resident rights

Nittlebug · Apr 17, 2002

I think each case is individual, but generally any confused patient who is a fall risk needs to be protected with FULL side rails on bed and bed alarm. You wouldn't put a baby in a crib without rails, that would be inhumane.

Anyone who abuses 911 should in my opinion be considered mentally ill. They are a danger to society when they tie up EMS services. Someone in a real emergency could die because they didn't get the ambulance.

Anyone who disagrees with these fundamental facts is just plain ignorant in my book.

Amy ER Nurse · Apr 17, 2002

Psych pts with cell phones.......We had a patient that was 1013 (involuntary psych hosp admission), just waiting for tranfer to the state hosp. He used the phone in the exam room to call 911, and told them that we were holding him against his will in the hospital. He had been causing quite an uproar, and security had confined him to his room (no seclusion rooms in this ER). When the police showed up the charge nurse said...oh, did security have to call you for backup? The officer said "no, the patient did!". We were shocked, then had a huge laugh about it.

cmggriff · Apr 17, 2002

"Perception is all there is." to quote a number of administrators across the land. And I think this illustrates the point perfectly. Obviously the paranoid-schizophrenic perceives himself being held illegaly. Therefore, he must be released and he has the right to help from any whacked out police officer he can convince to see the world his way. This also applies to the administrator who is obviously experiencing a reality no rational person I have ever met can experience. This administrator has the right to express his opinion, however ill thought out and uninformed. However, I suspect this admin weanie is just cracked. Gary

nursedawn67, LPN · Apr 17, 2002

I had a resident who would call her doctor at home in the middle of the night if she felt she wasn't getting her pain meds on time or enough of them. She called doc at 1am on my shift one night and he called me and gnawed on my hiney! He actually asked, "why does she have a phone in her room?" I about fell on the floor laughing, I said "becuase it is her right to have a phone in there!"

What about residents rights? I just couldn't get it through him that she can have a phone.

I hear it all the time, "Mr Smith has to go to bed now"......."well he doesn't want to"....."well has too"...I had to tell them that he has the right to stay up, and the next shift can assist him to bed.

The residents have the right to refuse and ask for things...and we should respect them as best as we can.

tiger · Apr 17, 2002

we had a psych pt who claimed to have invented band-aids, discovered pcn, you name it. he was scheduled for transport to a nursing home and didn't want to go. when the transport team went to pick him up he told them he had tb. they came out to the desk and told us they couldn't transport him to snf with tb. we had to clear that up and assure them he was not positive for tb and then they took him. little while later we get a call from the snf. the pt now was telling them not only that he had tb but that he was molested by the amulance drivers on the way from our facility. the guy could be pretty convincing.

cargal · Apr 17, 2002

How about the long term care resident that refuses to get out of bed ? I am new in this type of long term care. We have 2 or three that adamantly refuse; one has pain that the charge nurse says has been adressed with the MD multiple times with nothing stronger than darvocet. On shower days she screams and cries because the shower chair hurts her back.. Of course when I get a little more oriented I will try to obtain adequate pain control from the MD, but in the meantime, they still get her out of bed and she screams. Another, A & O thinks of every reason why she can't and when they do get her out, she says something cracked or pleads nausea. I am stuck between the charge nurse, the facility and the residents. Also , is there really so much difference between bed and the geri-chair that would positively address the hazards of immobility?

Thanks!

ktwlpn, LPN · Apr 18, 2002

Originally posted by momrn50
What do you think of residents rights??? Our administrator actually told us that residents have the right to fall, and the right to fall out of bed if they so wish.... :chuckle any other resident rights that you've heard about??? How about the right of a paranoid scizophrenic to have a cell phone to call 911 when she wants..or the NAACP...or the police...

>>>>>>>>>Resident's rights in LTC have been a big issue for years....Yes-they have the right to fall-however we must assess them to find out why they have fallen and take the appropriate steps to prevent it from happening again(check for uti,blood work,pain,hunger,etc)As for falling out of the bed-we utilize low beds,floor mats,bed alarms and half rails(don't use full rails much due to the danger of fatal entrapment) and regular incontinence rounds with pottying.We are now cutting the legs of chairs down to prevent injury when some of our confused friends forget that they can't walk.There are so many appropriate measures to try when dealing with a problem behavior without utilizing restraints-physical or chemical.It's so great when the detective work pays off and the team can come up with a workable solution.As for bathing problems they can be more difficult to manage-we have different styles of shower chairs-they can be padded with towels,too.If modesty is a big concern try showering the resident while they are wearing a clean hospital gown(don't laugh-it works) premed for pain. As for refusing to get out of bed(or staying on bed rest due to decubes) the key is your careplan...document the resident's wishes and the approaches you are trying to get her to become less isolated(try getting the resident to agree to get up for a certain number of meals a week-for a certain length of time-and establish trust by making sure that staff get her back into bed as promised)It is a shame that we have to spend so much time on careplanning for a resident who may have beena loner all of their life when we have so many others that need our time....Ethically I have a problem deciding whose rights are most important-that of the noisy confused resident (sometimes all interventions fail)or the more oriented higher functioning resident that is bothered by the other residents behavior.(especially since regs say that we can not segregate the units-imagine lying next to a resident with a trach day in and day out for years)..I can stand anything for 8 or 12 hours but I can not imagine having to live with some of the folks I have taken care of over the years.

KlareRN · Apr 18, 2002

I agree that full side rails are a bigger risk for injury when used as a "restraint" than other interventions. It is shocking the number of confused residents who have crawled over the siderails (adding a foot to fall) and those who have gotten an arm or leg caught resulting in fractures, etc. A low bed with a mat and a bed alarm is a workable solution. I never allow nursing staff to use siderails to restrain.

As for residents who refuse to get out of bed. I have gone around with surveyors and ombudsmen about this issue and it all comes down to this: The resident can refuse and stay in bed 24/7 if they want....but the key is that the nurse needs to document that the negative consequences have been explained (i.e. skin breakdown, contractures, constipation, etc...) and that the resident verbalizes or in some way communicates understanding. Then the careplan needs to reflect that staff will encourage and inform, etc...

The ombudsmen in my area said the res. who is alert and oriented has the same rights as you or I and if we decided to lay on our couch for 3 days and eat twinkies- we could do it without anyone "forcing" us to stop. I also have dealt with residents who have open areas but refuse to turn and the same thing applies. I also had a resident who posted signs on his door that the workers in the facility were abusive and his "rights" were ignored and violated. He was a quad but was young, alert and oriented. Of course all the visitors that came in passed his room and stopped to read the signs. We had a hearing and were informed by the state that he had a right for "freedom of speech" just like anyone else and we were not allowed to take the signs down. The "violation of his rights" were based on the nurses trying to follow Drs. orders but the orders were not what he wanted done. He wanted to be suspended over his bed in a sitting position in a lift to have a bowel movement to prevent him from incontinence during the day. The problem was that he had an open area and the Dr. said he was only allowed to be in the lift 15 mins no matter what.(The sling on the lift hit him directly on the pressure ulcer). He wanted to stay in the lift anywhere from 30 mins to an hour and a half. When the time was up and the nurses went in to lower him to the bed- he refused to let them lower him. When they went ahead and did so (to follow Dr. orders)- this res. called the police and said that he was being assaulted. It was a mess. Finally his family came in and when the nurse lowered him to the bed- he refused to be touched prohibiting us from taking him out of the lift and he then had his family raise the lift back up. Thankfully he eventually left the facility.

Resident rights are a tough issue because as healthcare workers we want all our residents we care for to do all the right things and make what we consider the "right" decision. Unfortunately we ourselves do not always make the best decisions and we have to let them make poor decisions sometimes.

Joelrn7 · Mar 30, 2005

>>>>>>>>>Resident's rights in LTC have been a big issue for years....Yes-they have the right to fall-however we must assess them to find out why they have fallen and take the appropriate steps to prevent it from happening again(check for uti,blood work,pain,hunger,etc)As for falling out of the bed-we utilize low beds,floor mats,bed alarms and half rails(don't use full rails much due to the danger of fatal entrapment) and regular incontinence rounds with pottying.We are now cutting the legs of chairs down to prevent injury when some of our confused friends forget that they can't walk.There are so many appropriate measures to try when dealing with a problem behavior without utilizing restraints-physical or chemical.It's so great when the detective work pays off and the team can come up with a workable solution.As for bathing problems they can be more difficult to manage-we have different styles of shower chairs-they can be padded with towels,too.If modesty is a big concern try showering the resident while they are wearing a clean hospital gown(don't laugh-it works) premed for pain. As for refusing to get out of bed(or staying on bed rest due to decubes) the key is your careplan...document the resident's wishes and the approaches you are trying to get her to become less isolated(try getting the resident to agree to get up for a certain number of meals a week-for a certain length of time-and establish trust by making sure that staff get her back into bed as promised)It is a shame that we have to spend so much time on careplanning for a resident who may have beena loner all of their life when we have so many others that need our time....Ethically I have a problem deciding whose rights are most important-that of the noisy confused resident (sometimes all interventions fail)or the more oriented higher functioning resident that is bothered by the other residents behavior.(especially since regs say that we can not segregate the units-imagine lying next to a resident with a trach day in and day out for years)..I can stand anything for 8 or 12 hours but I can not imagine having to live with some of the folks I have taken care of over the years.

I've been tying to find an article about this "Right to Fall" issue and I couldn't find one. Can anybody direct me on where I can find one???