Nurses blamed b/c patient no longer able to walk.

[Jo Dirt]

On one of the private duty cases I work we have an 85 yr. old alzheimer's patient with insulin dependent diabetes, anemia and a spastic bladder. I have worked in this home off and on for a year. The woman is going down hill and where she used to be able to ambulate with a walker she is now only able to do so once in awhile with a great effort and even then only very short distances.

So the doctor ordered a wheel chair for the patient.

However, one of the patient's daughters became very angry about the wheel chair and has made it loud and clear, "I don't want my mama in a wheel chair!" She even tried to intercept the doctor's order for us to obtain the wheel chair, even though the patient's knees will buckle under her and we the nurses must find a way to get her to a chair. This woman is very heavy and a dead weight when this happens and our backs can no longer take the load.

Last night it was all I could do to transfer the patient from the bed to the BSC and back again (the patient will not wear a brief at night and urinates all over the floor and even had several BM's on the floor last night before we could even get to the BSC anyway) there was a couple of times I didn't think we would make it. The patient started crying out of frustration and even said, "I will probably need to go to the rest home." It sounds to us like she would even welcome going to the nursing home, but her daughter will not hear of it.

The daughter has some major denial issues about her mother but as hard as we nurses work, she is now blaming us because "Mama" can't walk. The day nurse just called me and said the daughter came over and saw her mother in a wheelchair and lost it and said she was going to get rid of us and get some nurses in there who know what they are doing, which is more than fine with me, because I do not feel like I can handle staying with this patient another night.

But has anyone else had to deal with a situation like this and what did you do?

[UM Review RN, ASN, RN]

Yes. Had a man who'd refused a wheelchair for many years when I came on the scene. His problem was that he didn't like the way the wheelchair made him look "helpless."

After a physical checkup, blood work, and a physical therapy assessment, the client wound up agreeing to a transfer board and a Hoveround because he then didn't "look" disabled. He was able to assist in his transfers and control the speed and direction of the wheelchair. He was able to socialize and interact with family gatherings more easily, so suddenly the couple were going out to the mall and to church--places he hadn't gone in years!

There are many different styles of transfer boards and electric wheelchairs that might help this family adjust to the patient's declining physical abilities.

Would the patient object to using a bedpan and Chux for the patient at night?

In your discussions with the family, you might encourage the family to have the patient reevaluated medically. That will lay some of the daughter's fears to rest that some other problem is causing the mother's decline.

The next time the daughter accuses the nurses of allowing her to decline, I would have to suggest that you ask, "In what way?" in a very non-threatening way, and be prepared to listen.

You might suggest that "allowing her to decline" to the point where staff actually has to lift her and clean up after her seems counterproductive. After all, the patient who is able to stand, is continent, and is able to walk is much less work than the patient who is unable to do these things. So it is in the best interests of everyone to get the patient as ambulatory and as independent as possible.

[P_RN, ADN, RN]

Yes right here at home.

Mama is 87 and has been healthy as the proverbial horse.

Now she has trouble walking over about 30 feet and grabs whatever she can to keep her balance.

So I bought her one of these Rollator walkers that has hand brakes and a seat if you get tired. Sheesh you'd think I'd put her in a funeral home to hear her. "I'm not an old lady, get that out of here, I can hold onto you if I need some help."

At least you can ask off this patient's case. And yest that daughter is definitely in denial. Her doctor needs to inform her that the nurses are there to assist her mom not to be injured by her mom.