Volunteer Reference Manual

8/21/2019 Volunteer Reference Manual

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1NewYorkPresbyterianHospital2011

Volunteer Reference Materials

WelcometoNYPsVolunteerReferenceManual. Inthesepages,youwillfindavariety

ofinformation,tips,resources,andcontactnumbersdesignedtohelpyoubemore

successfulasavolunteerinthehospital.

Onceagain,thankyoufortime.


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Contents

CONTENTS.................................................................................................................................. 2

FIRSTFLOOR............................................................................................................................ 6

Volunteers

Basics

.............................................................................................................................

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

May

I

pay

a

friendly

visit?

................................................................................................................................

11

MayIwalkwiththem?....................................................................................................................................11

MayIengagethepatientinRangeofMotion(ROM)exercises?....................................................................11

MayIofferlightmassage?..............................................................................................................................11

IsthereanythingelseIneedtoknowaboutthispatient?..............................................................................11

Imhereforfourhours,willyoutellmeaboutanyotherpatientsyourecommendvisiting?and/orLetme

knowifyouneedanyhelp................................................................................................................................11

EnteringaPatientsRoom..............................................................................................................12

OptimizeYourInitialSuccessandPositiontoListen..........................................................................................12

TipsonBeingaGoodListener........................................................................................................13

Questionsto

Ask

Yourself

When

Communicating

With

aPatient:

.....................................................................

13

UseClarifyingResponses....................................................................................................................................13

TheAimoftheClarifyingResponse....................................................................................................................13

ClarifyingResponseExamples............................................................................................................................13

UseOpenEndedQuestions................................................................................................................................13

OpenendQuestionExamples............................................................................................................................13

BasicExerciseProgramforPatients................................................................................................14

ArmLifts..............................................................................................................................................................14


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ButtocksSqueezes..............................................................................................................................................14

AnklePumps.......................................................................................................................................................14

HeelSlides...........................................................................................................................................................14

KneeLiftsinSittingPosition...............................................................................................................................14

LegKicks..............................................................................................................................................................14

RecreationalActivities....................................................................................................................15

TalkingActivities.................................................................................................................................................15

Relaxationthrough

Visualization

........................................................................................................................

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

Guidelinesfor

Listening

......................................................................................................................................

33

TherapeuticInterventions..................................................................................................................................33

JustBeingThere..................................................................................................................................................34

SupportSystems.................................................................................................................................................34

PhrasesforSuccess........................................................................................................................35

Howtoapproachanurseandaskaboutpatients..............................................................................................35

Approachingnurseduringorafteravisit...........................................................................................................35

Greetingorintroductionwiththepatient..........................................................................................................35

Mobility...............................................................................................................................................................37

MealAssistance..................................................................................................................................................37

Patientiscrying...................................................................................................................................................37

Patientis

in

pain

or

has

discomfort

....................................................................................................................

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

=Tic

Douloureux

=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


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APPENDIX................................................................................................................................. 70

CONFIDENTIALITYSTATEMENT.......................................................................................................70

EvaluationofVolunteerServices....................................................................................................71

FeedbackOnYourVolunteers........................................................................................................72


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FIRSTFLOOR

VolunteersBasics

VolunteerProfessionalism:TenHospitalityStandards

1. Smilewith

your

face

&

your

voice

2. Greetallyoumeet

3. Neversayno,offeralternatives

4. FollowuponEverything

5. Speakfirst,listen,speaklast

6. AguestconcernisYOURconcern

7. Makeitpersonalusetheguestsname

8. Escortguests Donotpoint

9. Anticipateneedsandtakeaction

10. Applyallhospitalitystandardstocolleagues


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HIPAA

WhatisHIPAA?

ThefirstnationalprivacylawthatcoverseverypatientintheUnitedStates.

ThislawwentintoeffectApril14th,2003anditincludesseverefinesfor

anyonecaughtviolatingpatientprivacy.

TheHIPAA

privacy

laws

are

in

addition

to

the

existing

Patients

Bill

of

Rights,

whichispostedthroughouttheHospital.

WhatYouCanDotoProtectPatientConfidentialityandInformation

Neveraccessapatientsinformationunlessthereisaclinicalorbusiness

need.

Nevercall/pagepatientsinsuchawayastorevealtheirhealthissues(e.g.

PatientSmith,pleasereturntothedialysisunit)

Neverleavehealthinformationunattendedinanareawhereothersmay

inappropriatelysee

and/or

remove

it.

Ifyouareavolunteerwhohasaccesstoacomputer:

Besuretoobtainapersonalpasswordtosignin

Neverleaveacomputerwithoutsigningoff

Neversharecomputerpasswordswithanyone

Positioncomputerscreenssothatvisitorsorpeoplewalkingby

cannotviewinformation

Whatshouldntyoudo/HIPAAViolations

Youhear

that

acelebrity

is

in

the

Hospital

and

you

try

to

sneak

apeek

at

the

paperorelectronicrecord.

Youdiscusspatientinformationonanelevator,inalobby,thecafeteria,or

otherpubliclocationortoanindividualnotinvolvedinthepatientscare.

Youknowthatoneofyourfamilymembers,neighbors,friendsorfellow

volunteersisapatientandkeepothers(notinvolvedinthecare)uptodate.

Remember

Assuringpatientprivacyandconfidentialityisaserviceexcellenceinitiative.

BeHIPAA

aware

Thinkpatientconfidentiality

WhenpatientinformationisrequestedaskWhydoyouneedthis

information?

Accessonlyinformationyouneedtodoyourjob

Helpeducateothers


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CompliancewithHIPAAregulationsisnotjustalaw,itisthewaywedo

business.


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SECONDFLOOR

ShiftChecklistofTypicalVolunteerActivities

Arrival

SignintothecomputerattheVolunteerOffice(RoomJ144).

Changeintouniformsmock;buttonentirely;makesureyourIDisvisible.

Lockyourvaluablesandpickupamealcard(thegreencardsinplastic

sleeve).

Proceedtotheunit.

GettingStarted

ConsulttheVolunteerBinderatNursingStationandsignin.

Obtain

a

copy

of

the

latest

census

from

the

binder

or

clerk.

Checkthebinderforanymessagesandnotesfromthecoordinator.

Readnotesfromthepreviousvolunteersanddetermineappropriatevisits.

Beforevisitinganypatients,youMUSTtalktotheirnurse.(Refertoorcopy

thelatestNursingAssignmentSheetpostedbytheUnitClerk.)

IntroduceyourselftotheNurseandaskforanyreferrals.

Determineifyoucanconductmeals,walkingand/orrangeofmotions

withallofthepatients.

Placebinderbackandinitiatevisits.

Note: Do nottake 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:

building

rapport,

active

listening,

deep

conversations

FeedingAssistance:full;partial;encouragement/accompaniment

MobilizationAssistance:(WalkinganddoingROMs)

RecreationActivities:crossword/Sudoku,puzzles,newspapersfromgiftshop

Buildabridgeandbringnaturalclosuretovisit;smileandsaygoodbye.

IsthereanythingIcandoforyoubeforeIleave?

ExplaintheVideoOnDemandPatientEducationService


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Pain/ComfortAssessment

Areyouinanypain?(Informthenurse.)Areyoucomfortableinbed?Doyouneedtoberepositioned?

Howisthetemperatureintheroom?(Informclerkiftoohotorcold.)

Doesthepatientneedablanket/pillow?

AssessPatient

Satisfaction

Arethereanyneedsthatyouhavethatthestaffisntaddressing?

DoyouhaveanycomplaintsorissuesIcanhelptoresolve?

Remindthemaboutfreepatientservices.

Environment

Istheorientationboardupdated?

Placethecallbellarenearby;checkthatallcards/pictures/decorationsare

where

patient

can

seethem;

place

the

telephone

/

water

pitcher

(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?

MayIpay

afriendly

visit?

Isthereanythingspecificthatwouldbehelpfultoknow?

Arethereanyisolationprecautions(contact/droplet/respiratory)Ishouldbe

madeawareof?

Anyproblemswithforgetfulnessorattention?

MayIwalkwiththem?

Dotheyhaveanyassistivedevices(e.g.,walker)?

Do

they

have

any

connections

(e.g.,

IV

or

Oxygen)?

MayIengagethepatientinRangeofMotion(ROM)exercises?

IsthereanypartofthebodyIshouldavoidforanyreason?

MayIofferlightmassage?

Doanypatientsneedmealassistance?

Whattypeofdietareontheyon?

Isthere

anything

else

Ineed

to

know

about

this

patient?

Imhereforfourhours,willyoutellmeaboutanyotherpatientsyourecommend

visiting?and/orLetmeknowifyouneedanyhelp.


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EnteringaPatientsRoom

OptimizeYourInitialSuccessandPositiontoListen

Trythesequestionsforconversationstarters.BackgroundandUpbringing

AreyoufromNewYork?

Wheredidyougrowup?

Mostmemorablemomentfromchildhood?

Anysiblings?

FamilyDoyouhavefamilyinthearea?

Howdidyoumeetyoursignificantother?

Doyou

have

children

or

grandchildren?

Doyouhaveanypets?

Travel

Whatsyourfavoriteplacetovisit?

Wherehaveyoutraveled?

HaveyoueverlivedoutsideoftheUS?

Doyouspeakanyotherlanguages?

Entertainment

FavoriteTVshows?

Celebritygossip?

Whatmoviehaveyouwatchedmorethanonce?

Whatareyourfavoritebooksormagazines?

Whatsonyourreadinglist?


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TipsonBeingaGoodListener

QuestionstoAskYourselfWhenCommunicatingWithaPatient:

Canthepatienthearyou?(Dotheyhaveanysensoryneeds)?

Doesthepatientunderstandwhatyouaresaying(arethereanylanguage

barriers,dementiaorchangeinmentalstatus)?

Doyou

appear

unhurried

and

interested

in

what

the

patient

has

to

say?

UseClarifyingResponses

Clarifyingresponsesareatypeofreflectiveresponse. Whenclarifyingresponsesare

used,thefocusremainsonthepatient,whilethelistenerprobesforadditional

information.

TheAimoftheClarifyingResponse

Toacknowledgeandexpressthepatientsfeelings

Toencouragethepatienttoexpandfurtheronthecurrenttopic

ClarifyingResponseExamples

Itsoundstomelikeyouare(angry/upset/sad)isthatright?

Tellmemore

Howdidthatmakeyoufeel?

Whathappenednext?

Use

Open

Ended

Questions

Openendedquestionsgivethepatientawiderangeofoptionsonhowtorespond.

Patientscannotuseonewordresponses,suchasyes,no,fine,orgood,toanswerthese

questions.

OpenendQuestionExamples

Tellmeaboutyourfamily.

Whattypesofactivitiesdoyouliketodowhenyouarehome?

Yousounddown. Howareyoufeeling?


14/74

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Meals

GuidelinesforDysphagiaDiets

Patientswithdysphagiaordifficultyswallowingareatriskforaspiration. Aspiration

occurswhenfoodparticlesorliquidentertheairway. ThegoaloftheDysphagiaDietis

toreducetheriskofaspirationbyprovidingfoodinaccordancewiththepatientsability

toswallow

and

to

meet

their

nutritional

needs.

It

includes

three

levels

of

food

and

threeconsistenciesofliquid;additionallythereareinstanceswhennoliquidsare

allowed.

Adequacy

Thedysphagiadiet,whencarefullyplanned,willprovideadequatenutrients.However,

intakemaybelimitedduetodecreasedappetiteorincreasedtimerequiredtoeat.

Therefore,supplementationmaybenecessarytoconsistentlymeet100%ofthe

RecommendedDietaryAllowances.

Levels of Food: Consistencies of Liquid:I Pureed Honey-thickII Mechanically Altered Nectar-thickIII Advanced Mechanical 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

should

be

pureed

until

smooth

and

thickened

to

pudding

consistency

(see

below

for

thickeners).

MechanicallyAlteredfoodsshouldbesoftandcookeduntiltheyareforktender.In

general,theyaremoist,cohesive,requiresomechewingability,andarecutintosmall

pieces(lessthaninch).


18/74


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,

arecommercially

available.

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.

Takesmall

bites

of

food

and

sips

of

beverages.

Keepyourchindownatanaturallevelwhileswallowing. Donottiltyour

headback.

Clearmouthofanyresidueaftereatingwithatoothbrushoraswab.

Clearthroatafterswallowing.

Alternateeatingsolidsanddrinkingliquidswhiledining.


19/74


FollowanyotherfeedinginstructionsgiventoyoubyyourSpeechTherapist

orOccupationalTherapist.

This information isbriefandgeneral. Itshouldnotbetheonlysourceofyour informationonthis

healthcaretopic. Itisnottobeusedorreliedonfordiagnosisortreatment.Itdoesnottakethe

placeof instructions fromyourdoctor.Talk toyourhealthcareprovidersbeforemakingahealth

caredecision.


20/74


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 thatare gelled through entirethickness.

Pureed potatoes with gravy,butter, margarine, or sour cream.

Smooth, homogenous, cookedcereals such as farina-typecereals. Should have a pudding-like consistency.

Well-cooked pasta, noodles, or

rice that have been pureed in ablender to smooth, homogenousconsistency.

Moist polenta.

All other breads, rolls, crackers,biscuits, pancakes, waffles, Frenchtoast, muffins, and bread dressing.

All other potatoes, plain mashedpotatoes.

All dry cereals and any cookedcereals with lumps, seeds, chunks,including oatmeal.

Non-pureed pasta, noodles, or rice.

Dry polenta

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

Pureed vegetables withoutchunks, lumps, pulp, or seeds.

Tomato paste or sauce withoutchunks, lumps, or seeds.

Tomato or vegetable juices

(thickened if on nectar or honey-thick liquids)

All other vegetables that have notbeen pureed or with chunks,lumps, pulp, or seeds.

Tomato sauce with seeds, thintomato juice.

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

Pureed fruits or well-mashed freshbananas

Fruit juices without pulp, seeds orchunks (thickened if on nectar orhoney-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, 1oz cheese

Smooth yogurt without nuts, seeds

or whole or small soft pieces offruit.

Milk (thickened if on nectar orhoney-thick liquids)

Yogurt with nuts, seeds, or whole

or soft pieces of fruit.

Cheese or cottage cheese.


21/74


LEVEL 1: PUREED continued


Meat, poultry, fish, beans,legumes, eggs, nuts, meatsubstitutes(2-3 servings/day)1 serving = 2-3 oz or 1 c beans

Pureed meats, fish, or poultry.

Liverwurst

Pureed eggs. Souffls that aresmooth and homogenous.

Hummus or other pureedlegume/bean spread.

Pureed tofu.

Whole or ground meats, fish, or

poultry.

Non-pureed fried, scrambled, orhard-cooked eggs.

Non-pureed lentils or legumes.

Peanut butter, unless pureed intofoods correctly. All nuts & seeds

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

Soups that have been pureedcompletely in a blender or strainedof skins, seeds, and lumps

(thickened if on nectar or honey-thick liquids).

Soups that have chunks, lumps, andparticles.

Beverages Any smooth, homogenous

beverages without lumps, chunks,or pulp (thickened if on nectar orhoney-thick liquids).

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

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

Butter, margarine, strained gravy,sour cream, mayonnaise, whippedcream cheese, whipped topping.

Smooth sauces such as white

sauce, cheese sauce orhollandaise sauce (may need tobe thickened if on nectar orhoney-thick liquids).

All fats with coarse or chunkyadditives-such as whipped creamcheese with vegetables or salmon.


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Sweets/Desserts Smooth puddings, custards,

yogurt, souffls, flan and pureeddesserts.

Cookies, cakes, pies, pastry,textured puddings, bread or ricepudding, and fruit yogurt.

All candies including caramels orlicorice.

These foods are considered thin liquidsand should be avoided if thin liquids are

restricted:

Frozen malts, milk shakes, frozenyogurt, eggnog, nutritionalsupplements, ice cream, sherbet,frozen juice bars, regular or sugar-free gelatin, or any foods thatbecome thin liquids at either room(70F) or body temperature (98F).

LEVEL 1: PUREED continued


Miscellaneous Sugar, artificial sweeteners, salt,finely ground pepper, herbs andspices.

Honey, smooth jellies.

Ketchup, mustard, BBQ sauce

and other smooth sauces.

Coarsely ground pepper, herbs, andspices.

Chunky fruit preserves and jamswith seeds.

Seeds, nuts, sticky foods.


23/74


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/riceCereals may have cup milk orjust enough milk to moisten if thinliquids are restricted. Themoisture should be well-blendedinto food.

Cooked cereals with little texture,including oatmeal.

Soft pancakes, well-moistenedwith syrup or sauce.

Commercial pureed bread mixes,pregelled or slurried breads thatare gelled through entirethickness.

Well-cooked, moistened, boiled,baked or mashed potatoes. Well-cooked, shredded hash brownpotatoes that are not crisp.All potatoes need to be moist andin sauces.

Moist polenta.

Well-cooked noodles or pasta insauce of appropriate consistencyif on thickened liquids.

Spaetzel or soft dumplings thathave been moistened with butteror gravy.

Very coarse, dry, or cooked cerealsthat may contain seeds, nuts, driedfruits or coconut.

All other breads.

Potato skins and chips. Fried orfrench-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.

Cooked corn and peas.

Broccoli, cabbage, brussels sprouts,asparagus, or other fibrous, non-tender or rubbery cooked

vegetables.

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

Soft, drained, canned or cookedfruits without seeds or skin.

Fresh soft/ripe banana.

Fruit juices without pulp, seeds, orchunks (thickened if on nectar orhoney-thick liquids).

Fresh, frozen, or dried fruits.Cooked fruit with skin or seeds.


24/74


LEVEL 2: MECHANICALLY ALTERED continued


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

Soft, moist cheese (mozzarella,meunster, monterey, jack cheese)and cheese spreads. Yogurt withsmall soft chunks of fruits

Thinly sliced cheese and softcheese cubes.

Cottage cheese.

Milk (thickened if on nectar orhoney-thick liquids).

Crumbly or hard cheese (bluecheese, feta and cheddar).

Yogurt with nuts.

Meat, poultry, fish, beans,eggs, nuts, meat subs titutes(2-3 servings /day)1 serving = 2-3 oz or 1 cup ofbeans

Pieces should not exceed inch thick cubes and should betender.

All meats or protein substitutesshould be served with sauces,or moistened to help maintaincohesiveness.

Moistened ground or cookedmeat, poultry, fish or tender meat.May be served with gravy orsauce. Moist meatballs, meat loaf,or fish loaf.

Casseroles without rice. Moist

macaroni and cheese, well-cooked pasta with meat sauce,tuna-noodle casserole, and soft,moist lasagna.

Smooth quiche without largechunks.

Protein salads such as tuna oregg without large chunks, celeryor onion.

Poached, scrambled, or soft-

cooked eggs. Egg yolks shouldbe moist, but not runny (Cookeggs to 160F or use pasteurizedeggs for safety).

Souffls may have small softchunks.

Tofu.

Well-cooked, slightly mashed,moist legumes such as bakedbeans.

Dry meats, tough meats (such asbacon, sausage, hot dogs, andbratwurst).

Dry casseroles or casseroles withrice or large chunks.

Peanut butter.

Hard-cooked or crisp fried eggs.

Sandwiches.

Pizza.


Soups with easy-to-chew or easy-to-swallow meats or vegetables(particle sizes in soups should beless than inch thick). Soupsmay need to be thickened if onnectar or honey-thick liquids.

Soups with large chunks of meatand vegetables.

Soups with rice, corn, and peas.


25/74


LEVEL 2: MECHANICALLY ALTERED continued


Beverages Foods to Choose

All beverages with minimal

amounts of texture, pulp, andchunks (thickened if on nectar orhoney-thick liquids).

Foods to Exclude

All others.


Butter, margarine, cream forcereal (depending on liquidconsistency recommendations),gravy, cream sauces,mayonnaise, salad dressings,cream cheese, cheese spreadswith soft additives, sour cream,sour cream dips with softadditives, and whipped toppings.

All fats with coarse or chunkyadditives.

Sweets/Desserts Soft, moist cakes with icing orpregelled and slurried cakes andcookies or soft, moist cookies thathave been dunked in milk,coffee, or other liquid.

Pudding, custard.

Soft fruit pies with bottom crustonly.

Crisps and cobblers without seeds

or nuts and with soft breading orcrumb mixture.

Drained canned fruit pears andpeaches.

Soft smooth chocolate bars thatare easily chewed.

Dry, coarse cakes and cookies.

Rice or bread pudding.

Anything with nuts, seeds, coconut,pineapple, or dried fruit.

Chewy candies such as carameland licorice.

These foods are considered thinliquids and should be avoided if thinliquids are restricted:

Frozen malts, milk shakes, frozenyogurt, eggnog, nutritionalsupplements, ice cream, sherbet,frozen fruit bars, regular or sugar-free gelatin or any foods thatbecome thin liquid at either room(70F) or body temperature (98F).

Miscellaneous Jams and preserves withoutseeds, jelly.

Sauces, salsas that have small

tender chunks less than inchthick.

Seeds, nuts, coconuts, and stickyfoods.


26/74


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 cuppasta/rice, 3oz potatoCereals may have cup milk orjust enough milk to moisten if thinliquids are restricted. Themoisture should be well-blendedinto food.

Any well-moistened breads,biscuits, muffins, pancakes,waffles without nuts and seeds.

Add adequate syrup, jelly,margarine, butter, etc., to moistenwell.

All well-moistened cereals.

All potatoes and other starchesincluding rice, wild rice, moist

bread dressing, and tender, friedpotatoes.

Dry bread, toast, crackers

Tough, crusty breads such asFrench bread or baguettes

Dry bread dressing.

Coarse or dry cereals such asshredded wheat, bran cereals,muesi or granola.

Tough, crisp-fried potatoes.

Potato skins.


All cooked, tender vegetables,except corn.

All raw vegetables.

Cooked corn.

Non-tender or rubbery cookedvegetables.

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

fruit or fruit juice

All canned and cooked fruits.

Soft, peeled fresh fruits such as

peaches, nectarines, kiwi,mangos, cantaloupe, honeydew(without seeds).

Soft berries with small seeds suchas strawberries.

Watermelon without seeds (only ifyou can have thin liquids).

Fruit juices without pulp, seeds, orchunks (thickened if on nectar orhoney-thick liquids).

Difficult-to-chew fresh fruits such asapples or pears.

Stringy, high-pulp fruits such as

papaya, pineapple, or mango.

Fresh fruits that have skins or peelsthat are difficult to chew (grapes).

Uncooked dried fruits such asprunes and apricots.

Fruit leather, fruit roll-ups, and fruitsnacks.

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

Yogurt without nuts and seeds.

All cheeses.

Milk (thickened if on nectar orhoney-thick liquids).

Yogurt with nuts or seeds.


27/74


LEVEL 3: MECHANICALLY ADVANCED continued


Meat, poultry, fish, beans,

eggs, nuts, meat subs titutes(2-3 servings /day)1 serving = 2-3 oz or 1 cup ofbeans

Thin-sliced, tender, or ground

meats and poultry.

Well-moistened fish.

Eggs prepared any style.

Casseroles with small chunks ofmeat, ground meats, or tendermeats.

Tofu.

Cooked beans.

Tough, dry meats and poultry.

Dry fish or fish with bones.

Peanut butter.


All soup except those on theexclude list.

Strained corn or clam chowder.

(Need to be thickened if on nectaror honey-thick liquids.)

Soups with tough meats. Corn or clam chowders.

Soups that have large chunks ofmeat or vegetables (greater than 1inch thick).

Beverages Any beverages (thickened if onnectar or honey-thick liquids).

Liquids of inappropriateconsistencies.


All other fats except those on theexclude list.

All fats with coarse, difficult-to-chew,or chunky additives such as cream-cheese spread with nuts orpineapple.

Sweets/Desserts All others except those on Avoidlist.

Soft chocolate.

Dry cakes, cookies that are chewyor very dry.

Anything with nuts, seeds, dry fruits,coconut, or pineapple.

Chewy caramel or taffy-typecaramel.

These foods are considered thinliquids and should be avoided if thin

liquids are restricted: Frozen malts, milk shakes, frozen

yogurt, eggnog, nutritionalsupplements, ice cream, sherbet,frozen juice bars, regular or sugar-free gelatin or any foods thatbecome thin liquids at either room(70F) or body temperature (98F).


28/74


Miscellaneous All seasonings and sweeteners.

All sauces of appropriatethickness.

Jams, jellies, honey, preserves.

Nuts, seeds, and coconuts.

Any other sticky or hard foods.

DysphagiaDietSampleMenus

DYSPHAGIA DIET LEVEL 1PUREED

DYSPHAGIA DIET LEVEL 2MECHANICALLY ALTERED

DYSPHAGIA DIET LEVEL 3ADVANCED 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 moistenedwith syrup

1 pat butter

1 soft cooked egg

8 oz milk (appropriateconsistency)

Breakfast

1 medium ripe banana

2 French toast with syrup

1 scrambled egg

1 pat butter

1 cup yogurt

8 oz milk (appropriateconsistency)

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 (appropriateconsistency)

1 medium well-mashed ripebanana

8 oz beverage (appropriateconsistency)

Lunch

1 medium baked potato(no skin)w/ cheese sauce

2 oz ground beef moistened withgravy

1 cup soft cooked cut

vegetables inch thick pieces

1 cup split pea soup (appropriateconsistency)

cup drained canned peaches

8 oz beverage(appropriateconsistency)

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


Dinner

1 cup mashed sweet potato

1 pat butter

3 oz thickened pureed chicken

cup thickened pureed veggies

1 cup creamed soup (appropriateconsistency)

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 chickenwith sauce

cup soft cooked vegetables

1 cup vegetable soup(appropriate consistency)

1 slice moist pound cake (NO


29/74



consistency) nuts or seeds)



30/74


Challenges

YourOwnReflections

EarlyExperiencesInfluencingReactionstoLoss

Ourearlyexperienceswithlossleaveuswithmessages,feelings,fears,andattitudeswe

willcarry

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

youmaintain

currently?


31/74


DifficultConversations

TheRoleofSocialWork

Patients in the hospital are cared for using a multi-disciplinary approach totreatment, meaning that practitioners from a range of educational andprofessional backgrounds such as physicians, nurses, physical and

occupational therapists, and nutritionists work together to provide the best andmost comprehensive care possible for each patient.

Social workers act as members of this multi-disciplinary team and provide abiopsychosocial approach to assessment and treatment. Simply put, socialworkers look at the whole patient, while also considering influence of the manysystems of which they are a part their family, their culture, their community, etc.

Social workers use this information to provide supportive emotional counselingand education to patients and families, and to help develop and implement apost-discharge plan of care that takes all these factors social, medical,emotional, physical into account and will optimize the patients quality of lifepost-hospitalization.

As a volunteer, you too will be providing support to patients and their familieswhile they are in the hospital; however your role is very different from that of thesocial worker.

EmotionalReactions

Planned or not, being admitted to the hospital is an extremely stressfulexperience. Patients and their families are forced to cope with a great deal ofuncertainty as they go through the process of diagnosis and treatment, and thiscan bring up a lot of strong emotions such as anger, fear, sadness and grief. Asa volunteer, it is important to let a patient talk about these feelings even thoughthey may be difficult for you to hear. Being able to freely discuss emotions canhelp a patient feel safer, calmer and more in control.

You may encounter a situation in which a patients anger or other negativeemotions seem to be directed at you. It is important to remember that more oftenthan not the feelings being expressed are due to the patients illness andhospitalization, and not because of something you have done or said.

PatientCopingStrategies

When confronted with a lot of strong, negative emotions, people will often usecoping strategies to help them deal with what they are feeling. These areimportant because they act as a buffer, giving the patient both time and space tocome to terms with what is happening to them. It is important not to try andchallenge or correct what the patient may be thinking or feeling. Instead you canoffer them a safe place to talk, and work through their emotions whatever theymay be.


32/74


Some of the most common coping strategies used by patients who are dealingwith a difficult illness or hospitalization:

The first and most commonly used coping mechanism is denial. Patients who areusing denial will often say things like, this isnt happening to me or I know thedoctor 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 bybelieving that their illness was somehow intentionally given to them by a higherpower as a challenge or test for them to overcome. Finding a larger or deepermeaning in an illness may provide the patient with a sense of order and purposein an otherwise confusing and frightening situation.

Patients may also find a sense of comfort and safety by allowing others to takecare 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 ishappening to them.

Anger is also a very commonly used coping mechanism. When used as a copingmechanism, anger can help a patient feel as if they have a degree of control overwhat they believe to be an uncontrollable situation.

A patient may also react to a hospitalization or difficult diagnosis by activelyseeking out as much information as possible, a coping mechanism calledintellectualization. The gathering of knowledge can help give the patient a senseof control over their illness and helps them to better make sense of what ishappening to them.

In each of these cases, the coping mechanism used helps the patient to makesense of and emotionally cope with what is happening to them. If you recognize acoping mechanism being used by a patient, dont try to challenge their way ofthinking; instead allow them to talk, and when you respond focus on what andhow 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 morecomfortable. When you meet with a patient, you want to first build a trustingrelationship with those you visit. Do what you say and do not make promises youcant 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 waytowards making them feel less anxious.

ObjectivesinListening

One of the most important things you can do as a volunteer is to listen. Oftentimes, 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


33/74


or her to guide the conversation and tell their story, you can help them feel moreat ease.

If a patient seems somewhat reluctant to talk, a simple way to encourage them isto ask open ended questions. These are questions that require more than asimple, 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 aclosed 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 aboutwhat is important to them.

GuidelinesforListening

Listening is an active process, and how you listen is just as important as takingthe time to listen in the first place. Looking interested in what a person has tosay, expressing empathy for the feelings they express, and remaining non-

judgmental about the opinions they express can all help the person who isspeaking 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 sayspeaks more loudly than any words can. Body language is something all peopleunconsciously pick up on and can communicate a lot about what you are thinkingor feeling.

For example, if someone is listening to you speak with their arms folded tightlyacross their chest, would you feel that they were interested or empathetic to whatyou had to say? Would you feel differently if they were sitting with their handsfolded loosely in their lap?

One of the simplest things you can do to convey interest when you visit a patientis to sit instead of standing when you talk with them. By sitting, you show yourinterest and commitment to the conversation, and patients will feel as if you havespent more time talking with them than if you had spoken with them whilestanding.

The acronym SOLER gives an easy way to remember some of the cardinal rulesof 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 toreassure the patient that they are being heard. If you find yourself uncertain ofhow to respond to something a patient has told you, sometimes one of theseminimal 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 beuncomfortable at times, silence can sometimes convey both acceptance andsupport more powerfully than any words could.

Dont feel like you always have to say something in response to what a patienthas 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 notalone.

SupportSystems

Hospitalization, no matter the reason or the outcome, is a very stressfulexperience not only for the patient but for their family members and loved onesas well. As a volunteer it is important to know that there are several supportsystems 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, orthrough prayer you might consider asking them if they would like to be visited byone of the hospitals chaplains.

It is also important to remember that these services are available to support youas a volunteer as well. The work you do is important but can be emotionallydraining or raise a lot of questions. You should always feel free to talk with thecharge nurse, patient care manager, social worker, or your volunteer coordinatorabout 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?

Doany

of

your

patients

need

help

with

their

meals?

What

type

of

diet

are

theyon? Dotheyhaveanyphysicallimitations?

IsthereanyoneIshouldvisitfirstwhoneedsimmediateassistance?

IsthereanyoneIshouldnotvisitforanyreason?

Isthereanyonewhoneedshelpmovingroomsorbeingdischarged?

Approachingnurseduringorafteravisit

Hiagain. IwasjustvisitingMs.Xandshehassomeconcernsabout(state

theconcernorcomplaint).

Excuseme.

Mr.

Tis

having

some

pain.

(SeePainissuesbelowandshareanswerswithnurse.)

Note: alwaysreturntothepatientwithanupdate.

Hi Mr.T. Ijustspokewithnurse. Shewillbeinmomentarilytoassistyou.

Greetingorintroductionwiththepatient

Introducingnameandroleofvolunteer

Hi.My

name

is

Sally

and

Im

avolunteer

here

at

the

hospital.

Hi,Ms.X. MynameisSallyandImavolunteer.

Imheretohelpmakeyourstaymorepleasant.

Imheretohelpmakeyourstayascomfortableaspossible.


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CheckingID

MayIseeyourIDbandsoIcanmakesureImtalkingtotherightperson?

WouldyoumindreadingyourIDbandtomesoIcanmakesureImtalking

totherightperson?

TurningdownthevolumeonTV

MayIturndowntheTVsowecanheareachotherbetter?

DoyoumindifIturndownthevolumeontheTVsoIcanhearyoubetter?

Invitingoneselftositdown

MayIsitdownandvisitwithyouforawhile?

DoyoumindifIpullupachairandvisit?

Turningonlightsoropeningshades

Itsawfully

dark

in

here.

May

Iturn

the

lights

on

or

open

up

your

shades?

Doyouhaveenoughlight? MayIturnthelightonsoyoucanseebetter?

Askingabouttheirstay(patientsinthehospitaloftendonotliketobeasked

howtheyarefeeling)

Howisyourstaysofar?

IsthestafftreatingyouOK?

Howisthefood?

Isthereanythingwecandotomakeitbetterforyou?

Isthere

anything

we

can

do

to

improve

your

stay?

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.

Yournurse

recommended

we

do

some

exercises

together.

MayIaccompanyyoutothelounge?

Doyouneedtousetherestroom? MayIassistyouingettingthere?

Itsimportanttoexercise3timesaday. Letsworkonthatnow.

MealAssistance

MayIhelpyouopenanypackages? Cutanythingup?

Areyouhavinganydifficultyopeninganything? MayIhelpyou?

Wouldyoulikesomethingtodrinknow?

Idlove

to

get

that

for

you.

Let

me

quickly

check

with

nurse

to

make

sure

it

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.


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Patientisinpainorhasdiscomfort

Imsorrytoheartohearyouhavepainorareuncomfortable. Wedonot

wantyoutobeuncomfortable.

Howbadisyourpainonascaleof110,with1beingmildand10beingthe

worst?

Wheredoyouhurt?

Howlong

has

this

been

hurting?

Letmesharethiswithyournursesowecanhelpyou. (Pleasereportback

topatientwithanupdateandoffertoperformarelaxationexercise.)

Letsdosomerelaxationexercisestokeepyourmindoffofit. Then,you

candotheseonyourownwhenyouneedthem.

Patientiscomplaining

Imsorrythatthishappenedtoyou.Itisafrustratingsituation.Letmetell

yournurseandwhatwecandotomakeitbetterforyou. (Youmayoffera

voucher

from

the

service

recovery

toolkit

if

appropriate.)

Iwouldliketoapologizeonbehalfofthehospital.Thismustverydifficult

foryou.

Aboutfood

Ifyouwouldlike,Icangetyousomethingfromthecafeteriaforyouor

ordersomethingfromthekitchen.

AboutTV/DVD/Video

Letme

go

talk

to

the

clerk

to

correct

this

problem,

Ican

bring

the

channel

guidewhenIcomebackandwecangooverit.

Returningtoapatientsroomafterlookingintoasituationorjustasecondvisit

HiMs.X.Itsme,Sally,thevolunteer.WouldyoumindifIcheckyourID

bandagain?Ihavejustcomebacktoseeifthereisanythingthatyouneedor

wouldlike.Wouldyoulikemetorefillyourwaterpitcher?

HiMs.X.itsme,Sally,thevolunteer. Ijustspokeyournurseaboutyour

complaintand

we

are

doing

the

following

to

help

you.

Patienthasfamilymembersvisiting

Hi!ImSally.Iamavolunteerheretovisityou,Mr.T.Aretheseyourfriends

andfamily?(Thisisagoodleadintofindingoutmoreaboutthefamilyand


39/74


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.


40/74


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.


41/74


THIRDFLOOR

Geriatrics

DementiaResources

TheAlzheimers

Association

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


42/74


Oncology

NancysFriends/TheNancyKlauberForestFoundation

NancysFriendswasfoundedin2006byagenerousdonationfromtheNancyKlauber

ForestFoundation.

Theprogram

is

named

after

Nancy

Klauber

Forest,

aformer

cancer

patient

treated

here

atNewYorkPresbyterianHospital/WeillCornellMedicalCenter.Whileinthehospital,

Nancyhadalotofsupportbutsherealizednoteverypatientwassolucky.

Unfortunately,Nancypassedawayfromherdisease.Nancysfamilywantedtogiveback

tothehospitalandstartedaFoundationinhermemorytosupportcancerpatientsand

theirfamiliesduringtheirhospitalstay.

NancysfriendsandfamilycontinuetobeinvolvedwithNancysFriends.The

FoundationhostsAppreciationDaysforstaffandvolunteers,holdsannualfundraisers

fortheprogram,andcontinuestodonateitemsforpatientstoenjoy.Theknithats

availabletopatientsaredonatedthroughanannualfundraiserhostedbytheNancy

KlauberForest

Foundation.

KnitHats: handknithatsareavailablefordistribution.

NancysFriendsDVDcollectionandLibrary

ADVDlistisavailableforpatients.DVDscanbeborrowedandbookscanbegivenoutto

patients.

FormoreinformationontheNancyKlauberForestFoundation,pleasevisittheirwebsite

at:

www.nancysfoundation.org


43/74


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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