The right to refuse has so many interpretations - page 2

Inside one nursing home I have been adamently told, "You should not force her to do anything..." about an ill patient who said she wanted to stand up but was too weak. In the same facility on... Read More

  1. by   ThePrincessBride
    Okay, so I am volunteering at nursing home, and I am shock at what the nurses/staff allow patients to do. They allow them to take "smoking breaks" as well as feed them unhealthy foods (icecream, lollipops, and cake). I thought a nursing home was supposed to be about keeping the patients' healthy, not feeding them poisonous food and allowing them to smoke the rest of their lives away.
  2. by   Fribblet
    Quote from ThePrincessBride
    Okay, so I am volunteering at nursing home, and I am shock at what the nurses/staff allow patients to do. They allow them to take "smoking breaks" as well as feed them unhealthy foods (icecream, lollipops, and cake). I thought a nursing home was supposed to be about keeping the patients' healthy, not feeding them poisonous food and allowing them to smoke the rest of their lives away.
    Sweet food aren't poisonous unless someone has added poison to them.

    As to smoking the "rest of their lives away," they've been smoking most of their lives and don't have much life left. If they want to smoke, then let them smoke. I suppose you're also against hospices as well since they allow people to refuse treatment and enjoy what remains of their life? Why would you want to make these people unhappy? Let them eat what they want and smoke what they want. They've lived long lives, have been taken out of their homes and lost their independence. They don't need some young know-it-all bossing them around telling them they're "killing' themselves. They're old; they're dying.

    I quite smoking a while ago, and if I am ever diagnosed with a terminal disease or when I reach the terminal phase of my life, I have every intention of picking the habit back up. I loved smoking, and if some idiot in my nursing home has the gall to tell me I can't smoke, you'd better believe they'd be sending me to the ER for being combative because I'd used whatever strength I had to punch that jerk in the face.

    And, if I want ice cream, I'm gonna eat ice cream. That is true now and will be true when I'm old.
  3. by   ThePrincessBride
    Quote from Fribblet
    Sweet food aren't poisonous unless someone has added poison to them.

    As to smoking the "rest of their lives away," they've been smoking most of their lives and don't have much life left. If they want to smoke, then let them smoke. I suppose you're also against hospices as well since they allow people to refuse treatment and enjoy what remains of their life? Why would you want to make these people unhappy? Let them eat what they want and smoke what they want. They've lived long lives, have been taken out of their homes and lost their independence. They don't need some young know-it-all bossing them around telling them they're "killing' themselves. They're old; they're dying.

    I quite smoking a while ago, and if I am ever diagnosed with a terminal disease or when I reach the terminal phase of my life, I have every intention of picking the habit back up. I loved smoking, and if some idiot in my nursing home has the gall to tell me I can't smoke, you'd better believe they'd be sending me to the ER for being combative because I'd used whatever strength I had to punch that jerk in the face.

    And, if I want ice cream, I'm gonna eat ice cream. That is true now and will be true when I'm old.
    Just because one is "old" doesn't mean that one is "dying." My grandmother has a POOR quality of life due to years of chain smoking and drinking and she later had to insert a pacemaker in herself. My OTHER grandmother, who is 10 YEARS older, kept herself healthy and has a way better quality of health (she can drive and live by herself).

    Allowing a person who has breathing problems to smoke at a nursing home and letting a diabetic to have all the sweets they want is not right. You aren't allowed to smoke a hospital, so why should you be allowed to smoke at a Nursing home? If an old person wants to smoke and "overdose" on sugar, they can go do it elsewhere. If my grandmother (the unhealthy one) was put in a nursing home that allowed her to drink and smoke all day, I would be ****** and ask for my money back.

    P.S. If you cannot discuss in a mature fashion without throwing the insults ("idiot", "know it all"), please do not respond to me.

    Thank you.

    ETA: Not all of those in nursing homes are "old". Sure, some of them are, but I know some in their mid 40s who are in nursing homes.
    Last edit by ThePrincessBride on Jul 12, '10
  4. by   SolaireSolstice
    "Allowing a person who has breathing problems to smoke at a nursing home and letting a diabetic to have all the sweets they want is not right. You aren't allowed to smoke a hospital, so why should you be allowed to smoke at a Nursing home?"

    Because one is acute care and the other is a HOME. The day someone tells me what to do in my HOME is the day I grab my gun and yell F-R-E-E-D-O-M ala "Braveheart". And just because one isn't "dying" doesn't mean that someone else gets to make choices about what I am allowed or not allowed to do with my body no matter my age.
  5. by   mykrosphere
    i think long term care is a lot different than acute care. i have worked in both.
    at any rate, i think a patient has a right to refuse most definetly.
    right now i work in a ltach so there is a nice mixture going on.
    i think it depends on the patient and setting
    but for the most part, they are the owners of their body.
    and if they are alert, and most oriented, then i feel that they should have the right to refuse anything they want to.
    i hope to have the same choice someday.
  6. by   Fribblet
    Quote from ThePrincessBride
    Just because one is "old" doesn't mean that one is "dying." My grandmother has a POOR quality of life due to years of chain smoking and drinking and she later had to insert a pacemaker in herself. My OTHER grandmother, who is 10 YEARS older, kept herself healthy and has a way better quality of health (she can drive and live by herself).
    So what? They were each allowed to make decisions about their health when they were younger. Why should they be stripped of that decision making when they are old?

    And I know old does not equal dying. I never suggested it did. It is a fact that when one is old, that one does not have a lot of life left. It's ridiculous to assume that an 86 year old has many long years ahead of them, especially if they are unable to live independently.

    Allowing a person who has breathing problems to smoke at a nursing home and letting a diabetic to have all the sweets they want is not right.
    I see it all the time in the ER. We don't forbid diabetics from eating sweets at home or smokers from smoking at home. I won't give them cigarettes or sweets, but if the diabetic gets their family to bring them in a cake, I won't throw it in the trash and get security to throw the family out. The diabetic is allowed to make bad decisions even in the hospital. If a smoker with COPD is in the hospital and wants to go outside and smoke, they're allowed to make that decision. I may tell the doc that they are obviously feeling better and can probably go home, and I certainly don't assist in their habit, but I have no right to snatch their cigarettes and throw them away.

    It's pretty shocking that you think people should not be allowed to make decisions, engage in activities they find pleasurable and that you know so much better and should dictate how they spend their days.

    You aren't allowed to smoke a hospital, so why should you be allowed to smoke at a Nursing home? If an old person wants to smoke and "overdose" on sugar, they can go do it elsewhere.
    Where would they do it? At home? Oh wait, the nursing HOME is their HOME. People are allowed to smoke and eat what they want in their HOME.

    If my grandmother (the unhealthy one) was put in a nursing home that allowed her to drink and smoke all day, I would be ****** and ask for my money back.
    Wow. Do you stand over your grandmother and make sure she eats all of her peas? Do you throw away any sweets she buys and send her to her room? She's an adult; she can make decisions for herself even if they are bad.

    Do you eat only they healthiest of foods and never let a refined sugary, confectionary treat to touch your lips? Do you drive the speed limit ALWAYS? Do you exercise every day? Get the required amount of sleep every night? Drink 8 glasses of water a day?

    No. No one is perfect. Would you want someone dictating what you can and can't eat or do because they think it's "poison?" No. You're an independent adult who can engage in dangerous or unhealthy behavior as you see fit. You will pay for it later, but that's your choice to make. Everyone makes bad choices in life.

    P.S. If you cannot discuss in a mature fashion without throwing the insults ("idiot", "know it all"), please do not respond to me.
    Please try to read critically. I said "some idiot" not "you idiot." And, anyone who would try and dictate what I can eat and if I can smoke in my HOME, is an idiot in my mind. If that person doesn't agree with it, they certainly do not have to contribute or enable the behavior, but they have no authority to stop it.

    I cannot imagine what kind of controlling, egocentric personality would honestly snatch the birthday cake from my arthritic, diabetic hands that my family brought me on my 90th birthday at the old folks home and throw it in the trash because it was "poison" and god-forbid I enjoy a sweet.

    You also do not get to dictate who does and does not respond to your posts.


    ETA: Not all of those in nursing homes are "old". Sure, some of them are, but I know some in their mid 40s who are in nursing homes.
    Right, and if those who are younger want to eat cake and smoke, they can. You're not the boss of everyone.

    In a nursing home, you're there to help them manage their health, but more importantly enhance the quality of their life. And sometimes, sometimes, the activities that enhance the quality of life are not the same activities that prolong it.

    This is the same reason we "allow" people with terminal diseases to stop the treatment that is keeping them alive and let them ENJOY what time they have left, even though stopping treatment WILL ensure an earlier demise.
    Last edit by Fribblet on Jul 13, '10
  7. by   CrunchRN
    Here in the south "honey" "dear" Sweetie" are just considered being warm and friendly. It really depends on the person.

    Bottom line though is cognitively intact people have the right to make their own decisions at their own peril. Explain the consequences, document your actions, inform your higher ups if it may have a negative impact.

    Than let them have all the dang pudding they want!
  8. by   TDCHIM
    Quote from ThePrincessBride
    Just because one is "old" doesn't mean that one is "dying." My grandmother has a POOR quality of life due to years of chain smoking and drinking and she later had to insert a pacemaker in herself. My OTHER grandmother, who is 10 YEARS older, kept herself healthy and has a way better quality of health (she can drive and live by herself).

    Allowing a person who has breathing problems to smoke at a nursing home and letting a diabetic to have all the sweets they want is not right. You aren't allowed to smoke a hospital, so why should you be allowed to smoke at a Nursing home? If an old person wants to smoke and "overdose" on sugar, they can go do it elsewhere. If my grandmother (the unhealthy one) was put in a nursing home that allowed her to drink and smoke all day, I would be ****** and ask for my money back.


    ETA: Not all of those in nursing homes are "old". Sure, some of them are, but I know some in their mid 40s who are in nursing homes.
    We are not talking about hospitals. We are talking about LTC settings. These facilities are in fact HOME to their residents, who do not abdicate their personal freedom when they walk in the door. It doesn't matter who's paying for the care - the decisions are still that of the resident if said resident is still in control of her mental faculties. If you are angry that your grandmother is drinking, eating sugary foods and/or smoking while in a nursing home, you are obviously at liberty to stop contributing monetarily to her care. However, it is not the responsibility or right of the nursing home staff to stop your grandmother from making those decisions.
  9. by   nursemike
    Is there anything less healthy than stripping someone of his/her autonomy?
  10. by   Saiderap
    Quote from nebrgirl
    So I get that it has to due with regulations, but the regulations are kind of BS...no I don't want to see the elderly warehoused, but isn't that the whole point of the regulations, treat them like they are indviduals who have their own preferences....which they should only have to tell you ONCE. My sister, who in many ways was still very "young" fx her hip due to met. CA. She ended up in skilled care for 10 days rehab. This place also had LTC blended in, so the CNA kept bugging her that they would "fix" her hair...she relented...when I came in that night here she was with "little old lady hair" not the way I knew her at all. I laughed....but she was not humored at all..
    I was just talking with a therapist about this hair cutting thing some people have. "The CNA kept on bugging her that they would, "fix," her hair." The need to cut someone's hair is often a power and control issue. Sometimes these hair-cutting freaks almost never touch you unless it is to cut your hair or if they are talking about cutting your hair. Elderly patients are not flunkies that need to get their hair cut. The need to infantalize someone by cutting their hair is narcisistic. I remember one elderly patient with waist length hair and she would have a fit when we brushed it but we did NOT cut her hair.

    It makes me sick to think of hair cutting and styling being the only touch someone is getting.
  11. by   fuzzywuzzy
    Quote from tewdles
    A cna told my patient the other day....eat the rest of your sandwich and THEN you can have your pudding...I took the cold cut sandwich off the table, gave the old girl her pudding and advised the cna that Mrs R was 94 years old and if she wanted her pudding rather than her sandwich she could have it. I do work in hospice, and no, Mrs R is not actively dying.
    I agree with you. At the same time, as a CNA, I can understand why she said that. The majority of our residents can be 98 years old but unless they are actively dying, there's a lot of pressure to keep them from deteriorating, even though the changes are normal and inevitable. If someone loses weight, can't walk as far as they used to, can't wash themselves up, is more frequently incontinent, etc. it's like, OMG, the end of the WORLD! Now sometimes there's a reason for it and with some investigation and work, we can help the person bounce back. But most of the time it's just the progression of their dementia. But we get shamed for it... told that we must be lazy, not doing something right, whatever.

    Personally I feel a lot of pressure from certain nurses to, for instance, *somehow* get a resident to eat their sandwich in addition to their pudding. I wouldn't exactly phrase it the way your CNA did- I'd say "can you take a few bites of your sandwich first? That pudding's not going to fill you up until dinner," but if they still didn't want the freaking sandwich and I documented that I talked to them about it, offered an alternative, redirected them, AND returned multiple times to try again, that wouldn't be good enough-- because that person is going to lose weight and then there are all these effects from that and blah blah blah. Translation: Fuzzywuzzy sucks.

    Nursing home work is really busy and i have better things to do than harass old people. And better things to talk to them about than why they should eat their pureed ham. But a lot of the time I feel like aging is not allowed.
  12. by   leslie :-D
    Quote from fuzzywuzzy
    I agree with you. At the same time, as a CNA, I can understand why she said that. The majority of our residents can be 98 years old but unless they are actively dying, there's a lot of pressure to keep them from deteriorating, even though the changes are normal and inevitable. If someone loses weight, can't walk as far as they used to, can't wash themselves up, is more frequently incontinent, etc. it's like, OMG, the end of the WORLD! Now sometimes there's a reason for it and with some investigation and work, we can help the person bounce back. But most of the time it's just the progression of their dementia. But we get shamed for it... told that we must be lazy, not doing something right, whatever.
    no one has the right or authority to "shame you".
    the elderly feeling anorexic, is a common phenomena and thankfully you recognize this and respect it.

    it irritates me when i've heard a zillion tactic used in trying to get some of these folks to eat.
    i knew of one aide who used to put sugar on green beans, potatoes, etc.
    my logic is, you give them their dessert first and foremost.
    for one, the pt most always enjoys and appreciates it;
    and two, wouldn't it make more sense to give them the most fattening thing, first?
    they also like it when you mix their ensure and ice cream together.
    sweet, creamy, cool is usually a big hit.

    besides- i'll be darned if i'm going to worry if a 95 yo gets their veggies.

    bottom line: i am not their mother and can't imagine a bigger insult, than to treat these folks as if they're children.

    thanks fuzzy.
    you obviously see the big and real picture.

    leslie
  13. by   Saiderap
    There is a balance to be struck in which we may try to persuade and problem solve to encourage people to do what we think is good for their health. But we are their nurses not their keepers. Old people are not children. The closer I get to that age group the more I get annoyed by nurses who insist on treating the elderly like children. I work in acute care, so some of the imperatives are a bit different, but I also don't like to hear a sharp, intelligent, self sufficient older person described as "cute" or addressed by demeaning pet names like "dear" or "honey".[/QUOTE]

    One thing I learned from my teachers is that each patient is different from the last so some of mine had the mind of a baby and some of them like being called "honey" and being touched on the head. In one case, I sent a visitor to the D.o.N.s office because she expressed some irritation with my behavior toward a resident who I knew very well. I could not legally discuss the patient with her but our D.o.N got around it somehow because I overheard her laughing with the visitor and explaining that I was not abusing this patient.

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