Patient Rights vs nursing care

  1. I am looking for feedback with any of you who have faced this dilemma, particularly with the attempts by your institutions to formalize policies and procedures.

    We have adopted a philosophy of resident rights in our home, but the practical workings are fluid, leading to variations among staff.
    We deal with one specific at a time, ie. getting Mrs.X up out of bed against her wishes, or insisting Mr.Y eats a little that meal. Have any of you worked with a more general procedure, and did it work out well.

    Please send any thoughts you have directly to me at
    K. Kidd
    Staff Development
    Golden Door Geriatric Centre
    Winnipeg, Mb
    djkidd@mb.sympatico.ca
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  2. 7 Comments

  3. by   dancing_granny
    We do have a policy against force feeding. We include using a syringe as force feeding, therefore, we only use spoons, forks or cups. As for dealing with residents who refuse to eat, refuse showers etc. we go to the care plan. We have specific interventions developed on an individual through the care plan team. There may be 2 residents with the same or similiar problems, but the interventions could be quite different. Once the care plan interventions are developed the entire staff MUST follow that individuals plan.

    [This message has been edited by dancing_granny (edited September 11, 1999).]
  4. by   NURSE FOR LIFE
    I have worked with the elderly since I was sixteen and in nursing homes which have always dealt with residents rights including the ones you mentioned. Sometimes when residents appetites become poor, it helps to involve the family whenever possible. Ask them about favorite foods or drinks, or try adding sugar to foods to make them taste better. Also for residents with disease processes involved such as Alzheimer's, you can get them finger foods or sandwiches, things they can carry with them as they pace or wander. These things are placed in the care plan as dancing granny suggested and followed by staff. I hope I have helped you somewhat with the suggestions.
  5. by   theleader
    In our facility, we put resident rights first until their wishes have a negative impact on their health or violate a regulation. Then we go to the care plan and sometimes a behavior mod program. Hope this helps.
  6. by   PathFinder
    Patient (or resident) rights are crucial, but be sure you include a wholistic view of the "best interest of the patient".

    Does your state require (or even recommend) that you keep on record the patient's wishes regarding care (end of life, extent of treatment, etc.)?

    Does the family understand the difficulties you are encountering with the patient, and would they be of any assistance?

    Has anyone considered polypharmia? What drugs is the patient on, are they working at odds so that the patient is actually suffering a medication induced symptom (nausea, insomnia, muscle weakness?)? When did a pharmacist last review the patient's meds?

    Also, is your patient depressed? What kind of mental health resources can you call in so that the patient is able to act in his/her own best interests?

    Good luck in your pursuit of best practices -- the issue you raise is very complex and worthy of serious discussion!
  7. by   rachellesgram
    Just quick note about the use of finger food for the dementia pt. PBJ's are great as the sandwich doesn't fall apart. Cutting in halves or quarters is also a good thing.

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  8. by   midnight
    I work in a long term care facility...I greatly believe that residents rights are to be respected and ensured. More effort should be made to change our own routines to meet the needs of our residents. When working with the elderly they need to feel they have some decision making abilities it enhances there sense of self worth. Besides if they do not wish to get out of bed, or eat at that meal despite calming encouragement then what does it actually hurt? give them a snack later when they are more co-operative to do so. Forcing only enhances depression, aggression and anger which are in my opinion much worse not only for the resident but for the nurses.
    Quality of life .....should always take priority over staff convienience and routine.:
  9. by   leslie :-D
    I totally advocate residents' rights and will generally respect their wishes ONLY after ruling out any underlying etiologies. For example, why don't they want to eat? Has it always been their baseline or are they losing weight? Is it because of poor dentition, improperly fitted dentures, dysphagia, overly stimulating environment or they just don't like what's being offered. If I have a pt. as a diffucult feed, I have no problems giving them foods they like, even if it is chocolate... As for getting out of bed; are they depressed or in pain? Whatever the reason is, after addressing their issues, it would be appropriate to negotiate time spent out of bed, e.g., up for 2 hrs., then down for few hours, up again for dinner, etc. Unfortunately these cannot be blanket interventions for each person is unique in their chemical and biological makeup. Whether the pt. is demented or alert & oriented, everyone has a right to be treated with respect, and especially honor, for our elderly.

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