Putting a mask on a spitter

[NotFlo]

The situation is a dementia pt. in a LTC facility. Pt. is a peach much of the time but when pt. gets in a bad mood pt spits. Pt. has spit on multiple staff members, primarily CNAs (because it's usually during care/changing/repositioning/bathing that pt. gets upset) and also has been observed spitting on spouse.

Some CNAs decide that an appropriate intervention for this behavior is applying a mas over pts. mouth (standard surgical face mask). Pt. is unable to remove this mask on own so it blocks the spit.

So, is this abuse, an appropriate intervention, somewhere in between? There is disagreement among higher-ups about what should be done about this situation and what, if any, consequences the CNAs should face. Any opinions?

[netglow, ASN, RN]

Well, say said patient needs a cath and you need a CNA to help hold her legs out of the field because she tends to kick, or say she tends to move her hand in the field in response to your movements. This is restraint however temporary. Same goes with holding an arm down for IV insertion, etc. Can't placing a mask on a pt who spits, be considered the same? If when the procedure is done (bathing/care is a procedure as it must be done for the health of the patient), the mask is removed...

[Jolie, BSN]

Well, say said patient needs a cath and you need a CNA to help hold her legs out of the field because she tends to kick, or say she tends to move her hand in the field in response to your movements. This is restraint however temporary. Same goes with holding an arm down for IV insertion, etc. Can't placing a mask on a pt who spits, be considered the same? If when the procedure is done (bathing/care is a procedure as it must be done for the health of the patient), the mask is removed...

Your example differs for 2 reasons. First, when it is necesary to gently and temporarily restrain a patient while inserting an IV or Foley catheter, you are doing so to protect the patient from injury or infection. And there is no other reasonable alternative other than to hold the patient as still as possible.

When you place a mask on an uncooperative patient, you are protecting yourself from exposure to bodiy fluids. In this example, it is not necessary to restrain the patient in order to protect yourself. You have access to personal protective gear and should use it.

[heartnursing]

If there is no mask put in the pt that spits then what about the other residents in the dinning room? or the activity room? What if the pt gets mad in a common place and decides to spit, then the residents have to deal with possibly being spit on because that pt is mad at or agitated at something??

I dont think so...

[Jolie, BSN]

You don't put a mask on a resident because s/he might spit.

If a resident spits, you take him away from others until the behavior stops.

[Leelee2]

Is there an Ethic's Board at your facility?

Direction should come from them, or the nurse management team in your facility.