumindifIturndownthevolumeontheTVsoIcanhearyoubetter?
Invitingoneselftositdown
MayIsitdownandvisitwithyouforawhile? DoyoumindifIpullupachairandvisit?
Turningonlightsoropeningshades
Itsawfullydarkinhere.MayIturnthelightsonoropenupyourshades? Doyouhaveenoughlight?MayIturnthelightonsoyoucanseebetter?
Askingabouttheirstay(patientsinthehospitaloftendonotliketobeasked howtheyarefeeling)
Howisyourstaysofar? IsthestafftreatingyouOK? Howisthefood? Isthereanythingwecandotomakeitbetterforyou? Isthereanythingwecandotoimproveyourstay? Arethereanyneedsyouhavethatthestaffisnotaddressing?
Wakingapatientup(AskthenurseifitsOKtowakethepatientup)
Knockonthedoor.Callthepatientbyname:GoodafternoonMs.X. Tapthepatientonthearmorshoulder:GoodmorningMr.T. Didyounotsleepwelllastnight?Tellmewhy.Isthereanythingwecando tohelpyousleepbetter? Imsorrytoseeyousleeping.Icameintovisitwithyou. Isthisaregularnaptimeforyou? Iknowyoumustbetired,butitsimportanttotrytostayawake,soyoucan sleepatnight.
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Mobility
Ispokewithyournurseandsheaskedmetotakeawalkwithyou. Yournurserecommendedwedosomeexercisestogether. MayIaccompanyyoutothelounge? Doyouneedtousetherestroom?MayIassistyouingettingthere? Itsimportanttoexercise3timesaday.Letsworkonthatnow.
MealAssistance
MayIhelpyouopenanypackages?Cutanythingup? Areyouhavinganydifficultyopeninganything?MayIhelpyou? Wouldyoulikesomethingtodrinknow? Idlovetogetthatforyou.Letmequicklycheckwithnursetomakesureit isOK.(IfnotOK,pleasereturnandinformthepatientwhyitisnotOKat thistime.) Whatdoyouhaveinthisbrownbag?Lookitssomeensure(orbottled water).Haveyouhadanytoday?Itlookslikeyouhavealothere.MayI pouryouadrink?(Thisisgood,especiallybetweenmeals.) Itlookslikeyouhaventeatenmuch.Isthereareason?Wouldyoulike somethingdifferent? MayIhelpyouchooseyourmealsfortomorrow?
Choking
Donotleavethepatientalone. Youseemtobecoughingalot.Letmecallyournurse. Ithinkitstimetostopeatingforaminute.Letmecallyournurseforsome help.
Patientiscrying
Icouldnthelpnoticethatyouarecrying,doyouwanttotellmeaboutit? Imheretolisten. Youseemtroubled.MayIsitandwecantalkforabit? Youseemupset.Tellmewhatsbotheringyou.

Patientisinpainorhasdiscomfort
Imsorrytoheartohearyouhavepainorareuncomfortable.Wedonot wantyoutobeuncomfortable. Howbadisyourpainonascaleof110,with1beingmildand10beingthe worst? Wheredoyouhurt? Howlonghasthisbeenhurting? Letmesharethiswithyournursesowecanhelpyou.(Pleasereportback topatientwithanupdateandoffertoperformarelaxationexercise.) Letsdosomerelaxationexercisestokeepyourmindoffofit.Then,you candotheseonyourownwhenyouneedthem.
Patientiscomplaining
Imsorrythatthishappenedtoyou.Itisafrustratingsituation.Letmetell yournurseandwhatwecandotomakeitbetterforyou.(Youmayoffera voucherfromtheservicerecoverytoolkitifappropriate.) Iwouldliketoapologizeonbehalfofthehospital.Thismustverydifficult foryou.
Aboutfood
Ifyouwouldlike,Icangetyousomethingfromthecafeteriaforyouor ordersomethingfromthekitchen.
AboutTV/DVD/Video
Letmegotalktotheclerktocorrectthisproblem,Icanbringthechannel guidewhenIcomebackandwecangooverit.
Returningtoapatientsroomafterlookingintoasituationorjustasecondvisit
HiMs.X.Itsme,Sally,thevolunteer.WouldyoumindifIcheckyourID bandagain?Ihavejustcomebacktoseeifthereisanythingthatyouneedor wouldlike.Wouldyoulikemetorefillyourwaterpitcher? HiMs.X.itsme,Sally,thevolunteer.Ijustspokeyournurseaboutyour complaintandwearedoingthefollowingtohelpyou.
Patienthasfamilymembersvisiting
Hi!ImSally.Iamavolunteerheretovisityou,Mr.T.Aretheseyourfriends andfamily?(Thisisagoodleadintofindingoutmoreaboutthefamilyand
theirsupportsystem.Howmanydaughters?Howlonghaveyoubeen married?etc.) Hieverybody,ImSally.IamavolunteerandIcheckinonMrs.X.Ifthereis anythingyouwanttogetortakecareof,Icansitwithheruntilyoureturn. Excuseme,IhopeImnotinterruptinganything?MynameisSallyandIam avolunteer.WouldyoumindifIstayedtochatforawhile?
PatientRequests Newspaper
Iamsorrybutunfortunatelythehospitaldoesnotallowmetomake purchasesforpatients.IfyouhavemoneyIwouldbehappytogodownand getyouone.(Iftheydonthavemoney,youmayuseagiftshopvoucher fromtheservicerecoverytoolkitandpurchaseseveralpapersfortheunit.) Iwouldbehappytogopickupanewspaperforyou.Doyouhaveafew dollarstopurchaseitwith?
PawsforPatients/DogVisits
Icanhelpsetupadogvisitforyouifyouwouldlike.Wehavearegular teamthatvisitseveryThursday,butforadogvisitatanytime,anyonecan calltheinformationdeskandanydogteaminthebuildingwillcomeupto yourroom. Wehavespecialdogsthatmakevisitstopatients.Wouldyoulikemeto haveadogvisityou?
InformingaboutPawsforpatients,ComfortZone,activitiesandgames,concert
Wehaveprogramsforourpatients ComfortZoneisaplaceforpatientcaregiverstorelax. Wehavecards,checkers,coloringbooks,andlibrarybooks.Icouldrequest oneforyou.
Leaving/Goodbye
Itwasnicevisitingwithyou.ImhereeveryMondaymorning.Another volunteerwillbebytocheckinonyouthroughouttheweek. Ihaveafewotherpatientstovisit.Icanstayforthenext10minutesbut thenIwillhavetoleave.
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Itwassonicetomeetyou.IsthereanythingelseIcangetforyoubeforeI leave? Ok,Iamgoingontoanotherpatient,isthereanythingthatIcandoforyou beforeIgo? Itwasapleasuremeetingyou.Iwishyouallthebest.IsthereanythingI candoorgetforyoubeforeIgo? Thankyouforthecompany.Whatdoyouthinkyouwilldothis afternoon?
Patientbeginstodiscloseinformationtheydonotwantsharedwithanyoneelse
Ithinkthisisimportantinformationtosharewithyournurseanddoctor.I knowitmaybescary(orfrightening,embarrassing)todisclosethistothem, butweallareheretohelpyou. Iknowyoumustbenervoustosharethisinformation.However,Ithinkyou shouldsowecanmakesurewearetreatingyouproperly.Ifyouarenot comfortablesharingthis,Iwillpassthisinformationalongtosomeoneonthe team. Iunderstandyouwouldliketokeepthisasecret,butIcannotkeepsecrets foryou.Thisisimportantinformationandifyoudonotwanttoshareitwith theteam,Iwilldosoonyourbehalf. Beforeyougoonanyfurther,youshouldknowIcan'tkeepthisinformation tomyself.Itisimportantthateveryonecaringforyouisinformedaboutyour situationtogiveyouthebestcarepossible. Note:Ifthepatientiscomplainingaboutaspecificstaffpersonsuchasanurseoraide, thenyouwouldwanttosharethisinformationwithsomeoneelsesuchasthecharge nurseorpatientcaredirector.
Dischargeiscancelledandfamilyhascomeintopickthemup
Iwouldliketoapologizeonbehalfofthehospital.Thismustbeverydifficult foryou.Icanofferyouaparkingvouchersothatyoudonothavetopayfor parkingserviceor,ifyoutookthesubway,aMetroCard.
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THIRDFLOOR
Geriatrics
DementiaResources TheAlzheimersAssociation http://alz.org/index.asp http://www.alz.org/nyc
DeliriumResources http://www.mayoclinic.com/health/delirium/DS01064
InternationalAgingResources GlobalActiononAging http://www.globalaging.org/index.htm
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Oncology
NancysFriends/TheNancyKlauberForestFoundation
NancysFriendswasfoundedin2006byagenerousdonationfromtheNancyKlauber ForestFoundation. TheprogramisnamedafterNancyKlauberForest,aformercancerpatienttreatedhere atNewYorkPresbyterianHospital/WeillCornellMedicalCenter.Whileinthehospital, Nancyhadalotofsupportbutsherealizednoteverypatientwassolucky. Unfortunately,Nancypassedawayfromherdisease.Nancysfamilywantedtogiveback tothehospitalandstartedaFoundationinhermemorytosupportcancerpatientsand theirfamiliesduringtheirhospitalstay. NancysfriendsandfamilycontinuetobeinvolvedwithNancysFriends.The FoundationhostsAppreciationDaysforstaffandvolunteers,holdsannualfundraisers fortheprogram,andcontinuestodonateitemsforpatientstoenjoy.Theknithats availabletopatientsaredonatedthroughanannualfundraiserhostedbytheNancy KlauberForestFoundation. KnitHats:handknithatsareavailablefordistribution.
NancysFriendsDVDcollectionandLibrary
ADVDlistisavailableforpatients.DVDscanbeborrowedandbookscanbegivenoutto patients. FormoreinformationontheNancyKlauberForestFoundation,pleasevisittheirwebsite at: www.nancysfoundation.org
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AdditionalResources TheAmericanCancerSociety(ACS)
ACSiscommittedtofightingcancerthroughbalancedprogramsofresearch,education, patientservice,advocacy,andrehabilitation. www.cancer.org
TheLeukemiaandLymphomaSociety(LLS)
LLSisdedicatedtofundingbloodcancerresearch,educationandpatientservices. www.leukemialymphoma.org
CancerCare
CancerCareisanationalnonprofitorganizationthatprovidesfree,professionalsupport servicesforanyoneaffectedbycancer. www.cancercare.org
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Neurology
Thissectionprovides p moreindepthinformation nonneurologicalconditi ions.Itis in ntendedforvolunteerswho w wishtohaveamor edetailedunderstandin ngofthese co onditionsan ndhowtheyimpacthealthcaredeliv very.
Brai inAneurysm m
Thisisacereb brovasculardisorder in nwhichweaknessinthe ewallofan arteryinthebraincauses sswelling v Asth hesizeof ofthebloodvessel. ananeurysmincreases,thereisan ncreasedrisk kofrupture. . in What W doesitmeanforpa atients? He eadache Na ausea Vo omiting Visionimpairm ment Su urgicalinterv ventions coiling=seal s off aneurysm clipping=aneurysmistiedoff What W doesth hismeanforvolunteers? ? En ncouragepat tientstopra acticefunctio ons theyhavelost t As skthenursewhatareth hepatients de eficits Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p
44
Brai inTumor
Thisisamass sorgrowthof o abnormalcellsinthe brain.Thereare a manydif fferenttypes.Glioblasto oma multiforme m (G GBM)isthemostaggres ssiveandha s highestmorta alityrate. What W doesitmeanforpa atients? He eadaches Visionproblem ms Lo ossofsensat tionormove ementinan ar rmorleg Difficultywith hbalance Co onfusion He earingproblems What W doesth hismeanforvolunteers? ? Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits
45
Cere ebralAneur rysm=Brai inAneurysm

Acerebralan neurysmisabulgeinanarteryin th hebrainwhi ichcouldcau useastroke.Most occurinthearteries a atth hebaseofth hebrain.A smemboliza ationisthetreatment brainaneurys ovethebulge e. usedtoremo What W doesitmeanforpa atients? Weakness W orparalysis p ofone o sideof theface Do oublevision Na ausea Dr roppingofaneyelid Se eealsostrokesymptoms s What W doesth hismeanforvolunteers? ? Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits
46
Cran niopharyng gioma

Thisisatypeoftumorde erivedfrompituitary glandtissue,whichoccur rsinchildren nand men m andwom menintheir50sand60s s. What W doesitmeanforpa atients? Fa atigue Dizziness Do oublevision Na auseaandVomiting He eadache Frequentbloo oddraws What W doesth hismeanforvolunteers? ? En ncouragepat tientstopra actice functionsthey yhavelost As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng Pa atientmightneedemotionalsuppor rt
47
CSFLeak=Spo ontaneousCerebrospin C nalFluidLe eak

Thisamedica alconditioninwhichthe ecerebrospi nal fluid(CSF)(afluidthatoc ccupiesthesubarchnoid s d sp paceandthe eventricular rsystemaro oundtheand d in nsidethebra ain)ofapers sonspontan neouslyleaks sout oftheduramater. m What W doesitmeanforpa atients? He eadache Dizziness Do oublevision Na auseaandVomiting Lu umbardrain What W doesth hismeanforvolunteers? ? Se eeiftheheadacheisbet tteriftheyla ayhorizontally En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng Mayneedwal lkingassistanceduetoe extraequipm ment
48
Guil llainBarreSyndrome S
Thisisadisor rderinwhich hyourbody s im mmunesyste emattacksthe t nervesin n th heperiphera alnervoussy ystem(PNS), ca ausingsever reweakness sand numbnessthatusuallystartsinthe ex xtremitiesandbecomes sworse.Itis th houghttobe ecausedfroman in nfection.(Th helightblue eregioninth he illustrationisthePNS.) What W doesitmeanforpa atients? Difficultywith heye movement,fa acial movement,sp peaking, ch hewingorsw wallowing Difficultybrea athing Se everepainin nthelower ba ack What W doesth hismeanforvolunteers? ? Be epatient,cre eativeand un nderstanding g Askthepa atientto repeatque estions Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits
49
Headache=Ce ephalalgia
Thisispainin nanyregionofthehead.Itmightbe easharppai in, th hrobbingsen nsationordu ullache.Due etosevereh headacheso or sy ymptomssuchasdizzine ess,stiffnec ckornauseathen emergencyca areisrequired. Causes C Dysfunction D or o overactiv vityofpainsensitive s feat turesinthe headcauseheadaches.Chemical C activityintheb brain,thene erves orbloodvess selsofthehe eadoutsideoftheskull, ormusclesof th heheadandneckmayplay p aroleinprimaryhea adaches. What W doesitmeansforpatients? p No otwillingtotalk Pa ainintheheadorneck Vo omiting Inabadmood d What W doesth hismeansfor rthevolunte eer? Be epatientand dunderstanding As skthemifth hereisanythingthatyou ucandofort them Of ffertoasknurseforpain nmedication n
50
HeadTrauma=Traumatic cBrainInju ury=IntracranialInjur ry

Closedheadinjury i orpen netratinghead in njuryfrequentlyduetotransportatio t on accidents.Can ncauseprob blemswith a arousal,consciousness,awareness, dresponsive eness alertness,and Aheadinjury yisusuallyth heresultofa su udden,viole entblowtothe t head,wh hich may m launchthebrainonacollisionwith w th heinsideofthe t skull.Th hecollisionmay m bruisethebra ain,tearner rvefibersand ca ausebleedin ng.Theserio ousnessofahead in njurycanvar rygreatly,de ependingon nthe partofthebr rainaffected dandtheext tent ofthedamag ge. What W doesitmeanforpa atients? Am mnesiaorCo onfusion Lo ossofbalanc ce Slu urredspeech h Lo ossofcoordination What W doesth hismeanforvolunteers? ? Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits In njuriesmaycause: c Ce erebrallacer rationtissu ueiscutort orn. Ce erebralcontu usionbloo odismixeda amongtissue e. Int tracranialhe emorrhagebleedingn otmixedwithtissue. He ematomascollectionof o bloodresu ultingfromh hemorrhage e(bleeding)
51

Intrace erebralhemorr rhage bleedingwithbraintissueitself Epiduralhemat toma bleedingintothearea weentheskullandthe betw dura amater(oftencausing n) compression

Subd duralhematom ma
occursbetwee bleeding endura hearachnoidmater m andth

Sub bduralhemato oma
Subdu uralhematoma a whitear reainthemidd dle
What W doesth hismeanforpatients? Memoryloss,difficultymaintainingb alance Difficultyunde erstandingor o pronounciingspeech Pe ersonalitych hangesorbe ehavioralpro oblems What W doesth hismeanforvolunteers? ? As skthenurseifthepatien nthasanyd eficits. As skthenursewhatthepa atientiscapa ableofdoing.
Intr raventricularhemorrhageIVH H bleedingintheventricles
53
Hern niatedDisc c
Thespineismade m upofbones b called d ve ertebraewh hicharecush hionedbysm malloval padsofcartila ageordisks.Thesedisks s onsistofato oughouterlayer(annulu us co fibrosus)and asoftinner rlayer(nucle eus pulposus). When W ahern niateddiscoccurs,asma all portionofthe enucleuspu ushesoutthrougha te earinthean nnulusintothespinalcanal.Thiscou uldtouchan nerveandre esultinpain, , weakness w ornumbnesstheinback,arm, a orleg. What W doesitmeansforpatients? p Th hisdependsontheamou untofpaint thatthe pa atientisexpe eriencing. Mightormigh htnotbeabl letowalk No obendingor rheavyexer rcise Ex xperiencepa ainintheleg g,backorarm m Ex xperiencechronicpainfo ormanyyea ars What W doesth hismeansfor rthevolunte eer? Ch heckwiththenursebefo orewalking Iftoopainfulto t walkofferrangeofm motionexercises Cleanuproom msothatpat tientwillnot tbendover As skthepatien ntiftheyare einanypain n Pr rovideemoti ionalsuppor rt
54
Hydrocephalus s
Hydro H wate er+Cephalushead.Th hisisabnorm mal co ollectionofcerebrospin c alfluid(CSF)inthevent tricles orspacesofthe t brain. What W doesitmeanforpa atients? He eadaches,vo omiting Na ausea Sh horttermme emoryloss Visionproblem ms ManyCTscans What W doesth hismeanforvolunteers? ? En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p
55
Men ningioma
Themostcom mmonprima arytumorof fthecentral nervoussyste emthatoriginatesfromthemeninges (s systemofmembraneswhich w envelo opsthecentr ral nervoussyste em). What W doesitmeanforpa atients? Se eizure Weakness W inlegs Su urgeryorrad diation What W doesth hismeanforvolunteers? ? As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng Tr rytotakethe eirmindoffofthetreatment
56
Men ningitis
Thisisaninfla ammationof o themembranes(meniinges) andcerebrospinalfluidsu urroundingthe t brainan ndspinal co ord,usuallyduetothespread s ofaninfection.In nmost ca ases,itiscau usedbyavir ralinfection,howeverb acterial (v veryseriousandoftenfa atal)andfun ngalinfectio nsalso ca anleadtomeningitis. m What W doesth hismeansfor rthepatient ts? Co onfusionordifficulty d con ncentrating Sle eepinessordifficultywa akingup Se ensitivitytolight l La ackofinteres stindrinking gandeating g Se eizures What W doesth hismeanforvolunteers? ? He elpwithfeed dingthepatient As skifthelight tdisturbsthem As skthenursewhatareth hepatientsd deficits
57
Mya astheniaGr ravis=MG

Se eriousmusc cleweakness s.Thisisane euromuscula ardiseasele eadingtomu uscleweakness andfatigue.Itisanautoimmunediso order(failure eofanorganismtoreco ognizeitsow wn co onstituentpasts p asself,thisresultsinanimmun neresponseagainstitso owncellsand tissues.)Thisweaknessis scausedbycirculating c a ntibodiesth hatblockace etylcholine re eceptorsatthe t postsyn napticneuromuscularju nctioninhib bitingthestim mulativeeffect oftheneurot transmitteracetylcholine a e. 1.Presyn naptictermin nal(Nerveendingsendi nga signal) 2.Sarcolemma(coat tofamuscle ecell) 3.Synapt ticvesicle(sendnerveim mpulses) 4.Acetylcholinerece eptor(receiv ves acetylcho oline) 5.Mitoch hondrion(cr reatesenerg gyforthece ll) What W doesth hismeanforpatient? Th heeyeandeyelid e movem mentmaybe ecomedroopy. Fa acialexpression,chewing g,talking,an ndswallowin ngmaybeco omedifficult t lea adingtoimp pairedspeec ch. What W doesth hismeanforvolunteers? ? Pr rovidemealt timeassistan nce Co omfortpatie entswhoare escaredoru upset Allowpatienttosleepdur ringavisit
58
MultipleSclero osis(MS)
Thebodysim mmunesyste emeatsawa ayatthe protectivesheaththatco oversthener rves.This in nterfereswit ththecomm municationbetween b you ur brainandthe erestofyourbody. What W doesth hismeansfor rthepatient ts? Nu umbness,we eakness,orparalysisin or rmorelimbs s Lo ossofvisionordoublevi ision Dizzinessorfa atigue Po oorcoordina ationandbalance de epression What W doesth hismeanforvolunteers? ? Moreprogressivepatients smayneed ex xtensivephysicalsuppor rt Feeding Reposition ning Basicneed ds Ne ewlydiagnos sedpatients smaybegoi ng throughanem motionallych hallengingtiime As skthenursewhatareth hepatients de eficits
one
59
Park kinson'sDis sease

Thisisadege enerativedis seaseofthebrain th hatimpairsmovements, m ,speech,and dother fu unctions.Itdevelops d gra adually,oftenstarting with w atremorinjustonehand. What W doesitmeansforpatients? p Th hefaceshow wsnoexpres ssion Ar rmsdontsw wingwhenwalking w (balancebeco omesmoredifficult) d Pr roblemsspea aking Memoryprob blems De epression Sle eepproblem mstroublefallingaslee eporhavesleepattacksduringthed day What W doesth hismeansfor rthevolunte eer? Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits Mayneedassistancewith hambulation n
60
Pneumocephalus
Thisisthepre esenceofair rorgaswith hinthecranial ca avity. What W doesitmeanforpa atients? Pa aininthelow werback Nu umbness Sit ttingandtry yingtostand dupmaybe pa ainfulanddifficult What W doesth hismeanforvolunteers? ? As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng
61
Seizure=Epilepsy
Sy ymptomsre esultfromab bnormal,exc cessiveorsy ynchronousn neuronalact tivityinthe brain.Seizuresareoftenassociatedwithasudde enandinvoluntarycont tractionofa groupofmus sclesandlossofconsciousness.Seiz uretypesar reorganizedaccordingt to whether w thesource s oftheseizurewithinthebra ainislocalize ed(partialor rfocal)or distributed(g generalized). . Generalized G Ab bsence(petitmal=little eillness)pe ersonappea artobestaringintospac ce wi ithorwithou utjerking. Myoclonicbrief, b involun ntarytwitchiingofamuscleoragrou upofmuscle es, mostcommon nwhenaslee ep. Clonicinvolu untarymusc cularcontrac ctionsdueto ostretchingofthemusc cle. To onic To onicclonic(g grandmal=bigillness) affectthee entirebrain At tonicbrieflapseinmuscletoneca usingfalls. What W doesth hismeanforpatients? VideoEEGmo onitoring Involvesth heinpatienthospitalizat tionof thepatien ntforaperio odoftime,ty ypically daystowe eeks,duringwhichtheyare continuouslymonitore edandrecorded withavide eocameraand a electroenc cephalograp ph(EEG). Helpstodiscoverwhe ereinthebra aina givenpers sonsseizure esbegin Aidsindistinguishingepileptic e sei zures frompsychogenicnon nepilepticse eizures Supportsevaluating e apersonwho oisacandidateforsurge erytotreat epilepsy Pa atientsarenotpermitted dtoleaveth heroomand dbecomebo ored. What W doesth hismeanforvolunteers? ? Gr reatconvers sations;talktoandplaygameswiththesepatients(cards,w word pu uzzles),askif ftheyneedabook,new wspaper,oradogvisit. Discouragepa atientsfromnapping:mo orelikelytoseizurewhe enbrainisti ired an ndstressed,tryrangeof fmotionactiivitiesinstea ad. No otifyanurse eimmediatelyisapatien ntseizes. Makesureseizurepadsar resecurean ninplace.
Skul llbasedTumor
Thewordtum mormeansaswellingorlesion fo ormedbyan nabnormalgrowth g ofce ells.Tumoris s or notsynonymouswithcan ncer.Askullbasedtumo sabnormalgrowth g ofbo oneinthesk kull. is What W doesitmeanforpa atients? Cr raniotomy(o openingofth heskull) Ne ervefunctioncouldbeeffected e as ne ervespassth hroughtheskull s What W doesth hismeanforvolunteers? ? En ncouragepat tientstopra actice functionsthey yhavelost As skthenursewhatareth hepatientsd deficits
63
Spin nalStenosis s (Seealsocervical,th horacic,orlumbarsten nosis)

Thisisamedi icalconditio onthatisa narrowingofoneormore eareasin th hespine.The enarrowing gcouldput pressureonthe t spinalco ordoron th henervesth hatbranchoutfromthe co ompressedareas. a Itcouldalsobe ca ausedbydis scherniation nora tu umor. What W doesitmeanforpa atients? Lo ossoffeeling ginlegsor ar rms Lo ossofbladde erorbowelcontrol c Lo ossofbalanc ce Pa ainorcramp pinginthele egs What W doesth hismeanforvolunteers? ? En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits As skthepatien ntiftheyare eexperiencin nganypain
64
Spondylolisthe esis
Spondy=vert tebrae+Olis sthesis=slip p.Theanter rior displacement tofavertebraorthevertebralcolum mnin re elationtothevertebraebelowit. What W doesitmeanforpa atients? Pa aininthelow werback Nu umbness Sit ttingandtry yingtostand dupmaybepainful an nddifficult What W doesth hismeanforvolunteers? ? As skthenursewhatareth hepatientsd deficits Be epatient,cre eativeandunderstandin u ng
65
Stro oke=Cereb brovascularAccidentor o CVA

Astro okeoccurswhen w theblo oodsupplyto oapartofy your brain nisinterrupt tedorsevere elyreduced,deprivingb brain s, tissue eofoxygenandnutrient ts.Withinafewminutes brain ncellsbegintodie.With hcarotidste enosis,the carot tid(mainarteryofthebrain)stenosis(narrowin g)is arisk kforstroke. There Th aretwo otypesofca auses: Isc chemiablo oodsupplytopartofthe ebrainisdecreased. Transientischemicatt tack(TIA)=m ministroke He emorrhagebuildupof fbloodanyw whereinthe eskull. What W doesitmeanforpa atients? rating.Depe Sy ymptomsofstrokecanbe b debilitatin ngandfrustr endingonho ow longthebrain nsuffersfrom mthelackof fbloodflow w,astrokeca ancause temporaryorpermanentdisabilities: Lossofspe eechorswallowing Paralysisor o Numbness s(oftentoo onesideonly y) Lossoflite eracy Visionloss s Memorylo ossortroublewithunde erstanding Pain What W doesth hismeanforvolunteers? ? Be epatient,cre eativeandunderstandin u ng Askthepa atienttorepeatquestion ns Tryusingpictures p En ncouragepat tientstopra acticefunctio onstheyhav velost As skthenursewhatareth hepatientsd deficits Of fferassistancewitheating
66
TrigeminalNeu uralgia=Tic cDouloure eux=Proso palgia

Thisisaprobleminoneor o bothofth hefacial tr rigeminalne erves. What W doesitmeanforpa atients? Int tensepainin nanyofthefollowing(e ear, ey ye,lips,nose e,teeth,etc.) Mightnotbeable a toeat,talk,shaveo or rushteeth br What W doesth hismeanforvolunteers? ? Av voidtouchingthefaceofapatient As skthenursewhatareth hepatients de eficits Be epatient,cre eativeandunderstandin u ng
67
Resources
Forallrequestsbyapatient,identifythepatientsnameandroomlocation.
Facilities
Workrequests:61920orSentactonInfonet(accessedbyhospitalcomputer) PatientCareEquipment/BiomedicalEngineering:60919 CorporateCompliance:61644
PatientRelated
PastoralCare:64690(fornonemergencies) NutritionIssues:60850 FoodServiceIssues:60819 InformationDesk:64690(forDogsonCallandchaplainvisitationrequests) PatientServices:64293 TV/PhoneRental:65089
WorkforceHealthandSafetyDepartment
StitchMedicalBuilding 1315YorkAvenue,basement,between70thand71stStreets 2127464369 WeekdaysHours:8:3011:30am,1:304:00pm
DogVisits
PetTherapyDogsOnCall 64690
SpiritualNeeds/PastoralCare
Giveanyspecialreligiousrequests,suchasrabbi,priest,imam,communion,etc.For emergencies,theaskstaffforhelp. 64690or66970
Food/Nutrition
2FOOD 60819 SENTACTorderorvoucherforcafeteria
68
Newspaper/GiftShop
Patientscanuseagiftshopvoucher 64230
ComfortZoneforCaregivers
Spaceforcaregiverstofindsupport,information,companionshipandrest. Greenberg4Atrium AvailableTuesday,Wednesday,andThursdayfrom1pm4:30pm
HaircutNeeds
Inhospitaltrims,cuts,shaves 9175028942Franco
ExerciseBooklet
http://infonet.nyp.org/PatientEd/Rehabilita/AcuteCare/InpatientExercise BookletWC.pdf
PatientLibrary
64398
TV/Phone
65083
BuildingServices(roomtemp)
60630
PatientServices
64293
Security
60911
69
Append dix
CONF FIDENTIAL LITYSTATE EMENT
Co onfidenti iality is an a ethical l respons sibility of f every vo olunteer

The processing of employee, volunteer v and a patient information n is a key function of the Hospital. l. In order r to ensure e the confid dentiality of f this infor rmation, ea ach employe ee or volunteer must read, , sign and be e governed by b the follow wing stateme ent: olunteerand dpatientrecordscontain nconfidentia alinformatio on;theyare Employee,vo mentsbelon ngingtoNew wYorkPresby yterianHosp pital.Record ds privilegedbusinessdocum in ncludebothprintedandelectronicfiles f anddoc cuments. Privilegedinformationen ncounteredthrough t rou tinereviewfunctions,suchasthose e performedby yHospitalpe ersonnel,mu ustnotbeco ompromised dordivulged d.Discussio on, accessand/orreadingofemployee,volunteer v or rpatientrec cordsfornon njobrelated d easonsareprohibited. p Under U nocir rcumstances sshouldpati ient,employ yee,orvolun nteer re in nformationbe b discussed dcasuallyorinpublicare eas. Requestsforvolunteerin nformationshould s bedir rectedtotheVolunteerServices Department. D Patientsre equestsformedical m reco ordinformat tionshouldb bedirectedt to th hepatientstreatmentcoordinator c or o toHealth hInformation nManagement. Volunteers V sh houldalertstaff s ofanyattempts a ma adebyunaut thorizedper rsonstoobta ain employee,vo olunteerorpatient p informationthro oughunscrup pulous,deviousorillega al means m thatareinviolatio onofestablishedpolicie esofNewYo orkPresbyte erianHospita al. IhavereadNewYork N Pre esbyterianHospitals H Co onfidentialit tyStatemen nt.I acknowledge eunderstand dingofthecontent c and dintentofth hestatemen ntandIagre eeto co omplywithitsprovision ns.
______ ________ ________ _______

Voluntee er Name (pl lease print)
___ ________ ________ _____

Volu unteer Signa ature
________ __________ ___________ _________ Departm ment/Unit Assignment

Rev 6/2006 d:confidentiality statement2006 s
____ __________ ___________ ______ Date e
Witnessed d by ______ ___________ __________ ______

70
EvaluationofVolunteerServices
PleaseemailorFaxyourcompletedsurveyto: TrishaChoi Manager,VolunteerServices Email:pac2019@nyp.orgFax:(212)7468283
As a colleague who has worked with the Volunteer Department, we would like your feedback regarding the volunteers that have been provided to you as well as your perceptions of the service provided by our department to yours. Please respond to the questions below. Include any comments or suggestions that will help us to improve the delivery of services to your department. Feel free to have members of your staff also complete surveys, if they work with volunteers. If necessary,pleaseusethebackforadditionalcomments.Thankyou!
Thankyouforyourfeedback!
Thisinformationisoptional. YourName: Location: Phone/Pager:
Department:
Email:
71
FeedbackOnYourVolunteers
VeryPoor Poor Fair Good VeryGood FEEDBACK YOUR VOLUNTEERS 1. Staff and volunteers interact in a positive and productive manner in my department.
COMMENTS: 2. The volunteers sent to my department are reliable and consistently available according to a pre-set schedule.
COMMENTS: 3. Volunteers are properly oriented, evaluated and aware of critical safety information (e.g. fire safety) in my department.
COMMENTS: FEEDBACK ON INTERACTION WITH VOLUNTEER DEPARTMENT 4. Volunteer Department staff are courteous, responsive and helpful. 1 2 3 4 5
COMMENTS: 5. Communications received from the volunteer department are clear and helpful. 1 2 3 4 5
COMMENTS: 6. Volunteers have been adequately oriented to general hospital issues when they arrive for their work assignments.
1 2 3 4 5
72
COMMENTS: 7. Volunteer services staff are willing to work with me to create volunteer roles for my department. 1 2 3 4 5
COMMENTS: 8. The Volunteer Services department has recruited appropriate volunteers to meet my Departments needs.
COMMENTS: 9. Forms and instructions necessary for volunteer management (e.g. orientation checklists, annual evaluations) are clear and easy to use.
1 2 3 4 5
COMMENTS: DO YOU HAVE SUGGESTIONS FOR HOW THE VOLUNTEER DEPARTMENT CAN IMPROVE OUR SERVICE TO YOU?
73
74

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Volunteer Reference Manual

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WelcometoNYPsVolunteerReferenceManual.Inthesepages,youwillfindavariety ofinformation,tips,resources,andcontactnumbersdesignedtohelpyoubemore successfulasavolunteerinthehospital. Onceagain,thankyoufortime.

IsthereanythingelseIneedtoknowaboutthispatient? Imhereforfourhours,willyoutellmeaboutanyotherpatientsyourecommend visiting?and/orLetmeknowifyouneedanyhelp.

Basic cExerciseProgramfor f Patients

Butt tocksSquee ezes

Rela axationthro oughVisualization

AdvancedMechanicalfoodsincludeallfoodsexcepthard,sticky,orcrunchyfoods. Adequatechewingabilityisrequired.Thesefoodsstillneedtobemoist. NOTE:Level2MechanicallyAlteredDietincludesLevel1PureedFoods.Level3 AdvancedMechanicalDietincludesbothLevel1PureedandLevel2Mechanically Alteredfoods.

Vegetables (3-5 servings/day) 1 serving = cup

Dairy-milk, yogurt, cheese (2-3 servings/day) 1 serving = 1 c milk or yogurt, 1 oz cheese

LEVEL 1: PUREED continued

Soups (May need to be thickened if on nectar or honey-thick liquids.)

Any beverages with lumps, chunks, seeds, or pulp.

Fats and Oils (use sparingly) 1 serving = 1 teaspoon

Smooth puddings, custards, yogurt, souffls, flan and pureed desserts.

LEVEL 1: PUREED continued

LEVEL 2: MECHANICALLY ALTERED

Vegetables (3-5 servings/day) 1 serving = cup

Fruit (2-4 servings/day) 1 serving = 1 piece or cup of fruit or fruit juice

LEVEL 2: MECHANICALLY ALTERED continued

LEVEL 2: MECHANICALLY ALTERED continued

Foods to Exclude All others.

Fats and Oils (use sparingly) 1 serving = 1 teaspoon

All fats with coarse or chunky additives.

LEVEL 3: MECHANICALLY ADVANCED

Vegetables (3-5 servings/day) 1 serving = cup

Yogurt with nuts or seeds.

LEVEL 3: MECHANICALLY ADVANCED continued

Soups (May need to be thickened if on nectar or honey-thick liquids.)

Beverages Fats and Oils (use sparingly) 1 serving = 1 teaspoon Sweets/Desserts

All others except those on Avoid list. Soft chocolate.

Nuts, seeds, and coconuts. Any other sticky or hard foods.

8 oz beverage (appropriate consistency)

nuts or seeds) 8 oz beverage (appropriate consistency)

Itwassonicetomeetyou.IsthereanythingelseIcangetforyoubeforeI leave? Ok,Iamgoingontoanotherpatient,isthereanythingthatIcandoforyou beforeIgo? Itwasapleasuremeetingyou.Iwishyouallthebest.IsthereanythingI candoorgetforyoubeforeIgo? Thankyouforthecompany.Whatdoyouthinkyouwilldothis afternoon?

InternationalAgingResources GlobalActiononAging http://www.globalaging.org/index.htm

Cere ebralAneur rysm=Brai inAneurysm

Cran niopharyng gioma

CSFLeak=Spo ontaneousCerebrospin C nalFluidLe eak

HeadTrauma=Traumatic cBrainInju ury=IntracranialInjur ry

occursbetwee bleeding endura hearachnoidmater m andth

Sub bduralhemato oma

Subdu uralhematoma a whitear reainthemidd dle

Mya astheniaGr ravis=MG

Park kinson'sDis sease

Spin nalStenosis s (Seealsocervical,th horacic,orlumbarsten nosis)

Stro oke=Cereb brovascularAccidentor o CVA

TrigeminalNeu uralgia=Tic cDouloure eux=Proso palgia

CONF FIDENTIAL LITYSTATE EMENT

Co onfidenti iality is an a ethical l respons sibility of f every vo olunteer

______ ________ ________ _______

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Anda mungkin juga menyukai

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__ _ ___ Departm ment/Unit Assignment

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