First day of CNA clinical - Elder abuse? - pg.2 | allnurses

First day of CNA clinical - Elder abuse? - page 2

Good afternoon everyone. I just need some perspective on what I witnessed today to see if I can expect to see this kind of thing everywhere. I'm not sure if I can handle it. This is going to be kind... Read More

  1. Visit  Davey Do profile page
    7
    stefanyjoy:

    I sense the consternation you must be experiencing at this time. You have adequately expressed your concern and have recieved some really good feedback with appropriate critiques and sound reality checks.

    Bottomline: You need to do what you believe and feel is the right thing to do. The majority, if not all, of us have experienced similar circumstances and have dealt with them the best we could. No matter what choice you make in dealing with this situation, this process will be a learning experience.

    Remember: This current situation is not the whole enchilada- it's only a piece of the pie. You will have world and time to digest this whole pie we call caregiving.

    Also be aware of the fact that you can only do what you can do when you are there for the patient. You have no power over what goes on in your absence.

    Finally, I'd like to leave you with this quote for you to consider in your decision-making process: "It is better to light a candle than curse the darkness."

    You've already begun to show your light. Do with the darkness as you so choose.

    May you find peace in your decision.

    Dave
    1feistymama, GrnTea, azcna, and 4 others like this.
  2. Visit  northernguy profile page
    0
    This sounds like a horrible facility, not some place I would ever work. The aide you worked with also sounds pretty bad, BUT its hard to judge them without knowing more about the situation from someone who has worked as a CNA and taken care of 7 or more patients/residents during the day for months or years. Some of the things the aide said are simply the harsh reality of being an aide, you only have so much time to spend on one person, so you may have to prioritize or other residents or patients will suffer. There is a HUGE difference between taking care of one person and taking care of 7, or on the evening shift, 10, or on the night shift maybe even 20 people.

    People are only willing or able to spend so much to take care of the elderly who need 24/7 care, so facilities have to make do with what they have. Lower income urban areas are probably generally going to have the worst nursing homes. I think nursing homes in remote rural areas tend to offer the best care, because everyone knows everyone. You will often be taking care of your cousin's wifes mother, or your neighbors father, or your former high school teacher etc. so the care tends to be better. Aides also have less places they can work, so getting fired from a job or having a bad reputation as an aide can haunt them. You may only have two nursing homes and one small hospital in the area, with employees at each who have worked at the other facilities, so if you were a crappy aide other potential employers will know it. At least thats my opinion. I've never worked in a big city and never want to.
  3. Visit  nguyency77 profile page
    0
    I wasn't there, so I don't know exactly why that CNA was behaving in that manner. I do know, however, from my own experience that LTC tends to be understaffed, and some of the NA who work there cut corners in order to finish their work.
    Many times, the quality of care suffers. That's the reality of long term care. That's why many residents appreciate it when students do our clinicals with them. We don't cut corners, and we make sure to treat them well.

    You did right to take care of her the way you did. Maybe it should have been made clear that you were supposed to care for that lady that day instead of the other CNA. I just want you to know that sometimes it is hard to always do what we're taught in school. When you begin work, you'll find that many residents refuse to have oral care. Dentures are very quick to clean. I can really do a decent job in 3 or 4 minutes. I can't give any legal advice, though.
  4. Visit  interceptinglight profile page
    11
    Oh my god people. Why are you all so timid about calling abuse ABUSE!!?? When you start out as a CNA student and you notice that everything is not all neat and tidy like it is in your text book and all your co-workers not all kind and happy and competent like you expect, it's quite a shock -- the answer is for the newbie to toughen up just a bit and roll up her sleeves and get to work being the best CNA she can be. Cutting corners here and there is NOT a good practice, but because of the workload of the average CNA it can sometimes become part of the routine to skip oral care once in a great while, or when you're pressed for time just dress the resident without giving him/her a choice of what outfit they want first. The LTC facility that I trained in made a very specific point of showing us videos and discussing at length what constitutes ABUSE and NEGLECT. Continuing education is also a requirement for every CNA at that facility and training about what abuse and neglect really is was also very clear and specific. Treating a person roughly when performing cares is ABUSE. Throwing a post-stroke patient around when transferring them is ABUSE. Preventing a fellow CNA from providing proper care is NEGLECT. Call it what it is, please, and don't be so quick to make excuses for co-workers that hurt people.

    Am I over-reacting? Perhaps. Nevertheless, if that were my grandma being treated as described by the OP, I would personally see to it that heads would roll, including the DON if she didn't put a stop to the abuse.
    Last edit by interceptinglight on Mar 2, '12 : Reason: added information cuz I'm angry
    Juniper248, GrnTea, Cessna172, and 8 others like this.
  5. Visit  Getting To Great profile page
    3
    I couldn't even get through the first paragraph; that so shameful and careless.
  6. Visit  HoT1 profile page
    2
    Quote from interceptinglight
    I would personally see to it that heads would roll, including the DON if she didn't put a stop to the abuse.
    Op, you've described my Grandmother's experience to a T. It's just awful. And when LTC is understaffed, no reports are made. Our family told the DON about the unnecessary roughness and the very next day she "just so happened" to have 4 perfect crescent moon nail cuts on her forearm. Her experience haunts me almost daily. All anyone can do in that situation is just pray for a quick passing. It's awful, and it's why I'm studying to be a nurse.
    Last edit by HoT1 on Mar 2, '12
    sharpeimom and interceptinglight like this.
  7. Visit  yousoldtheworld profile page
    6
    Quote from interceptinglight
    Oh my god people. Why are you all so timid about calling abuse ABUSE!!?? When you start out as a CNA student and you notice that everything is not all neat and tidy like it is in your text book and all your co-workers not all kind and happy and competent like you expect, it's quite a shock -- the answer is for the newbie to toughen up just a bit and roll up her sleeves and get to work being the best CNA she can be. Cutting corners here and there is NOT a good practice, but because of the workload of the average CNA it can sometimes become part of the routine to skip oral care once in a great while, or when you're pressed for time just dress the resident without giving him/her a choice of what outfit they want first. The LTC facility that I trained in made a very specific point of showing us videos and discussing at length what constitutes ABUSE and NEGLECT. Continuing education is also a requirement for every CNA at that facility and training about what abuse and neglect really is was also very clear and specific. Treating a person roughly when performing cares is ABUSE. Throwing a post-stroke patient around when transferring them is ABUSE. Preventing a fellow CNA from providing proper care is NEGLECT. Call it what it is, please, and don't be so b to make excuses for co-workers that hurt people.

    Am I over-reacting? Perhaps. Nevertheless, if that were my grandma being treated as described by the OP, I would personally see to it that heads would roll, including the DON if she didn't put a stop to the abuse.
    AGREED. Now, it's true that a person has no idea what it's like to care for 10, 15, 20 residents at a time until they have to DO it. And it's true that sometimes, you have to prioritize and skip doing something until later, that you might not be able to change someone every 2 hours like you want to/should, and that corners will be cut, in general. But there is no excuse for some of these things. No matter how short or busy you are, there is no excuse for dehumanizing a resident. Period. These aren't breathing sacks of potatoes we're caring for, they're human beings, and should be treated as such.
    pnut8377, azcna, sharpeimom, and 3 others like this.
  8. Visit  Altra profile page
    6
    The difficulty is, that to those not acclimated to the physical reality of caring for physically incapable adults, many things appear upsetting that are not neglect, and not abuse.

    Just recently 3 coworkers and I transferred a patient from one stretcher to another. The patient was small, a slider board was used, and the transfer was seamless. But it visibly upset a family member to see the patient, in her words, "manhandled". A lot of hands-on care that we perform automatically can appear to be a huge invasion of personal space, privacy and dignity to laypeople. (and since the OP reports that this was her very first clinical day ... for the moment, I would categorize her as a layperson)

    There is a lot of emotion in the OP. And that is why I take the "sack of potatoes" phrase with a large grain of salt. I wasn't there, nor were any of us ANers.
    Last edit by Altra on Mar 3, '12
    KimberlyRN89, *4!#6, loriangel14, and 3 others like this.
  9. Visit  interceptinglight profile page
    3
    Quote from Altra
    The difficulty is, that to those not acclimated to the physical reality of caring for physically incapable adults, many things appear upsetting that are not neglect, and not abuse.

    Just recently 3 coworkers and I transferred a patient from one stretcher to another. The patient was small, a slider board was used, and the transfer was seamless. But it visibly upset a family member to see the patient, in her words, "manhandled". A lot of hands-on care that we perform automatically can appear to be a huge invasion of personal space, privacy and dignity to laypeople. (and since the OP reports that this was her very first clinical day ... for the moment, I would categorizer her as a layperson)

    There is a lot of emotion in the OP. And that is why I take the "sack of potatoes" phrase with a large grain of salt. I wasn't there, nor were any of us ANers.
    I understand your point; there may be a 'gray area' in what is considered abuse and some things can be a matter of opinion about what abuse really is, that's why I thinking training about the subject is really important. In my opinion, tossing a 107 lb malnourished little lady around like an inanimate object is clearly abuse. I think that the OP being very 'emotional' about her experience shows that she has a good heart and will make a compassionate, caring nurse -- the kind I'd want taking care of me or my family. The fact that she 'mocked' the broken English of the CNA from hell doesn't make her points any less valid, Ms. Fuzzy -- you ought to know that CNA work is a refining fire and can bring out the very best in us...and for some, the very worst. stefanyjoy did the right thing at every turn and should be lifted up and validated, not torn down by a fellow CNA. I can tell by the way she writes she's very intelligent.
    pnut8377, azcna, and HoT1 like this.
  10. Visit  Altra profile page
    3
    The OP did what she had the luxury of time to do, including time to reflect on innumerable details of her experience.
    KimberlyRN89, GrnTea, and psu_213 like this.
  11. Visit  yousoldtheworld profile page
    2
    I agree that sometimes, what we have to do can seem like being mean to outside people. For example, many of the residents I care for have severe cerebral palsy and many of them are very constricted, so dressing them is difficult. As such, we've had new people concerned that we are "too rough" when we dress them...until they do it a few times and realize that pulling that arm through the sleeve is the only way it's going into it.

    Similarly, as only a handful of our residents can walk, stand, bear weight, etc. most of them are lifted. That's another thing that throws people off, picking up a resident and putting them in bed sometimes comes off as "tossing them around", even when it's not done in a rough fashion. So I do understand that perception is a lot different.

    HOWEVER, the things that concern me most are the verbal things - like the aide telling the OP that they don't brush teeth, and that letting her choose her clothing was a big deal. It's the neglect. I have been working more consistently short staffed in the last 3 months than I have in my adult life, having between 17-21 fully physically dependent nonverbal residents an evening to care for, so I definitely do understand the time constraints. However, regardless of short staffing, we have to provide at least the most basic care - bathing, oral care, and incontinence care.

    And by the OP's account, it sounds like this is not being done at this facility...and considering that no one there knew where to find a toothbrush and the water was dirty, it seems like this is not a one time thing.
    GrnTea and azcna like this.
  12. Visit  northernguy profile page
    0
    Altra completely hit the nail on the head, and this is why I have to admit I dont automatically trust the judgement of someone who hasnt done the job for a while and understands what it entails to successfully take care of multiple patients and residents, as well as manage your time so that you dont create even more harm and neglect for others by taking too long on one person.

    The fact the aide was making a big deal out of the resident wanting to wear a certain vest doesnt seem excusable though. When an aide does get hung up on something like that, it might be time for them to take some time off to destress. Also I think its important to help other aides out if you see them overreacting to someone, maybe offer to switch patients, or have them take a time out while you take over for the moment. Maybe that person and/or their family ran the aide ragged on previous shifts, caused them to fall way behind and the aide is reacting to that. Thats not to say you dont report abuse if it happens.
  13. Visit  acerbia profile page
    4
    I wasn't there, so I can only give an opinion on what has been said thus far, but there's a lot of things about this post that I find disturbing.

    From disgusting water to not changing diapers to neglecting pressure ulcers and not getting someone a simple glass of water, there's definitely something wrong with this facility. I don't care how busy you are - there is no excuse for letting a pt sit or lay in her own filth, having a dirty emesis basin by their bed, not following a simple request to get a piece of clothing from the closet, etc. The descriptions about the pt being thrown around is subjective, however. Like what others have said, sometimes it looks "rough" when pts are being moved. But the other things mentioned in the post are highly suspect.

    If you are concerned about this facility and the treatment of their residents, you have a few options here:

    - Talk to your clinical instructor (which you did, and hopefully she will have some feedback for you after she talks to the faculty there).

    - Google this facility and see what kind of reviews it has and if there are any lawsuits against it (pending or otherwise). You should also take a look at how the other residents are being treated. If everyone else is being cared for appropriately, but this particular resident is not, see if you can find out why. Talking to the family or even ask the resident herself may lend you some insight.

    A quick Googling of "reporting elder abuse" led me to a website for The National Center on Elder Abuse. What I found out sums up your situation pretty well. Some info from the site:

    Report suspected mistreatment to your local adult protective services agency or law enforcement. Although a situation may have already been investigated, if you believe circumstances are getting worse, continue to speak out.
    Neglect typically means the refusal or failure to provide an elderly person with such life necessities as food, water, clothing, shelter, personal hygiene, medicine, comfort, personal safety, and other essentials included in an implied or agreed-upon responsibility to an elder.
    Signs and symptoms of neglect include but are not limited to:

    - Dehydration, malnutrition, untreated bed sores, and poor personal hygiene;
    - Unattended or untreated health problems;
    - Hazardous or unsafe living condition/arrangements (e.g., improper wiring, no heat, or no running water);
    - Unsanitary and unclean living conditions (e.g. dirt, fleas, lice on person, soiled bedding, fecal/urine smell, inadequate clothing); and
    - An elder's report of being mistreated.
    They have a sate directory of helplines and hotlines specifically for elder abuse, and they can give you more detailed information about your state's laws, where to report suspected abuse/neglect and more. I highly suggest you call them and find out for sure, from a legal standpoint, what they consider to be as elder abuse. Maybe this case is, maybe it's not, but it's definitely worth looking into (an giving you a great learning opportunity).

    As a future nurse, you will learn that you have an obligation to be a pt advocate, and part of advocating for a pt is standing up for them and making them central to your care. Based on what I've read, it does not seem like this is happening here. I am but a lowly nursing student (so what do I know, right?), but I find this situation concerning, and frankly I'm astounded at how many posters excuse it.

    It's been a few days since you've update this post. Any news on what's happened so far?
    GrnTea, azcna, sharpeimom, and 1 other like this.


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