Spotlight on new NHH expertise in Geriatric Care – Geriatric Specialist Maryanne Brown and Clinical Nurse Specialist Beverly Ryan-James

Delirium is a subtle, but all-too-common problem that can strike elderly adults when they are ill and hospitalized.

Sometimes presenting itself as an inability to pay attention or think clearly, delirium can, in its most extreme cases, lead to agitation and aggression not typically part of an individual’s character. Frightening for both the patient and their family members, it can come on within hours of admission, or it may come and go throughout the day.

Different than the long-term confusion caused by dementia or Alzheimer’s disease, delirium can nevertheless have serious consequences for a patient’s recovery if it is left untreated.

In recent years, research into the specific impact of hospitalization on older adults has led to new knowledge about delirium and other physical side effects such as loss of muscle mass. Maryanne Brown and Beverly Ryan-James are two new additions to the NHH team who will bring this knowledge to our community hospital and, in turn, improve outcomes for a distinctively large segment of our local patient population.

With a Bachelor of Science in Nursing from Ryerson University and Master of Science (Nursing) from the University of Toronto, Maryanne joined the NHH team in December 2010 in the new role of Geriatric Specialist.

Specialized in the care of the senior patient, Maryanne’s experience includes specialist roles in the areas of cognitive impairment, palliative care, medically complex geriatric assessment and treatment, and dementia management. Actively involved in research, Maryanne has been a clinical teacher, consultant and advisor at the university level, all within the field of gerontology.

RN Beverly Ryan-James, NHH’s first Clinical Nurse Specialist, took on her new role in January. Previously a member of the NHH Emergency Department team, Beverly will complete Geriatric Assessments of inpatients, and work with the health care team in the development of customized care plans that meet the needs of older patients. Moving forward, she will work to integrate and expand geriatric best practices throughout all clinical programs and services.

An early focus for Maryanne and Beverly is the establishment of specialized Hospital Elder Life Program (HELP). Developed by a team of experts at the Yale School of Medicine, HELP is a program for hospitals, designed to prevent delirium by keeping older inpatients oriented to their surroundings, meeting their needs for nutrition and sleep and keeping them mobile within the limitations of their physical condition.

Maryanne summarizes the rational for HELP as follows: “We have the clinical knowledge to improve the way we care for older patients so that we minimize the adverse affects of hospitalization. Our next step is to put that knowledge into practice. Traditionally, western medicine has focused on the illness, rather than the individual. We are learning that when we take the time to get to know the person--their patterns before they came to hospital, the triggers that can upset them, the daily practices in which they find comfort--we can, in fact, provide better care, with better patient outcomes.”

“HELP is a framework,” adds Beverly, “which will guide our teams through the latest tools and techniques to evaluate and intervene in older hospitalized patients to prevent delirium and functional decline. For every one day an older patient spends inactive in acute care, we can see five to seven days of recovery. We can do better than this and, using HELP as our guide, we will.”

Launching initially on medical unit 2B, the intent is to expand HELP throughout the Hospital.

As Geriatric Specialist, Maryanne Brown will work with the hospital’s clinical teams to develop the vision, strategic direction, leadership, operational management and clinical practices that will position NHH as a Centre of Excellence in the provision of acute care that is sensitive to the specialized care needs of the senior patient population.

Helen Brenner, Vice President, Patient Services and Chief Nursing Executive at NHH, points to a timely coincidence of NHH’s own strategic focus on senior-friendly care and new provincial investments in the same. “NHH’s new Geriatric and Clinical Nurse Specialist positions and, by extension, the Hospital Elder Life Program, would not be possible without the new funds received from the Central East Local Health Integration Network. We look forward to demonstrating the value this support brings for patients and our Hospital.”