Blindfolding: Is this an intervention or abuse?

[dicecream]

I have been wondering about one of my residents who has advanced alzheimers and hits very hard any time anyone but her husband touches her. She also scratches, grabs, and squeezes, and has come very close to breaking my fingers. She is bedridden but still has very strong arms, and cannot speak but yells very loud. I've tried talking to her many different ways, even singing to her which sometimes helps for a few minutes (holding her hands and singing "say say my playmate" is a good way to make her smile) but I can't do that and give care at the same time. For a while her husband would hold her hands while we changed her but this became too stressful for him. I've learned to stay out of her range and cover her arms when I need to get closer.

Recently another CNA suggested putting a blindfold on her so we can get in close to give care without restraining her or getting hit. Does anyone know if this is considered abuse? I've tried it (I just lay a pillowcase over her eyes) and it makes such a difference. When she can't see us, she can't hit us, at least not accurately. She still yells at first, but I can actually take care of her without getting punched or smacked. It also seems to make her a little calmer after little while when she can't see us. Of course I take it off immediately when I'm done. I also think a factor in her behavior is annoyance at having the light turned on to change her, so covering her eyes actually makes her more comfortable.

I'm afraid to ask my DNS (it's been a long time since she did anything hands-on) because I don't want her to tell me not to do it, but I still want to know. I really do want what's best for the resident, but I have to consider my own safety. :redpinkhe

[gusblom]

I'm sorry but if you worked with me I would have you fired and report your license to the board. You have the right to ask to be removed from caring for a Resident and to ask for the nurse to intervene when a Resident is difficult but never to ABUSE a Resident!

[nursel56]

I don't know how everyone feels about this but I think that if we base our judgment centered around empathy, and not what is the easiest resolve then I think we are doing justice. From my point of view taking away a sense would cause me a lot of fear. I also believe that in spite of our research dementia is like death as in that we all have preceptions of what it is like but until someone returns we really don't know know. There is a fine line between dementia and delerium. Could we cause a dementia pt to actually become delerious by blindfolding,? are we seeing a calmer pt or a more scared pt ? I don't know but this has been a very thought stimulating issue....

Yes, exactly. The reason it is a restraint is that you are taking away a sense. That could be quite terrifying, and may cause them to hallucinate. They have done studies on the effect of blindfolding on psych patients. When someone is confused, explaining what you are doing can't be considered adequate communication with the resident, because they have no way of letting you know that they understood what you are saying. When someone has dementia, they have no way of verbalizing what they are experiencing. It's just something that shouldn't be decided without the input of the doctor and/or nurse taking care of the patient.

If a family member or accrediting entity sees it, or reads it, or hears about it, the semantics won't matter to them.

[escpthemadnss]

I would lean more towards abuse on this one. While this person might be a little calmer for now, I would think as the dementia progresses, you're going to cause fear by her not being able to see what is happening.

There are a few residents where I work that have a history of becoming very aggressive during care and I've got my share of scars from trying to help the CNAs get these people washed or out of bed. What's proven effective for us is getting a doctor to order Ativan to be given 1/2 hour before care. We only use this for the most aggressive residents - currently 3 out of 80 (though this doesn't include the PRN orders). One resident in particular that we used the Ativan with for awhile became much calmer. He's even to the point that most days the CNAs can do his morning care without the need for pre-medicating him. It was almost like it had become a habit to scream/kick/hit/pinch/etc during care. Once he was helped with the medication to be calmer, the habit was broken. There are still days that it's needed, but far fewer than before.

I really feel like the blindfold would be a restraint and bordering on abuse.

Jackie

[Who?Me?]

It would absolutely be considered abuse! First off, no doctor, NP, or PA would ever write an order to blindfold a patient. There have been studie about "blindfold therapy" for visual hallucinations, but I have yet to find any that exist for long-term care environments vs inpatient psychiatric settings.

How about bunching her cares during her more lucid moments? Getting her doctor(s), family, social work, nursing to sit down in a care meeting and discuss options for medical and physical treatments.

Don't blindfold her--aka elder abuse by a caregiver.

[Ddestiny, BSN, RN]

I've tried it (I just lay a pillowcase over her eyes) and it makes such a difference.

Maybe I'm wrong here, but I thought it wasn't considered to be a restraint as long as it is something the resident can reasonably remove? So many things can be considered restraints (putting the feet up on a recliner so that they have to be put down in order for a resident to stand, having "seatbelts" in wheelchairs so they don't slide out, etc) but they're still used for resident safety. Maybe all of these residents had signed something in order to have it care planned, I'm not sure.

[Cobweb]

What about using the bathroom light instead of the overhead light, or some other way of using a dim light instead of a bright light? I've even bathed and dressed people by the light of the television :) I've also taped a flashlight to a dresser to change people before.

Does she like TV? How about turning on a show she likes, or music? We have a patient who we can work with if we sing to her.

And I'm sure you know this, but for me the key to remember is (because I'm naturally speedy) to slow down and do everything in slo-mo and tell her what I'm going to do ahead of time, talking all the time to her and being very careful not to frighten her. I hope that helps a bit. If you can find they key to what triggers her, sometimes you can figure an easy way to work with her.

,

[red2003xlt, LPN]

Would the smell of her husband's aftershave calm her down?

[kate45]

We have so many residents in our facility who has behavioural problems likes hitting the staff,naming and swearing at staff and racist residents who really hate black people. Most of my staff are black people and we have this resident that swears and hit my staff who is black. What we usually do,we have to send two people to do the care, one staff to distract her attention while the other one will do the care. Blindfolding I think is considered a restraint or considered as abuse to the resident. There are other ways you can do the care. If the resident is aggressive during most of the care,does the RN in charge or the manager knows about the behaviour? If yes, did they do something about it? There are some medications that can help calm down the residents like giving them ativan or risperdal as prn before doing the care. I find this effective to my aggresive residents. I know how stressful it is to deal with this kind of residents and we don't deserve to be hit and abuse by the residents also but we must find a way to prevent it. I think the other way would be to change your approached.Try to win her trust,smile and do the care slowly and make sure that you not rushing her and try to tell her what you are going to do with her.

[jackiesue94]

I have worked in a LTC for the last 16 years and YES this is abuse. Period. My LTC is a state facility so we get the residents that the private facilities reject-like ones that may be abusive. The way we have tried to handle these residents is getting the family physician involved, possibly getting a prn med to administer an hour before cares. An employee would be fired instantly at our place and their license reviewed for such an action. No, I am not a supervisor, I am a floor nurse so I know the difficulties of caring for abusive, dementia ridden patients.

[JoanJuxtaposed]

I'm leaning towards the 'abuse' angle. If she is still hitting out, blindly, then the blindfold isn't doing much. she is probably still scared.

I take three people in with me with the kickers/punchers. One person holds both arms whilst we do the care. It just means that someone may have to wait a little while until 3 people are free. Taking care of people with dementia can be hard, but there are always ways to manage the aggression without restraints. (restraints are illegal in care facvilities in the UK- the dung would hit the fan if we even placed a table by a chair so that the person couldn't get up and walk of their own free will!)

So a blindfold is worse than two people physically restraining a pt?

[Poi Dog]

I have a resident who is combative. He has a heck of left hook and will use it if he gets agitated.

Our solution? We speak to him calmly, address him by name, get his permission to change him, and amazingly Mr. P will grab his sheet covers and cover his eyes. While he does that, we ask him to turn in order to take off the brief and he complies. We do it as quickly as possible and thank him for his help.

Then we run out of his room...:sofahider:hhmth:

[JDZ344]

So a blindfold is worse than two people physically restraining a pt?

I think so. By holding a persons arms close to the body, you are not taking away a sense. The person can be changed quickly, communicated with (A huge part of communication is non-verbal) and can see what is going on. You are making sure that the person is safe, can't whack out and hit a siderail, etc. In my experience, by holding somebody close to their body, 9 times out of 10, they calm down. But that is just my experience, of course every person is different.