2. HELP Project Planning Tool In this section think about…. Will you be able to do all of the HELP interventions? Will you have to modify any of the original HELP interventions? How will you go about recruiting, training and retaining volunteers? What type of attributes will you look for in volunteers?

3. Categories of HELP Interventions Elder Life Specialist Protocols/Volunteer Interventions Comprehensive Gerontological Assessment, Interventions and Protocols Interdisciplinary Interventions

4. Elder Life Specialist Protocols Risk factor ELS Protocol Cognitive Impairment Daily Visitor /Orientation/ Therapeutic Activities Sleep Deprivation Sleep Enhancement Immobility Early Mobilization Vision Impairment Vision Hearing Impairment Hearing Dehydration Meal Assistance/ Fluid Repletion

5. Sleep Enhancement Criteria- difficulty falling asleep or sleeps poorly at home or in hospital Intervention Avoid sleeping pills Instead: Back rub (if not contraindicated) Warm blanket Warm drink such as herbal tea or warm milk Soft music

6. Early Mobilization Criteria- all patients assessed for early mobilization Intervention- ELS/CNS consults with Physiotherapist to determine appropriate mobilization protocol: Active range of motion exercises 3 times per day Supervised walking 3 times per day according to PT guidelines

7. Healthy Eating/Fluid Repletion Criteria-appetite rated as poor Criteria-clinical evidence of Intervention- dehydration and Assist with set-up of meals Urea X10/Creatinine> 0.7 Encourage food intake Intervention- Encourage fluids Ensure regular mouth care if not contraindicated Assist with menu completion

8. Healthy Vision/Healthy Hearing Vision Criteria- if near vision in both eyes <20/70 Intervention - Eyeglasses clean and on - Magnifying glass Hearing Criteria-<3 whispers from each ear on whisper test Intervention -Hearing aids in and turned on -Consider use of hearing amplifier

9. Orientation/Daily Visitor/Therapeutic Activities Criteria- all patients are enrolled Intervention-Orient 1 time per day if MMSE >20, orient 3 times per day if MMSE <20 -Explore patient’s interests and possible therapeutic activities -Discuss current events, structured reminiscence, word games (Inouye et al. N. Engl. J. Med. 1999, March 4 340 (9): 669-676)

11. In this section you will learn about… Elder Life Clinical Nurse Specialist’s (CNS) practice roles in HELP Nursing specific HELP protocols HELP education strategies Program operations

12. CNS’ Role in HELP Clinician; CNS as an expert clinician of older adults population conducts focused assessments and interventions based risk factors and “geriatric vital signs”; emphasis is on prevention of delirium and functional decline; post-discharge follow up Consultant; CNS as a consultant shares her knowledge with patients, families, nurses, unit manager, allied health and physicians Educator ; CNS as a staff coach; a mentor; a resource for staff, patient and families Leader; CNS as a change agent, role model, patient advocate, resource for staff, coordinator of provider education program and gerontological nursing in-services. Researcher ; CNS participates in transfer of knowledge

13. HELP Nursing Protocols Targeted Risk Factor Approach using protocols Evaluation of Cognitive Status Delirium Protocol Dementia Protocol Psychoactive Medications Protocol Sleep Enhancement Protocol Early Mobilization Protocol

14. More Nursing Protocols… Hearing Protocol Fluid Repletion Protocol Discharge Planning Protocol Optimizing Length of Stay Protocol Additional Areas –

15. Education strategies employed at HHS… On demand Scheduled education sessions for staff and students Annual Seniors month education HHS new staff orientation; yearly staff review sessions Orthopedic staff orientation Seniors HHS Corporate initiative – environment, culture and clinical processes Gentle Persuasive Approaches, e-learning RNAO fellowships (many!)

16. PROGRAM OPERATIONS Record and maintain ELNS interventions progress reports Serve as a liaison between the program and nursing administration Track and address quality assurance Provide clinical and administrative support for ELS and volunteers

17. Recruitment Training and Retention

18. HELP Project Planning Tool In this section think about…. How will you go about recruiting volunteers What qualifications will you set for the volunteer role?(age, personal attributes, previous experience, time commitment, police check, health clearance) How will you go about training the volunteers? What strategies will you use to help retain volunteers?

19. Recruitment Work closely with Volunteer Resources -provides volunteer recruitment, screening and general training. They also identify hospital volunteers who seem suited to undertake the additional training to become a HELP volunteer. While the program seeks volunteers of all backgrounds, it has become a sought-after experience for many college/ university students, especially those interested in the health care field. Look for a mixture of different types of volunteers. If you only draw from the student population you will struggle with covering shift during student downtimes like exams

20. Volunteer Qualifications Reliable and caring; enjoy working with older people Mature in judgment Discreet, empathetic behavior and ability to exercise diplomacy in talking to patients, patient’s family and staff. Ability to relate with sensitivity to all patients Ability to work independently and assume responsibility Ability to refer questions to others as needed Minimum time commitment of 1 shift per week for 6 months

21. Training Training should be done a minimum of three times a year Volunteers attend 12 hours of classroom training which includes An overview of the Volunteer Manual and HELP videos Guest speakers which include Physiotherapist to demonstrate safe mobility with patients, Speech Language Pathologist to help instruct on meal assistance, a Recreation Therapist to provide training in Montessori based activities, and a member of the Alzheimer Society to provide an overview of dementia 12 hours of ward training which includes Includes a detailed tour of the environment-where to find supplies and how to get information Shadowing a several different experienced volunteers during their shifts

22. Retention Consistent and ongoing support and mentorship from HELP staff Volunteer Recognition