Is it wrong to tell patient that they might physically hurt you

  1. You have a patient that insist on leaning on you. You have a patient that refuses to use a hoyer lift. Is it wrong to tell these patients that you too can be harmed?
    Last edit by DesiDani on Sep 20 : Reason: Grammar
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  2. 21 Comments

  3. by   AJJKRN
    Not in my view, I have said things like "we don't want to end up in the hospital along with you" or even more bluntly "I am not willing to risk our backs and livelihood with being pulled on". My favorite is the 300lb 6ft plus male farmer, etc that just wants a "tug" on their arm or to pull on you...uh no!
  4. by   JKL33
    Probably kindest to just say, "No, that's not safe."

    Plenty of people assume I am going to move them but a couple of times they've been very rude when I declined. One disgusted person said to me, "You're just standing there and all I need to do is link my arms around your neck and I'll be able to stand." My discussion with that patient was a bit more frank.
  5. by   djh123
    I'm facing a big problem related to this right now. A pt's condition is worsening, to where he is now needing more help with transfers, 'scooting up' in his wheelchair, pushing WC - and he weighs quite a bit. My aides are usually good, but sometimes they're busy elsewhere - and besides, I'm worried about all of us getting hurt with this guy, not just me. And he's a nice guy. I probably need to get a back brace at a minimum.
  6. by   JKL33
    Quote from djh123
    I'm facing a big problem related to this right now. A pt's condition is worsening, to where he is now needing more help with transfers, 'scooting up' in his wheelchair, pushing WC - and he weighs quite a bit. My aides are usually good, but sometimes they're busy elsewhere - and besides, I'm worried about all of us getting hurt with this guy, not just me. And he's a nice guy. I probably need to get a back brace at a minimum.
    In which setting is this?

    If possible I would suggest PT work with the patient to maximize whatever strength he has and to suggest methods and aids for moving and for teaching the patient how to move safely. I understand why you're thinking about a back brace, but to me that thought should merely serve as a clue that other help is needed. Human bodies are not meant to be large-people-moving-machines.
  7. by   djh123
    It's LTC. I'm not sure whether he's still getting PT or not, but I do need to check into that. The thing is, he's still continent... so the sit-to-stand or Hoyers that we use with incontinent patients haven't come into play, and aren't practical for say, just going to the bathroom quickly to urinate.

    And I totally agree that we're not meant to be big people moving machines...
  8. by   JKL33
    Quote from djh123
    It's LTC. I'm not sure whether he's still getting PT or not, but I do need to check into that. The thing is, he's still continent... so the sit-to-stand or Hoyers that we use with incontinent patients haven't come into play, and aren't practical for say, just going to the bathroom quickly to urinate.

    And I totally agree that we're not meant to be big people moving machines...
    Good luck!

    I suggest remaining pleasant but firm in seeking a solution for this situation. I would not give anyone (the patient, PT, your charge nurse or DON) the impression for one second that you are willing to handle this situation individually. I am never derogatory when speaking about the patient nor unwilling to help, but at the same time I will not entertain suggestions that staff should risk their back health with incorrect solutions. Just keep those options off the table.
  9. by   AJJKRN
    Quote from djh123
    It's LTC. I'm not sure whether he's still getting PT or not, but I do need to check into that. The thing is, he's still continent... so the sit-to-stand or Hoyers that we use with incontinent patients haven't come into play, and aren't practical for say, just going to the bathroom quickly to urinate.

    And I totally agree that we're not meant to be big people moving machines...

    Out of curiosity, would a sit-to-stand and a urinal not be both practical and safer?
  10. by   Borisarah
    It is well within your right to remain safe. If I have a large patient that is unsteady, I always remind them that they are bigger than me and can hurt me if the do not follow directions. In the op situation are you placing a front wheeled walker in front of him that he can hang on to instead of you? Also sound like time for a pt eval to se if he does need sit to stand.
  11. by   Neats
    I would just say no I cannot transfer you this way it is not safe for both of us. I would also make a note about the need for additional assist with transfers to protect my co-workers. I would also document this significant change in condition so the nursing staff i.e. MDS coordinator can update the patient condition. They will then refer to therapy or their physician for work up for the new condition.
  12. by   martymoose
    pts usually dont care if you get hurt. They know there will be other employees to take your place.
  13. by   Here.I.Stand
    Tell the pt/resident that a manual transfer isn't safe for either of you, and so it is not an option. The Hoyer is required. Of course you won't force him into the Hoyer, but without it he will stay in bed.

    Never EVER compromise your safety. Years from now this person won't even remember you... but your back is yours until you die.
  14. by   jdub6
    Quote from djh123
    It's LTC. I'm not sure whether he's still getting PT or not, but I do need to check into that. The thing is, he's still continent... so the sit-to-stand or Hoyers that we use with incontinent patients haven't come into play, and aren't practical for say, just going to the bathroom quickly to urinate.

    And I totally agree that we're not meant to be big people moving machines...
    Why can't you sit to stand him to use a urinal?

    If he is declining and not recieving and/or unlikely to benefit from PT someone needs to have a hard discussion with him and his care plan changed. You are NOT getting a back brace to move him. Even if you did at some point you won't be able to do it even unsafely with the brace so might as well deal with it now.

    "Mr X, we've noticed you're having more difficulty with weakness and the MD/PT have said it won't get better right away [or ever, or whatever]. Unfortunately it is no longer safe for us to help you as we have been. Because of the risk to you and to the staff we need to start doing things differently. When people have these troubles getting up these are the things we can do" and then give his options (urinal in bed, urinal using stander, condom cath...). If he objects that Betty helped him yesterday and it worked and all you have to do is xyz, reiterate that all staff have noticed he's having more trouble and he's been lucky so far but you are no longer confident you can do it without him falling/getting stuck/getting hurt/hurting staff.

    His care plan should be modified and all staff informed so you don't have a few people manually lifting while others refuse (even if they [think they] can do so safely this puts an unfair burden on them and makes the others appear to him not to care or to be less skilled.) I still recall a resident years ago with severe unilateral deficits from stroke "wait, I'm a 2 assist" and a CNA lifting her alone replying "you have to understand some people are better at this than others." To an extent she was right but that should never be tolerated for multiple reasons.

    The fact that the man is nice makes it sad for you (been there, done hospice) but should have no bearing on his plan of care (I'm sure you wouldn't refuse to transfer a nasty but capable man!) If applicable get PT, OT, and his doc to opine on his capabilities.

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