The Enhancement Project: A Program to

Improve the Quality of Residents' Lives

The Enhancement Project helped certified nursing assistants better meet psychosocial needs of residents. MARY BAYER, LEON BRESLOFF, AND DARLENE CURLEY Current staffing patterns in nurs- ing homes are designed to ensure that residents receive adequate physical care but not much beyond that. Nursing assistants are usually so busy trying to meet physical needs that they seldom have time and oftenlack the training to meet psychosocial needs (1).

To upgrade resident care, the ad- ministration of the Sandy River Nursing Care Center of Farming- ton, Maine applied for and was awarded a grant for Innovative Practices in Nursing Homes from the Maine Department of Human Services. The grant funded the "Enhancement Project," a one- year staff-development program designed to improve the quality of

Mary Bayer, RN, (2, BSN, is co-owner/ developer and director of nursing and health-care services at Sandy River Nurs- ing Care Center, Farmington, Maine. Leon Bresloff, RN, (2, MA, is co-owner/developer and administrator for the Center. Darlene Curley, RN, MS, is an independent nurse consultant.

resident care by extending training in psychosocial needs for the pri- mary care givers-----certified nursing assistants (CNAs)--as well as in- crease their job satisfaction.

The grant paid for the services of a nurse consultant and the salary of one full-time CNA and covered secretarial and miscellaneous costs. The directors of nursing, social ser- vices, and recreational therapy coordinated the program and served as clinical resource people to "Enhancement CNAs."

The new program was well publi- cized both inside and outside the Center. Program participants were chosen from the 7-3 tour after the nurse consultant had worked out program details and reviewed the results of two attitude surveys. The surveys asked residents how they felt about the quality of their inter- actions with CNAs and nursing as- sistants about levels of job satisfac- tion. The Project Design

Once every ten days, each En- hancement CNA came to work out of uniform and donned a gold- colored lab coat with the Project in- signia, a "smiley" face. On this spe- cial day, the CNA was n o t allowed to carry out any physical nursing care. Instead, he or she gave psy- chosocial nursing care, including eating and socializing with resi- dents, letter writing, helping trans-

port residents to and from activi- ties, and taking part in recreational therapy programs and small group work. During the life of the project, participants had, among other spe- cial assignments, opportunities to work with hospice volunteers, at- tend total health-care planning meetings, and participate in dis-

Celebrat ing the first snowstorm of the season, CNA Sheree Metcal f and Hazel James prepare for an indoor snowbal l f ight in the activi ty room.

192 Geriatric Nursing July/August 1986

The Enhancement Project:A Program to

Improve the Quality ofResidents' Lives

The EnhancementProject helped certifiednursing assistants bettermeet psychosocialneeds of residents.MARY BAYER, LEONBRESLOFF, AND DARLENECURLEY

Current staffing patterns in nurs­ing homes are designed to ensurethat residents receive adequatephysical care but not much beyondthat. Nursing assistants are usuallyso busy trying to meet physicalneeds that they seldom have timeand often lack the training to meetpsychosocial needs (1).

To upgrade resident care, the ad­ministration of the Sandy RiverNursing Care Center of Farming­ton, Maine applied for and wasawarded a grant for InnovativePractices in Nursing Homes fromthe Maine Department of HumanServices. The grant funded the"Enhancement Project," a one­year staff-development programdesigned to improve the quality of

Mary Bayer, RN, C, BSN, is co-owner/developer and director of nursing andhealth-care services at Sandy River Nurs­ing Care Center, Farmington, Maine. LeonBreslotr, RN, C, MA, is co-owner/developerand administrator for the Center. DarleneCurley, RN, MS, is an independent nurseconsultant.

192 Geriatric Nursing July/August 1986

resident care by extending trainingin psychosocial needs for the pri­mary care givers---certified nursingassistants (CNAs)-as well as in­crease their job satisfaction.

The grant paid for the services ofa nurse consultant and the salary ofone full-time CNA and coveredsecretarial and miscellaneous costs.The directors of nursing, social ser­vices, and recreational therapycoordinated the program andserved as clinical resource people to"Enhancement CNAs."

The new program was well publi­cized both inside and outside theCenter. Program participants werechosen from the 7-3 tour after thenurse consultant had worked outprogram details and reviewed theresults of two attitude surveys. Thesurveys asked residents how theyfelt about the quality of their inter­actions with CNAs and nursing as­sistants about levels of job satisfac­tion.

The Project Design

Once every ten days, each En­hancement CNA came to work outof uniform and donned a gold­colored lab coat with the Project in­signia, a "smiley" face. On this spe­cial day, the CNA was not allowedto carry out any physical nursingcare. Instead, he or she gave psy­chosocial nursing care, includingeating and socializing with resi­dents, letter writing, helping trans-

port residents to and from activi­ties, and taking part in recreationaltherapy programs and small groupwork. During the life of the project,participants had, among other spe­cial assignments, opportunities towork with hospice volunteers, at­tend total health-care planningmeetings, and participate in dis-

Celebrating the first snowstorm of theseason. CNA Sheree Metcalf and HazelJames prepare for an indoor snowball fightin the activity room.

charge-planning meetings. It was hypothesized that CNAs

would learn to give better care and socialize with residents if they re- ceived more guidance in caring for psychosocial needs and had time to visit frequently. Since one of our primary objectives was to help nursing assistants become more sensitive to residents' social needs, we hoped that proximity would give birth to empathy. For example, En- hancement CNAs in the program would now have the experience of beingserved according to the con- venience of the staff and would per- haps be more able to put them- selves in the resident's shoes.

By including Enhancement CNAs in interdisciplinary team care-planning sessions and dis- charge-planning meetings with res- idents and families, we hoped to give them a more comprehensive picture of the American Nurses' Association's (ANA) standards of gerontological nursing.

Finally, by encouraging them to visit hospitalized residents across the street or to accompany them by ambulance to the emergency room, we hoped nurse assistants would better understand crisis and trans- fer shock, as well as feel capable of giving emotional support to some- one needing to see a familiar face.

Assigned Articles The director of nursing, who is

ANA certified in both psychiatric/ mental health nursing and geronto- logical nursing, assigned reading for the beginning of every tour of duty. Articles dealt with many is- sues, including feelings about de- pendence and living in a nursing home and putting family members in a nursing home. When the nurs- ing director wanted to make a par- ticular point, she published an edi- torial in the Center's newsletter and then assigned that as reading.

Supervision and Journal Keeping Every morning, after completing

the reading, the Enhancement CNA for that day met briefly with the directors of nursing, social ser- vice, and recreational therapy. At that time they reviewed activities

Enhancement CNA Dan Hall talks with some Center residents over a group lunch.

planned for the day. Toward the end of their tour, this group met again for a short "debriefing." Then the CN.A commented on the reading and explained how he or she had used it that day.

On alternating months partici- pants met with the administrator and directors of nursing, social ser- vice, and recreational therapy and with the nurse consultant. Based on responses of the participants, the

pressed feelings of insecurity and shyness. They felt they lacked di- rection and found it hard to move from being highly supervised and task oriented to being flexible and self-directed. While they appeared to enjoy the program, by the end of the first month they still felt awk- ward and guilty about "hanging out" (because they were not al- lowed to give physical care) while their co-workers were "working."

"You'd never think this was a nursing home. You'd think it was high noon in downtown

Farmington," said one visitor arriving at 2 AM.

consultant made recommendations to administration about Project modifications and improvements. In addition, department heads and head nurses made sure they fre- quently touched base with Project CNAs to offer encouragement and advice.

At the start of the Project, parti- cipants were given a spiral note- book and asked to keep a journal. Journals proved to be useful not only to the researchers, but also to the nursing assistants, who could see their awareness and self-confi- dence growing. Getting Off the Ground

In their first discussion with the nursing consultant, participants ex-

One person did drop out. She was excellent in giving physical care but felt awkward in the group set- ting. She was quietly supportive af- ter returning to her regular tour of duty. Two others in the original group resigned: One left her hus- band and moved away as a result of listening to residents tell how they had stayed in abusive, growth- denying relationships (an outcome we hadn't anticipated!). The other, who gained self-confidence through program participation, took a pri- vate-duty position. These three people were replaced.

Six-Month Evaluation Six months later, we realized

that the Enhancement Project was

Enhancement CNA Dan Hall talks with some Center residents over a group lunch.

"You'd never think this was a nursing home.You'd think it was high noon in downtown

Farmington," said one visitor arriving at 2 AM.

charge-planning meetings.It was hypothesized that CNAs

would learn to give better care andsocialize with residents if they re­ceived more guidance in caring forpsychosocial needs and had time tovisit frequently. Since one of ourprimary objectives was to helpnursing assistants become moresensitive to residents' social needs,we hoped that proximity would givebirth to empathy. For example, En­hancement CNAs in the programwould now have the experience ofbeing served according to the con­venience of the staff and would per­haps be more able to put them­selves in the resident's shoes.

By including EnhancementCNAs in interdisciplinary teamcare-planning sessions and dis­charge-planning meetings with res­idents and families, we hoped togive them a more comprehensivepicture of the American Nurses'Association's (ANA) standards ofgerontological nursing.

Finally, by encouraging them tovisit hospitalized residents acrossthe street or to accompany them byambulance to the emergency room,we hoped nurse assistants wouldbetter understand crisis and trans­fer shock, as well as feel capable ofgiving emotional support to some­one needing to see a familiar face.

Assigned Articles

The director of nursing, who isANA certified in both psychiatric/mental health nursing and geronto­logical nursing, assigned readingfor the beginning of every tour ofduty. Articles dealt with many is­sues, including feelings about de­pendence and living in a nursinghome and putting family membersin a nursing home. When the nurs­ing director wanted to make a par­ticular point, she published an edi­torial in the Center's newsletterand then assigned that as reading.

Supervision and Journal Keeping

Every morning, after completingthe reading, the EnhancementCNA for that day met briefly withthe directors of nursing, social ser­vice, and recreational therapy. Atthat time they reviewed activities

planned for the day. Toward theend of their tour, this group metagain for a short "debriefing."Then the CNA commented on thereading and explained how he orshe had used it that day.

On alternating months partici­pants met with the administratorand directors of nursing, social ser­vice, and recreational therapy andwith the nurse consultant. Based onresponses of the participants, the

consultant made recommendationsto administration about Projectmodifications and improvements.In addition, department heads andhead nurses made sure they fre­quently touched base with ProjectCNAs to offer encouragement andadvice.

At the start of the Project, parti­cipants were given a spiral note­book and asked to keep a journal.Journals proved to be useful notonly to the researchers, but also tothe nursing assistants, who couldsee their awareness and self-confi­dence growing.

Getting Off the Ground

In their first discussion with thenursing consultant, participants ex-

pressed feelings of insecurity andshyness. They felt they lacked di­rection and found it hard to movefrom being highly supervised andtask oriented to being flexible andself-directed. While they appearedto enjoy the program, by the end ofthe first month they still felt awk­ward and guilty about "hangingout" (because they were not al­lowed to give physical care) whiletheir co-workers were "working."

One person did drop out. She wasexcellent in giving physical carebut felt awkward in the group set­ting. She was quietly supportive af­ter returning to her regular tour ofduty. Two others in the originalgroup resigned: One left her hus­band and moved away as a result oflistening to residents tell how theyhad stayed in abusive, growth­denying relationships (an outcomewe hadn't anticipated!). The other,who gained self-confidence throughprogram participation, took a pri­vate-duty position. These threepeople were replaced.

Six-Month Evaluation

Six months later, we realizedthat the Enhancement Project was

Geriatric Nursing July/August 1986 193

CNA Lisa Whit ley chats with resident Eva Brady during a manicure.

Alma Clements listens attentively as CNA Diane Currier reads a letter.

working even better than we had hoped. Enhancement CNAs were meeting the psychosocial needs of residents with a "'Dear Abby" group, impromptu birthday cele- brations, discussion groups, craft and exercise groups, and card games, and by filling in for volun- teers who were absent and thus not available to carry out planned pro- grams. CNAs' input into interdisci- plinary team care-planning meet- ings was valuable, and residents were more willing to attend if a

CNA they knew was there too. Residents, staff, and community

became more aware of the Project after six months, and the gold jack- ets were readily recognized by resi- dents' families. CNAs at the same time became more confident, crea- tive, and enthusiastic. The lan- guage changed from "the resi- dents" to "our residents." Resi- dents and families referred to parti- cipants very often by name and Ihey, in turn, expressed pleasure in knowing the personal history of so

many residents. One CNA spent the day photographing residents and then developed and printed the pictures and gave them to residents as gifts for their children.

Halfway through the Project, CNAs on the 3-11 and 11-7 tour were clamoring to participate and clearly were being affected by the Project although they weren't di- rectly involved. More activity was apparent during "down times" (for example, between 4:00-5:00 PM on the 3-11 tour), CNAs involved themselves in the talking-book pro- gram or in quiet conversation with residents rather than talked with one another. Residents who couldn't sleep at night were often seen visiting at the desk or having a warm drink with staff. A funeral director who came in one morning at 2 AM when several hospice-vol- unteer residents were up helping staff comfort a bereaved family commented, "You'd never know this was a nursing home. You'd think it was high noon in downtown Farmington."

CNAs were very frank in their journals and were relieved that it was "safe to be critical." Conse- quently more trust developed be- tween managers and staff. Journal entries showed an appreciation of knowledge gained from assigned reading and discussions. CNAs de- veloped more insight, into their own feelings and how their own lives and situations could affect their performance at work.

Increased activities generated by the Project improved the quality of residents' lives in many ways. At- tendance at "coffee club" and other social activitier was high and con- tinued to grow. The number of people coming to exercise group quadrupled. CNAs became more sensitive to the feelings of residents, and more of their important special needs were met. Those in the hospi- tal also received emotional support from Center staff.

One obvious result of heightened awareness of the need to provide choices was that staff no longer fixed" residents' coffee and set it down in front of them. Instead, cups, spoons, a bowl of sugar, and a

Alma Clements listens attentively as CNA Diane Currier reads a letter.

CNA Lisa Whitley chats with resident Eva Brady during a manicure.

many residents. One CNA spentthe day photographing residentsand then developed and printed thepictures and gave them to residentsas gifts for their children.

Halfway through the Project,CNAs on the 3-11 and 11-7 tourwere clamoring to participate andclearly were being affected by theProject although they weren't di­rectly involved. More activity wasapparent during "down times" (forexample, between 4:00-5:00 PM onthe 3-11 tour), CNAs involvedthemselves in the talking-book pro­gram or in quiet conversation withresidents rather than talked withone another. Residents whocouldn't sleep at night were oftenseen visiting at the desk or having awarm drink with staff. A funeraldirector who came in one morningat 2 AM when several hospice-vol­unteer residents were up helpingstaff comfort a bereaved familycommented, "You'd never knowthis was a nursing home. You'dthink it was high noon in downtowIlFarmington."

CNAs were very frank in theirjournals and were relieved that itwas "safe to be criticaL" Conse­quently more trust developed be­tween managers and staff. Journalentries showed an appreciation ofknowledge gained from assignedreading and discussions. CNAs de­veloped more insigh~ into their ownfeelings and how their own livesand situations could affect theirperformance at work.

Increased activities generated bythe Project improved the quality ofresidents' lives in many ways. At­tendance at "coffee club" and othersocial activitie: was high and con­tinued to grow. The number ofpeople coming to exercise groupquadrupled. CNAs became moresensitive to the feelings of residents,and more of their important specialneeds were met. Those in the hospi­tal also received emotional supportfrom Center staff.

One obvious result of heightenedawareness of the need to providechoices was that staff no longerfixed' residents' coffee and set itdown in front of them. Instead,cups, spoons, a bowl of sugar, and a

CNA they knew was there too.Residents, staff, and community

became more aware of the Projectafter six months, and the gold jack­ets were readily recognized byresi­dents' families. CNAs at the sametime became more confident, crea­tive, and enthusiastic. The lan­guage changed from "the resi­dents" to "our residents." Resi­dents and families referred to parti­cipants very often by name and!hey, in turn, expressed pleasure inknowing the personal history of so

working even better than we hadhoped. Enhancement CNAs weremeeting the psychosocial needs ofresidents with a "Dear Abby"group, impromptu hirthday cele­brations, discussion groups, craftand exercise groups, and cardgames, and by filling in for volun­teers who were absent and thus notavailable to carry out planned pro­grams. CNAs' input into interdisci­plinary team care-planning meet­ings was valuable, and residentswere more willing to attend if a

194 Geriatric Nilrsing July/August 1986

, . ,, , , , , i , , . . . . , , , ,

Ft~IOM THE J:OUIRNALS: A RECORD OF Gt~OWTH

~ac~ ~,grand time ]T~.Iplilg With Porter House, BreakfaSt Nook. The, reel.* deiltS IoYed ~,it end d id a: 'I0t o f zfoClallzlngi It was furl rio [ listen to t h e b *elk :aleut ~lie lypes O! dis_hware, that • ey hacl in •elr day~ aS oPP~S~

~ I~P: ~p~gram h~Ip~ residents get out Of their t0oms ,end; d~, ffr0uP ~iv i f fes~vi th other :residont6. R also,makes me feeLgOod~Nhetr my a~iv. ~ ¢[0sS,o~er wall,

i~er~;[sS ~ 1 ; ~lun 'this AM and all seemed to enjoy, even, those who ~Fdt~;¢ think lhoy could dO it. AUr~out Feel ing:

~;P~ wasoOpleasadtO harems just sit and talk today. She reai~ did!z't kh0w, M:M, all that well,.but she knew who she was and needed to tell ~6dieone her thoughts about her.

! ~pent time with J,M., who was very depressed and Sad; His d~ughter d le¢last week and he felt so bad. I was glad I could spend timelust being wi!h him.

spat;a/N~t~ ~ ; ~ WaS promised yesterday that I would do her nails, Went this AM tO

d~,them and she said "Oh, you didn't forget." That was a nice thing to hear first thing;

B.M~ came out and asked for an "enchantment" aide to wdte some leffers for him.

! wrote a letter for R.D. Her eyes ju~st lit dght up when, I suggested Wt[fiflg tOherdaughter. [The patient died t(fn days laterafld thedaughter s hal~e~: how much the letter had meant to her.]

l~Wtote Some thank-you letters for G.P. She was ver~i!ad~t.ogeItlz~m d0rle~aildiln the mail. We had a very nice talk while doing $0, ~;he ~let out ~ome feelings about her son-in-law, which made her feel ; t Ice,better.

R. and I have a special relationship. I really don't know why or how it happened bgt we can. sit and talk and I, know she understa[Ida what I'm sa~r~g even though she doesn't" speak very often.

I h a d a ¢;t~ance to really talk with I.H. and it feels like now we, amreal ly fd(;nds,

Each lime I do this Project I feel like I'm getting mu(~h ~[0Ser tO our geSRlents ia ways that will improve how I work as a regula~:C3N&

My most rewarding project was my visit to thehospitalt@~ee~.J, and N;T. They r es l~ Imed tO knOW we're there and we cam, ti0 r~att~r where they are or how sick they are.

Today was very fulfilling and interesting for me. I we~t t~ the hosplfal with C.E. (in the ambulance) and stayed until some,of the relatives could get ,there. He was really afraicl to go by himself:

E, was more relaxed when I went with him tO the h0~spitaL He JUst needed to have someone listen while ha talked away. It re;ally made a difference to him. He thanked me so many times for going willt h|m. His fdend, who couldn't get there right away, w~'~ also very gratefuJ:

! had a very enjoyable day with residents. Each time [ work as an Enhancement Aide I learn more about residents end their feelings and why they say and dO the things they do. Also, I enjoy writing letters for them and helping them with things that I don't have time for as a regular GN~

small carton of milk were put on each table so that residents could fix their own coffee. Plates of cof- fee brea:Is were also passed around, and residents helped tidy up after- ward. They no longer demanded to be served immediately, gulped down their food, and dashed off. Instead, they relaxed and had real "coffee klatches."

Journal notes revealed that resi- dents were encouraged to make choices about room decor and what they wore. They were being treated more like responsible adults and less like witless children.

After reading " W h o Is My At- tendant?" (2) all journals showed an awareness of the importance of residents' knowing the name of the person who is taking care of them. Since nursing assistants were pay- ing more attention to this need, re- sidents seemed to be more aware of who their attendants were.

In the third quarter of the Pro- ject, CNA-res ident interactions were videotaped, and the research- ers continued to study and compare journal notes. In the last three months of the Project, a facility- wide in-service took place, and vid- eotapes about the talking-book pro- gram and hospice (produced by Center staff and volunteers) were shown to Enhancement CNAs.

For us at the Center, the impact of the Project on patient care and employee satisfaction was far greater t h a . . ~ e had dreamed possi- ble. The Enhancement Project be- came an "institution," and CNAs ~nd residents alike lost sight of the fact that it was a one-year pilot.

Since it was so successful, we ap- pealed to the D e p a r t m e n t of Hu- man Services to fund it for another year. We are happy to report that the Project has been refunded. One thing is sure. We don't know how we managed .to function before it began, and we hope never to be without it in the future!

References I. Barney, J. L. Common Concern: a new per-

spcctive on nurse's aide training. Gerlatr.Nurs. 4:44-48, Jan.-Feb. 1983.

2. Rantz, M., and Roethlc, L. Who is my attend- ant today? Geriatr.Nurs. 5:187-190, May-June 1984.

F~OM THE JOURNALS:A RE(;ORD OF GROWTH

(Jb AetMties:

:HaJjJagrandtilTlQ.heJplngwtth'POtterHol,!$eBreakfastNook. The,resl~

C;fentS!:(O\,jI(J',ff'Qn(f:(f14s rotorS"OClantlng, It wufUilIOifisten,tother.. 'liltabOut tha'lYPesof(lishwQre,that they badin theIr d4y.aa,OJ,'lPOJe:cll1Wsuntdill"

1hEfBP; iPrQgramheJPJl··rQSId.&nts .gatOlltQf tb.eit ,raomlJ ,Qnd;d'C"ffrOllPilJ,ClMJresrwltltolhQr'ireslde.nts. ltil\lso,rnakes'me feeltlOod:wheitltlyaetlv<fly,' i$lpes 'Oller welt

:EXe.rQI:se waS' 'fun 'thiS ~" sn.d'all seemed to enjoy. ey,enthose Whodi:cfn!t: ,thTnk theycOLlICfdo It.

lttKIutfZeeJi1Jgs:

a1lt waa,so'pleased to have;mejust sitand talk todQY. SherealIydldn~t:knQw)M:M;allthat well•.but'she knew Who she was and needed to felliSomeone her thoughts about her.

• ePenttln1e With J.M., who was very depressed and sad: HiSdtlughterdJed11astweek and he felt so bad. I was,glad I couldspencftlmeJustbelngwIth him.

MlIetiRg SpecialNeeds

iE.s. was promised yesterday that I would do hernans. Went this AM todo"lhemand she said "Oh, you didn't forget." That was a nice thing tohearfirat·thlng.

SiM;CamsOllt and asked for an "enchantment" aide to write somele.ttenJ for him.

Ii wrote a letter for R.D. Her eyes jQst lit right up When,) $uggest.edwrffiJ1gtOherdaughter. [The patient died tEtn days laterand the dQ.yghtetthat'll:! h-ow muCh the letter had meant to her.]

IwroteaOme thank.,you Jettersfor G.P. She was very;:sIIM'fQg;et:tfn~m

d'OnEf'land:lnthe ,mail. We had a very nice talk while dOlog)80:. Sbali;ll outtomefeenngsabout her son.ln·law, which made her feel alo1J ibefter,

8JJilt1_ Retathnships

R.and I have a special relationship. I really don't kno.wWby or bow Ithappenedbllt we a-an. sit and talk and ~know she undetstandswJ1all'rnsayJ~ even though she doesn't speak very often.

I had a c:.1tance to really talk with I.H. and it feels like n.ow we,are·reattyfri.ends.

each liine I do this PrOject I feel like I'm getting muCh Closer foourtesl(lents tn ways that wlllln1prove how I -work as a tegulat:(ltfA

My most rewarding project was my visit to thehosplfalloseelB,J.anl;lN.T. They r.eallSt: lIIed to krlOw we're there and we Care. tiO:rtlaftervmeretbeyare or J'lowslck they are.

'l'oday was V'eryfulfilling and Interesting fOrme. I went totheJ'losplfaJWitbC;;e. (ill the ambulance) and stayed untU some ofthatelatiV8S'CQuldglu'there. He was really afrala togo by himself;

1:. was more relaxed When I went with himtothQ: hospital. He jUstneeded to have someone listen while he talkeel away. It rEOOlymada adiffetenceto him. He thanked me so rnanytil1lesfor golns Wftlthil1l. His.friena. who COUldn't get there right away. wPo.... also very gra:tefQt

I bad a very enjoyable day With reslden(s.Each tln1e I WOrk as an!=nhancement Aide' leam More about residents and their feellng$ snd whytheY say and do the things they do. Also. I enloy writing letters for themand helping them with things that I don't have tll1lefor asa regularOflA.

small carton of milk were put oneach table so that residents couldfix their own coffee. Plates of cof­fee breais were also passed around,and residents helped tidy up after­ward. They no longer demanded tobe served immediately, gulpeddown their food, and dashed off.Instead, they relaxed and had real"coffee klatches."

Journal notes revealed that resi­dents were encouraged to makechoices about room decor and whatthey wore. They were being treatedmore like responsible adults andless like witless children.

After reading "Who Is My At­tendant?" (2) all journals showedan awareness of the importance ofresidents' knowing the name of theperson who is taking care of them.Since nursing assistants were pay­ing more attention to this need, re­sidents seemed to be more aware ofwho their attendants were.

In the third quarter of the Pro­ject, CNA-resident interactionswere videotaped, and the research­ers continued to study and comparejournal notes. In the last threemonths of the Project, a facility­wide in-service took place, and vid­eotapes about the talking-book pro­gram and hospice (produced byCenter staff and volunteers) wereshown to Enhancement CNAs.

For us at the Center, the impactof the Project on patient care andemployee satisfaction was fargreater thl:l~,:liIehad dreamed possi­ble. The Enhancement Project be­came an "institution," and CNAsand residents alike lost sight of thefact that it was a one-year pilot.

Since it was so successful, we ap­pealed to the Department. of Hu­man Services to fund it for anotheryear. We are happy to report thatthe Project has been refunded. Onething is sure. We don't know howwe managed ,to function before itbegan, and we hope never to bewithout it in the future!

ReferencesI. Barney. J. L. Common Concern: a new per­

spective on nurse's aide training. Geriatr,Nurs.4:44-48, Jan.-Feb. 1983.

2. Rantz, M.• and Roethle. L. Who is my attend­ant today? Geriatr.Nurs. 5: 187-190, May-June1984.

Geriatric Nursing July/August 1986 195