February 2013 Issue 26 An independent newsletter for people working in Aged Care In this issue: “So - Rewrite the Manual!” The following is a must read letter written by the wife of a gentleman with dementia. She
• So - re-write the hits the nail on the head and should make us all think.
Things happen now – life is not predictable. Rules do not matter, time does not
matter – well not to the patients anyway.
• Building a strong Rules are made by “Ordinary People”, often applied by “Ordinary People” to
people who are now “Extra – Ordinary”.
Children learn from their mistakes as they remember the consequences of
to breaking rules. These Patients do not remember – they do not remember how to
There will be falls – They will not understand how it happened, what caused the
As a consequence they may lash out at other patients – blaming the nearest
Rod was in a “don’t touch me” mood – He was agitated – He would not go near
the others even me. Then I saw the scrape on his leg – He has, no doubt, got too
near the side of the step – He felt pain – he would assume he’d been hit and
blamed whoever was in the vicinity instead of his ‘carelessness’ as he once
Time no longer means anything. It does not mean what it does to you and me.
We start with breakfast, we have lunch, we have tea interspersed with various
snacks. It is now just food to Rod. It doesn’t matter when or how anymore.
He loves his puddings and doesn’t want the savoury taste of the main meal.
Jo has a solution – IT WORKS, 2 spoons pudding/one spoon main/2 spoons
“Just a spoonful of sugar helps the medicine go down”
A brilliant solution to a problem. Clever Jo
firstname.lastname@example.org Who cares if it is not the way “it is supposed to be done”
So---------Rewrite the Manual ------------
mobile: 021 311055 This is a Dementia Manual now
I don’t, Rod doesn’t (every mouthful now tastes like pudding!!) He is happy.
Yet another confirmation I made the right choice (as if I had ever doubted as I haven’t!) Rod’s needs are being met in every way possible at Lyndale Manor and more!! Rosamunde SCABIES TREATMENT I was made aware by one of my RN readers, Carolyn, that there is this oral treatment for scabies which they have used very successfully in their facility during a recent outbreak. I verified with my Pharmacy friend, Billy, and he confirmed this and has shared the following with me. Thank you both Carolyn and Billy.
Ivermectin is an established treatment for scabies and is funded by PHARMAC –
it is said to be as effective as topical treatments, but easier to administer if you
have a large outbreak. It requires a Special Authority approval before it will be
funded. The GP can prescribe for a single patient, or for multiple residents
(probably the more common scenario) - the GP can obtain a supply on a
practitioners supply order (PSO) or bulk supply order (BSO), provided s/he has
applied for a Special Authority for at least one resident of a facility.
Here is the detail from the Pharmaceutical Schedule:
IVERMECTIN – Special Authority see SA1225 below – Retail pharmacy
Tab 3 mg – Up to 100 tab available on a PSO.17.20 4 Stromectol
PSO for institutional use only. Must be endorsed with the name of the
If you can't see
institution for which the PSO is required and a valid Special Authority for
the bright side of life, polish the
Ivermectin available on BSO provided the BSO includes a valid Special
Authority for a patient of the institution.
For the purposes of subsidy of ivermectin, institution means age related
residential care facilities, disability care facilities or penal institutions.
SA1225 Special Authority for Subsidy Initial application — (Scabies) from any relevant practitioner. Approvals valid
for 1 month for applications meeting the following criteria:
1 Applying clinician has discussed the diagnosis of scabies with a dermatologist,
infectious disease physician or clinical microbiologist; and
2.1.1 The patient is in the community; and
2.1.2 Any of the following: 126.96.36.199 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 188.8.131.52 The community patient is physically or mentally unable to comply with the application instructions of topical therapy; or 184.108.40.206 The patient has previously tried and failed to clear infestation using topical therapy; or 2.2 All of the following: 2.2.1 The Patient is a resident in an institution; and 2.2.2 All residents of the institution with scabies or at risk of carriage are to be treated for scabies concurrently; and 2.2.3 Any of the following: 220.127.116.11 Patient has a severe scabies hyperinfestation (Crusted/ Norwegian scabies); or 18.104.22.168 The patient is physically or mentally unable to comply with the application instructions of topical therapy; or 22.214.171.124 Previous topical therapy has been tried and failed to clear the infestation. Note: Ivermectin is no more effective than topical therapy for treatment of standard scabies infestation EFFECTIVE NEGOTIATIONS
Being a manager of a facility has its challenges. I am sure that most managers
shake their head in agreement when they read this!
You often wear many hats and you have to be a champion negotiator as you are dealing with often many different people, who all have their own expectations.
It is your responsibility to keep everything running smoothly without conflicts if
possible! An enormous task and this is a skill that you don’t learn overnight. Most
managers learn this through experience or, sadly, finding out the hard way.
If you can relate to any of the following statements then read on.
• Are people taking advantage of you? • Is it difficult to get people to help you achieve something especially
people over whom you have no direct authority?
• Is it a constant struggle to get the resources you need?
Don't set your goals by what
Effective negotiation helps you to resolve situations where what you want is in conflict with what someone else wants.
It is important to find a solution that is acceptable to all parties. Ideally with
everybody feeling like the “winner”.
only you know what is best for
There is no one way that fits all as a lot depends on the circumstances.
There are situations during which it is alright to play ‘hardball” but only if it is around a once off negotiation and you will not have dealings with the other person again i.e large sale negotiations. But if it relates to resolving disputes with people with whom you have an ongoing relationship you can undermine trust and teamwork if you take this stance. Playing “hardball” can turn on you or have a negative effect on relationships. Honesty and openness are almost always the best policies. NEGOTIATING SUCCESSFULLY
To be successful you have to carefully explore your own and the other person’s position. Your goal is finding a mutually acceptable compromise that gives you both as much of what you want as possible. People's positions are rarely as fundamentally opposed as they may initially appear – the other person may have very different goals from the ones you expect! Ideally the other person wants what you are prepared to trade, and that you are prepared to give what the other person wants. If this is not the case and one person must give way, then it is fair for this person to try to negotiate some form of compensation for doing so – the scale of this compensation will often depend on the factors we discussed above. Ultimately, both sides should feel comfortable with the final solution! Achieving a win-win outcome is the ultimate aim. All the best! DIETITIANS REVIEW
I am often asked if I know of a good service for a reasonable price to review menus and have input in special diets. If you use a dietitian for a good price and you don’t mind sharing your information please let me know. As this information will help other providers. Thanking you in advance
BUILDING A STRONG TEAM
There will be times that conflicts are inevitable in a work place.
Not everybody has the same point of view about everything all the time and
under certain circumstances it is these differences that can turn into a conflict.
How a manager handles these situations determines whether it works to the
team's advantage or contributes to its demise.
You can choose to ignore it, complain about it, blame someone for it, but if you
want to make the team stronger than the best way of dealing with it is to clarify
what is going on, and attempt to reach a resolution through negotiation or
Dealing with it in a constructive and planned manner will prevent you from being
A conflict doesn’t always have to be a bad thing.
The important thing is to maintain a healthy balance of constructive difference of
opinion, and avoid negative conflict that's destructive and disruptive.
Maintaining that balance requires well-developed team skills, particularly the
ability to resolve conflict when it does happens, and the ability to keep it healthy
and avoid conflict in the day-to-day course of team working.
Resolving Conflict We are most
A conflict involves our emotions, perceptions, and actions; we experience it on
effective as a team all three levels, and we need to address all three levels to resolve it. We must
replace the negative experiences with positive ones.
The conflict has to be acknowledged before it can be managed and resolved.
Ignoring it does not make it go away. Once the team agrees there is an issue it
embarrassment and disagree
As a team, discuss the impact the conflict is having on team dynamics and
Everyone involved must agree to resolve the conflict.
The most important step is for everyone to keep communications open. The people involved need to talk about the issue and discuss their strong feelings. Really listening is most important because to move on you need to really
understand where the other person is coming from. Understand the Situation Allow each person to voice their point of view establishing the true nature of the conflict. Clarify people's positions. Each position needs to be clearly identified and articulated by those involved. This alone can go a long way to resolve the conflict, as it helps the team see the facts more objectively and with less emotion. List facts, assumptions and beliefs underlying each position – What does each group or person believe? What do they value? Where do they base this on? What decision-making criteria and processes have they employed? Which facts and assumptions are true? Which are the more important to the outcome? Is there additional, objective information that needs to be brought into the discussion to clarify points of uncertainly or contention? Is additional analysis or evaluation required? By considering the facts, assumptions, beliefs and decision making that lead to other people's positions, the group will gain a better understanding of those positions. Not only can this reveal new areas of agreement, it can also reveal new ideas and solutions that make the best of each position and perspective. Take care to remain open, rather than criticize or judge the perceptions and assumptions of other people. Everyone needs to feel heard and acknowledged if a workable solution is to be reached Building a strong team cont’d Reach Agreement
When everybody understands the others' positions, the team can decide what
decision or course of action is to be taken. When all the facts are considered, it's
easier to see the best of action and reach agreement.
If further analysis and evaluation is required, agree what needs to be done, by
when and by whom. Make sure the team is committed to work with the outcome
of the proposed analysis and evaluation.
When conflict is resolved take time to celebrate and acknowledge the
contributions everyone made toward reaching a solution. This can build team
cohesion and confidence in their problem solving skills.
• Deal with a conflict immediately – don’t ignore it.
• Be open – if people have issues, they should be able to express these.
building block of
• Encourage clear communication. • Listen! – paraphrasing, clarifying, questioning.
• Ask yourself "why" on a regular basis.
• Don’t let conflict get personal – stick to facts and issues, not
for a leader to promote the feeling that every human being is unique and adds
• Ensure confidentiality. Team issues stay within the team
Dealing with Conflict. Conflict can be constructive as long as it is managed and dealt with directly and
quickly. By respecting differences between people, being able to resolve conflict
when it does happen, and working to prevent it, a healthy and creative team
atmosphere can be maintained. Remain open to other people's ideas, beliefs,
and assumptions. This can lead to new and innovative solutions, and healthy
WISE WORDS "In Life you will realize that there is a purpose for everyone you meet.Some will test you, some will use you and some will teach you.But the most important are the ones who bring out the best in you, respect you and accept you for who you are.Those are the ones worth keeping around."NEWSLETTER BACK ISSUES
A quick reminder regarding the newsletter. All the issues are available on my website with an alphabetically index list per year. So if you ever misplace your issue or delete it than it is always available to you. I received many emails of readers telling me that this index has been of great help to find certain topics. Thank you for letting me know.
RELAY FOR LIFE Not long to go now As you will know by now I have a strong affiliation with the Cancer Society, especially with their two main annual events; Daffodil Day and Relay for Life. As the committee chair I like to make as many people as possible aware of these great events and knowing the number of readers of this newsletter I hope to motivate you to participate. It is so good to see some facilities participating one way or another, either having a team signed up or fundraising and supporting us. Thanks heaps for that. So if you can not physically be there with us on the track than support by making a donation. You can mail a cheque to me with your details (for tax receipt) made out to the Cancer Society and I will make sure it gets there. Thanking you in advance on behalf of all the people affected by this horrible disease. Lets all make a difference in the fight against it! What is Relay for Life? Relay For Life is the Cancer Society’s signature community activity. Often
described as a life-changing experience, Relay is an opportunity to celebrate
cancer survivors and caregivers; remember loved ones lost to cancer; and fight back against a disease that affects ONE IN THREE New Zealanders. Relay is for people of all ages and fitness levels. Anyone can take part in Relay For Life. Relay is a family-friendly event and teams come from all parts of the community. What happens before Relay? Each team raises funds and awareness to support the work of the Cancer
Society. Local organising committees provide information, ideas and encouragement to help Relay teams every step of the way. What happens at Relay? Relay begins with a moving Opening Ceremony, with cancer survivors and their caregivers and supporters leading the first lap of the event. Next, team members take to the track with most walking, while some prefer to jog or run. When they’re not on the track, participants enjoy a festive, family-friendly environment with heaps of activities and entertainment. At dusk a Candlelight Ceremony is held. This is a time to remember loved ones who have been affected by cancer. Decorated candle bags are placed around the track, and their light emits a warm glow throughout the Relay venue. Team members continue to walk/jog through the night. This symbolises the fact that cancer never sleeps. At least one member of the team is on the track at all times. Quiet activities keep teams going through the night. In the morning, after a healthy breakfast, teams come together for an inspiring Closing Ceremony. This is a time to celebrate accomplishments and acknowledge the community’s support and commitment. Relay For Life is much more than a fundraiser. Relay For Life enables communities to:
remember the people we've lost to cancer.
educate people about detecting cancer early.
educate people about ways to reduce the risk of cancer.
recruit new volunteers for the Cancer Society's local programmes and services.
For RELAY FOR LIFE events throughout New Zealand please check the website http://www.relayforlife.org.nz/event/event SOMETHING TO THINK ABOUT
Imagine that you had won the following prize in a contest: Each morning your
bank would deposit $86,400.00 in your private account for your use.
However, this prize has rules, just as any game has certain rules. The first set of
Everything that you didn't spend during each day would be taken away from you.
You may not simply transfer money into some other account. You may only
Each morning upon awakening, the bank opens your account with another
Life is not a race, but a journey - to
The bank can end the game without warning; at any time it can say, Its over, the
be savoured each game is over! It can close the account and you will not receive a new one. step of the way.
You would buy anything and everything you wanted right? Not only for yourself,
but for all people you love, right? Even for people you don't know, because you couldn't possibly spend it all on yourself, right?
You would try to spend every cent, and use it all, right?
ACTUALLY This GAME is REALITY!
Each of us is in possession of such a magical bank. We just can't seem to see it.
The MAGICAL BANK is TIME!
Each morning we awaken to receive 86,400 seconds as a gift of life, and when
we go to sleep at night, any remaining time is NOT credited to us
What we haven't lived up that day is forever lost. Yesterday is forever gone. Each morning the account is refilled, but the bank can dissolve your account at any time. WITHOUT WARNING. SO, what will YOU do with your 86,400 seconds? Those seconds are worth so much more than the same amount in dollars. Think about that, and always think of this: Enjoy every second of your life, because time races by so much quicker than you think. So take CARE OF YOURSELF, BE HAPPY, LOVE DEEPLY AND ENJOY LIFE! Here's wishing you a wonderful and beautiful day. Start spending. REMEMBER! Send your feedback, suggestions and articles showcasing your local, regional and workforce activities for publication in future issues. This brings me to the end of this issue. I hope you enjoyed reading it and welcome any feedback you have. With your help I hope to keep this a very informative newsletter with something for everyone. SUBSCRIBE OR UNSUBSCRIBE
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Tassone P, Tagliaferri P, Rossi M, Calimeri T, Bulotta A, Abbruzzese A, Caraglia M, Curr Cancer Drug Targets. 2009 Nov;9(7):854-70. Marra M, Abbruzzese A, Addeo R, Del Prete S, Tassone P, Tonini G, Tagliaferri P, Curr Cancer Drug Targets. 2009 Nov;9(7):791-800. Tagliaferri P, Ventura M, Baudi F, Cucinotto I, Arbitrio M, Di Martino MT, Tassone P. Blotta S, Tassone P, Prabhala RH, Tagliaferri P
Häufig gestellte Fragen (FAQ) Wofür steht "XSTM"? "XSTM" leitet sich von dem englischen Wort "Excess" ab und symbolisiert die Fähigkeit, über sich selbst hinauszuwachsen und die eigenen Grenzen zu überschreiten. Wird die energiesteigernde Wirkung reduziert, wenn das Produkt täglich konsumiert wird? Nein. Wie viel Koffein ist in den XSTM Power Drinks