What would you do???
- 0Dec 1, '13 by MissingyouNot what SHOULD you do, but what would you honestly do in this situation:
You work in a nursing home. You have an awesome hall partner (Jessica)who loves taking care of her residents and seems to really care about them...
One of her residents (Mary) has dementia and her family request her teeth be brushed 2x daily. Your hall partner(Jessica) asks you to help because she's a "fighter". The resident "Mary" refuses to have her teeth brushed as soon as she sees the toothbrush. Jessica proceeds to push the toothbrush into her mouth and Mary begins slapping Jessica and swearing. Jessica still continues, and Mary continues to punch, slap, cry, swear, etc....Jessica turns to you and tells you to hold Mary's hands down so she can continue, you tell her it isn't worth it, let Mary be, Jessica calmly insists that it be done as family requests.....
Right then and there, in that moment, what do you do???
- 5Dec 1, '13 by chrisrn24What I would do? Stop immediately. Actually I would've stopped if she was raising her hand to me the first time. Similar things have happened to me and I've said "it's not worth it" and tried reapproaching a few minutes later.
People with dementia are often unable to be reasoned with, so try redirection and reapproaching.
- 9I would never lay a hand on (Mary) when she is like that, and I would tell Jesica that she had to stop as well or I'd have to report it. Sure the family wants it, but it is ultimately the patients right to refuse to brush her teeth. Just document it as a refusal and explain to the family that we can keep TRYING to see if we can brush her teeth as requested but that we can not force it upon her if she is that adimit against it. It is abuse no matter how you cut it. And I have to say if a family member would see two aides pinning her down and shoving a toothbrush in her mouth forcefully I am sure they would be changing their request.
- 2If she has severe dementia and her poa is requesting it, I'm not sure charting that she "refused" is really worth that much. How can she refuse? She has no idea you're trying to help her.
Address it with the family. If they still want the teeth brushed, they need to be brushed. Not brushing them can lead to severe diseases, including deadly pneumonia.
I don't consider this abuse bc you are not hurting this woman. I wouldn't use force, Just hold her hands. Speak kindly and gently. You are doing something for her own good.
- 1Maybe I have these above opinions because I worked for years on a neuro floor, but honestly, what's the difference between this and my dementia patient that tells me he needs to leave the hospital to go play in the street at 11pm. It's not abuse to stop him. I'm keeping him safe, even though he's kicking and punching me.
- 7I only mentioned to write refuse down so that it is recorded that you at least tried to brush her teeth. It also sounded to me in this senerio that Jessica WAS forcing herself onto mary. That is what I am picturing and to me is wrong. If you can find gentle easy ways to maybe get Mary's teeth brushed of course you keep trying to see if you can get her teeth brushed. But pinning her down and holding her against her will to brush her teeth I would think is a no no and would be seen as abuse
- 1Dec 1, '13 by chrisrn24Quote from MissingyouOf course not. You ideally both leave and reapproach. And try again later. If it doesn't work call the family and explain the situation. Maybe they will come sit with Mary while you try to brush.So,
you would just walk out of the room and leave Jessica there to continue on without you??
Other posters have suggested good ideas - hold Mary's hands as opposed to hold them down.
- 3Quote from schnookimzYeah that would work, or maybe Non compliant perhaps would be a better word. Just as long as it is documented that you tried to brush her teeth but she did not allow you to do it properly is all I was trying to get across in my statementIf she is non decisional and you write down "refuse" and are sued, I'm sure they would ask how in the world she refused you. There must be a better word for this. Perhaps "unable to complete" along with a progress note.