Quote from Missingyou
And if Mary did not have dementia, she was of sound mind, but had a stroke and needed assistance, but refused to have her teeth brushed...whether or not she knew of the ill effects of not brushing??
what about the same scenerio only instead of tooth brushing, make it showering 2x a wk and she refuses everytime?
Having a BM in her brief and she refuses to be washed up??? (with or without dementia)
refusing to eat??
I think it's sometimes a fine line we, as CNA's, walk. Clearly, it's a health issue if she needs to be washed of BM, refusal or not.
But, Toothbrushing? showering?? EATING?? Can "forcing" them to do any of these things be viewed as abuse?, at the same time, can NOT getting them done be viewed as abuse too!?
When in doubt, ask the charge nurse what to do, but still, it depends on how long the refusal has been going on and what it is that they are refusing....still a fine line that frightens me....
All great questions. I'll try to take them as you present them:
1. Mary doesn't have dementia but she had a stroke and refuses to brush her teeth.
I'd start by trying to figure out why she doesn't want to brush her teeth. Is she embarrassed to accept assistance? Is she afraid of something? Is she depressed? Is her refusal due to a mental status change secondary to another condition, such as another stroke?
For a patient who is A&Ox3 and able to understand the need for personal hygiene, refusal to take care of oneself could be indicative of an underlying issue, such as depression, that needs to be addressed.
2. Mary refuses to shower x2 weeks.
Again, if Mary is A&Ox3 and refusing, I'd try to figure out why and assess for mental status changes. I've never forced a patient who is A&Ox3 to clean up, but I've also never had to.
3. Mary has a BM and refuses to be washed up.
Again, why? This is clearly a matter of immediate hygiene for not only the patient but for the nursing staff. I'd do all of the above as previously listed (assess for mental status changes, depression, etc) and go from there.
4. Mary is refusing to eat.
Well, you sure can't make her eat. Repeat all steps above and discuss a plan of care with the patient's physician. If the patient is at the end of their life, some patients will just stop eating, and there's nothing you can do to change that. If they're A&Ox3, that's their right and it's natural as the body declines to stop feeling hungry/thirsty.
Bottom line, if you're confused, talk to the patient and try to understand what's going on in their mind. If you're still confused, talk to the nursing staff about the problem. Perhaps they know something you don't or they know a good way to approach the issue.