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AMDA Long Term Care Medicine - 2013


C26 - The Conflicted Surrogate Syndrome: Implications for Nursing Facility Workforce Stress, Safety and Turnover


Mar 23, 2013 4:00pm ‐ Mar 23, 2013 5:30pm

Standard: $24.00

Description

Accreditation
The American Medical Directors Association (AMDA) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation Statement:
The American Medical Directors Association designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AMDCP Credit Designation:
This session has been approved for a total of clinical 1.5 credit hours toward certification as a Certified Medical Director in Long Term Care (CMD).

Session Description:
This session will discuss risk factors and diagnostic criteria for the Conflicted Surrogate Syndrome.  Three cases meeting the criteria in which violence toward facility staff occurred will be reviewed.  The symposium will discuss the role of the Medical Director, director of nursing, administrator, and ombudsman in recognizing and managing the syndrome.  The perspective of a family member is also presented, bringing a word of caution regarding the potential for inappropriate use of the label “conflicted surrogate syndrome".  The impact of the syndrome on work force stress, safety, and turnover are discussed.  Strategies for early detection and intervention are presented, to mitigate the potential for negative outcomes. 

Learning Objective(s):

  • Identify the risk factors for developing conflicted surrogate syndrome and be able to apply the diagnostic criteria to recognize the syndrome.
  • Explain concerns of possible misuse of the label “conflicted surrogate” when interacting with difficult family members.
  • Discuss possible negative outcomes for the family members, residents, staff and the facility if the syndrome is not recognized and well managed.
  • Construct a care plan for intervention when the syndrome is recognized and describe the roles of the medical director, the director of nursing, the facility administrator, and the ombudsman when the syndrome occurs. 



Speaker(s):
Rebecca D. Elon, MD, MPH, CMD; Donna Z. Leister, PhD, RN; Fatima A. Naqvi, MD, CMD; Laura L. Waterman, RN 

Disclosure(s):
None

Reference(s):
1. Kidder SW, Smith DA. “Is there a conflicted surrogate syndrome affecting quality of care in nursing homes?” J Am Med Dir Assoc 2006; 7: 168-172. 2. Bright-Long LE, Kidder S. “Conflicted Surrogate Syndrome.” AMDA annual meeting March 30, 2007. www.prolibraries.com/amda (last accessed 4/23/2012) 3. Finley MR, Smith DA, Garcia C, Nichols JN. “A cross cultural ethics approach to conflicted surrogate syndrome. AMDA annual meeting. March 9, 2012. www.prolibraries.com/amda (last accessed 4/23/2012) 4. Scannell K. “An Aging Un-American” NEJM 2006; 355(14):1415-1417. 5. Utley-Smith Q, Colon-Emeric CS, Lekan-Rutledge D, et al. The Nature of Staff – Family Interactions in Nursing Homes: Staff Perceptions. J Aging Stud 2009; 23(3): 168-177. 6. Grabowski DC and Mitchell SL. Family oversight and the quality of nursing home care for residents with advanced dementia. Med Care 2009 47(5):568-74. 7. Elon RD. “The American Geri-Wars: Moving beyond our encampments.” J of Legal Medicine 2005; 26: 69 – 83. 8. Leister, D.Z. (2009). The Vanishing Nursing Home Administrator: Stress and Intent to Leave. (Doctoral dissertation, Capella University, 2009). (UMI No. 3359575). Dissertation Abstracts International-A 70(06). 9. Andrucci – Armstrong, G. (2001). A longitudinal study examining the stability of occupational stressors identified by nursing home administrators. (Doctoral dissertation, Old Dominion University, 2001). Dissertation Abstracts International, 63(2), 722B. 10. Marziali E, Shulman K Damianakis T. Persistent family concerns in long-term care settings: Meaning and Management. J Am Med Dir Assoc 2006 7(3):154-62. 11. Selye, H. (1975). Stress without Distress. Philadelphia: J.B. Lippincott. 12. Elon RD, Leister DZ, Naqvi FA, Waterman LL. The conflicted surrogate syndrome: Implications for nursing facility workforce stress, safety and turnover. JAMDA 2012 in press (manuscript # D-12- 00149).

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