2/13/2017

1

A L E O N A R D O D A V I N C I

G U I D E T O

A S S E S S M E N T A N D

P R O B L E M S O L V I N G

R E S I D E N T H E A LT H S E R V I C E S A N D

C H A N G E O F C O N D I T I O N

C O N S U L T D E V E L O P E D U C A T E C O N S T R U C T

“ S H A P I N G S P A C E A N D S Y S T E M S F O R V I B R A N T A G I N G ”

M A R C H 9 , 2 0 1 7

O R E G O N H E A L T H C A R E A S S O C I A T I O NS P R I N G E X P O C O N F E R E N C E

C Y N T H I A M C D A N I E L M S N R N

E L D E RW I S E I N C

TODAY’S LEARNING OUTCOMES

• Explain the seven principles of da Vincian thinking and how to apply

them in critical thinking and problem solving.

• Discuss how da Vincian thinking helps one to address resident

change of condition assessments and complex care management.

• Explore personal thinking preferences and identify ways to enhance

critical thinking.

Discovery consists of seeing what

everybody has seen and thinking

what nobody has thought.

-Albert Szent-Gyorgyi

Y O U R B R A I N

I S M U C H B E T T E R

T H A N Y O U T H I N K

2/13/2017

2

C H A N G E O F C O N D I T I O N & R E S I D E N T M O N I T O R I N GT H E R U L E S

THE RULES – 411-054-0040SHORT TERM CHANGE OF CONDITION

• Short term change of condition – Change in health or function that is

expected to resolve or reverse with minimal intervention or in an established

predictable manner.

– Determine and document action or intervention.

– Communicate action or intervention to staff on all shifts.

– Document resident specific interventions and staff instructions as part of

the resident record.

– Minimum of weekly progress notes until the condition is resolved.

THE RULES – 411-054-0040SIGNIFICANT CHANGE OF CONDITION

• Significant change of condition – A major change from the most recent evaluation that

may affect multiple areas of function and/or health. A change that imposes a significant

risk on the resident.

– Evaluate resident

– Nurse referral for assessment and follow up

• Document findings, resident status, and interventions made as a result of the

assessment (and thinking)

– Documentation of change

– Communicate to staff

– Update the service plan

THE RULES – 411-054-0040MONITORING

• Monitor each resident specific to need and service plan.

• Train staff to identify changes in the resident’s physical, emotional, and mental

function.

• Train staff to document and report on the resident’s changes of condition.

• Have a reporting protocol with access to a designated staff person 24 hours a

day who can determine if the resident’s condition requires further action.

• Provide written communication of a resident’s change of condition, and any

required interventions, for caregivers on all shifts.

C H A N G E O F C O N D I T I O N & R E S I D E N T M O N I T O R I N GH O W W E D O I T N O W

G AT HE R

I N F O R M AT I ON

Admit Evaluation

Medication Administration

Record

24 hour report

Interim service plan

Alert charting

Incident reports

Incident report logs

Behavior monitoring

Pain monitoring

2/13/2017

3

H E R D I N G C AT S

WHAT WE COULD PROBABLY DO MORE OF…

MICHAEL J. GELB (2004)

GELB’S SEVEN DA VINCIAN PRINCIPLES

•Curiositá

•Dimostrazione

•Sensazione

•Sfumato

•Arte/Scienza

•Corporalitá

•Connessione

WHY

LEONARDO?

http://image.slidesharecdn.com/leonardo-da-vinci-ppt-1204527819891627-

4/95/leonardo-da-vinci-ppt-2-728.jpg?cb=1204499021

2/13/2017

4

http://image.slidesharecdn.com/leonardo-da-vinci-ppt-1204527819891627-

4/95/leonardo-da-vinci-ppt-4-728.jpg?cb=1204499021

Art is an 85 year old former

pilot in the Korean War.

His plane was shot out

from under him twice.

Fiercely independent, he

misses his wife of 54 years.

He loves golf but is not able to

play anymore. Art is having

some challenges with balance

and fell yesterday. He does not like

to wait for care staff to help him.

He is hard of hearing and wears

glasses.

Art

An active 88 year old, Lisa loves to walk and pull weeds in the garden. She needs a walker although she often forgets to use it. She worked as a model and enjoys getting dressed up and going out. Lisa has Alzheimer’s dementia and recently started leaving the community.

Yesterday she was found 10 blocks away and everyone is now concerned for her safety.

The challenge - Lisa always wants to “go.”

CURIOSITÁ

An insatiable

curious approach

to life and an

unrelenting quest

for continuous

learning.

• What is the problem? Are there underlying

issues? What haven’t I considered? What if?

• When did it start? When does it happen?

When doesn’t it happen?

• Who cares about it? Who is affected by it?

Who can solve it?

• How does it happen? How can I get more

information? How can it be changed? How

can I know it’s been solved? How come?

• Where does it happen? Where did it start?

Where else has this happened?

• Why is it important? Why did it start? Why

does it continue? Why, why, why, why, why…

DIMOSTRAZIONE

A commitment to test knowledge through

experience, persistence,

and a willingness to learn

from mistakes.

• Test every idea.

• Don’t take anything for granted.

• Try new approaches to solve old problems.

• Identify evidenced-based resources to support your solution.

• Experiment with hypothesis – “if we implement this intervention, then this is what we expect to happen.”

• Be a Devil’s advocate. Make strong arguments against the solution or invention and then defend your solution.

2/13/2017

5

SENSAZIONEThe continual

refinement of

the senses,

especially sight,

as the means

to enliven

experience.http://www.nature.com/scientificamerican/journal/v308/n1/images/scientificamerican0113-72-I2.jpg

SYNESTHESIA AT WORK

PR OM OTIN G CR EATIVIT Y, IN N OVATION , AN D IN VOLVEM EN T

DRAW MUSICSHAPE THE

INVISIBLE

MAKE SOUNDS OF COLOR

SFUMATO

“Going up in Smoke”

A willingness to

embrace ambiguity,

paradox, and

uncertainty.

• Curiositá Equals Uncertainty

• Make Friends with Ambiguity

• Cultivate confusion endurance

• Meditate on Mona

• Embody Mona’s smile

• Trust your intuition

ARTESCIENZAThe development

of balance

between art and

science, logic and

imagination.

“Whole-brain”

thinking.

http://assets4.bigthink.com/system/idea_thumbnails/45642/size_1024/rightbrain.jpg?1344535021

- Leonardo da Vinci

2/13/2017

6

LEFT BRAINED

• I like details

• I am almost always on time

• I rely on logic

• I am skilled at math

• I am organized and disciplined

• I like lists

RIGHT BRAINED

• I am highly imaginative

• I am good at brainstorming

• I love to doodle

• I often say or do the unexpected

• I rely on intuition

• I often lose track of time

U S I N G M I N D

M A P P I N G F O R

P R O B L E M S O L V I N G

CORPORALITÁ

The cultivation of

grace,

ambidexterity,

fitness, and

poise.

DA V I N C I ’S RU L E S

F O R G O O D

H E A LT H• Beware of anger and avoid grievous moods

• Rest your head and keep your mind cheerful

• Be covered well at night

• Exercise moderately

• Pay attention to diet, eat simple

• Keep upright when you rise from the table

• Do not be with the belly upward or the head lowered

• Chew well

• Go to the toilet regularly

•Develop body awareness

•Relearn poise

•Get enough sleep

•Cultivate ambidexterity

•Learn to juggle

CONNESSIONE

A recognition of and

appreciation for the

interconnectedness of

all things and

phenomena.

Systems Thinking.

2/13/2017

7

http://www.chumans.com/blog/wp-content/uploads/2012/03/Systems-Thinking.jpg

SYSTEMS THINKING

•Taking vast amounts of information and creating lists,

routines, organization, and interventions/solutions.

•Creating systems and recognizing patterns.

•Recognizing the connectedness of everything –

complexity theory.

SYSTEMS THINKING

• Characterized by the fact that there often aren’t simple, linear

solutions to problems – and problems are evaluated in the context of

the whole system.

• It is a basic philosophy of problem solving – it focuses on system

issues rather than immediately observable symptoms.

• Root cause analysis should be conducted from a systems thinking

viewpoint, with knowledge of complex systems phenomena.

• The focus should be on understanding the system rather than

fixating on blame and human error.

N E W S Y S T E M S T H I N K I N G – A L I T T L E F I L M A B O U T A B I G I D E A

https://s-media-cache-ak0.pinimg.com/originals/ec/80/1f/ec801f38094beb2833e56fb35c944e69.gif

THE RIPPLE EFFECT

One small change can have an

enormous impact.

“Reality is made up of circles,

but we see straight lines.”

Peter Senge

2/13/2017

8

• Curiositá – Am I asking the right questions?

• Dimostrazione – How can I improve my ability to learn from my

mistakes and experiences? How can I develop my independence of

thought?

• Sensazione –What is my plan for sharpening my senses?

• Sfumato – How can I strengthen my ability to hold creative tension to

embrace the major paradoxes of life?

• Arte/Scienza – Am I balancing Art and Science in my problem solving?

• Corporalitá – How can I nurture the balance of body and mind?

• Connessione – How do all the above elements fit

• together? How does everything connect to everything else?

T H A N K YO U !

Cynthia McDaniel MSN RN

Nurse Consultant/Gerontologist

541-419-4036

cmcdaniel@elderwiseinc.com

ElderWise Inc