A serious issue regarding patient care

[jon1989]

Hello, I am just a pre-nursing student, but my grandmother has recently been through the ordeal of a hip replacement rather than send her home, her doctor has placed her in a rehabilitation facility for two weeks before she goes home. Now keep in mind she is well aware of her surroundings and suffers from no dementia or forgetfulness of any kind. There are two seperate serious occurences that i did not witness and one minor annoyance that i witnessed.

first occurence:

it was after visiting hours it was about 0100 which i do believe is 1am in the morning, she pressed her call light, in order to have someone assist her to the bathroom, so the "aide" most probably a CNA, stood at her door and did not enter the room and said, "What do you want?" my grandmother then stated she needed help getting to the bathroom, the aide then said she would be right back, she never came back which caused my grandmother to have an accident (she does suffer from incontinence), she then had to stay in it all night until the morning shift came on and changed her.

Second occurence:

she was having her compression hose put on and the aide was pinching her as she put them on, and my grandmother said you are hurting me, please be more gentle, the aide then snottily replied "thats the only way to get them on, would you like to try to put them on yourself?" my grandmother said "no im sorry you are just doing your job." So the compression hose were put on then she needed to go to the bathroom, so she told the aide she needed to go to the bathroom so the aide roughly put her in her wheelchair, then wheeled her to the bathroom and then left her there to go back in the room and as my grandmother was in the bathroom she heard something being slammed around in the room and heard something fall. the aide never came back to help her back to the bed.

minor annoyance i witnessed:

I was visiting her and she needed to go the bathroom, so i pressed her call light because i did not know whether it would be a liability issue or not if i moved her or helped her to the bathroom. so the aide came in and my grandmother was having trouble getting up from the bed and the aide just stood there and watched so i got up and helped her into the chair and the aide went to the bathroom to help from there.

Now I have no doubt that the two occurences happened just as my grandmother said she did. I visit her twice a week due to work and school, these occurences happened last week, and she told me about them last night, i asked her why she didnt inform anybody of these incidents, and that it was her right as a patient to voice any concerns or issues like this, she said "i didnt want to I was afraid it would make them not like me and treat me worse." I then called my aunt who is an office manager at a home health agency and she came up there and the matter was handled.

now my question is: She should have informed somebody long before now of what happened, she is also one of the patients that realises that nurses are busy people and cant wait on her every need. am i overeacting in my view of things? I know i did not witness the first two occurences, but i do feel that she would not make up something serious like that just for attention. i just feel that two occurences in the past week, is far too many for a "respected rehabilitation facility" because what if some other occurences have happened that she hasn't told us about? I feel that she should be removed from there and possibly be placed in another facility am i wrong in assuming this?

For the record I realise I am long winded in my post but I wanted you all had as good an idea of what happened as possible and to voice my concerns and i really would like some imput on this matter. please try not to flame me

[Chapis]

i feel for your grandma', the cna shouldn't have been like that, i wish she would've said something sooner, but it's all taken care of right? and no, you're not over reacting, that's rediculous behavior from the cna or nurse that treated her that way, shame on them/her.

[greeniebean]

Her complaints weren't that the nurse aides were taking to long in helping her (it happens when you're short staffed!) It's that she's being neglected, so No i don't think you're over reacting. There's no excuse for being hateful to the residents, or leaving them in the bathroom unattended. I will say that maybe the CNA that never came back to toilet her may have gotten busy and forgotten but the other stuff isn't right. I'm glad it's been taken care of!

Since you posted she would only be there 2 weeks total I'm assuming her stay is almost over. I don't see the need in moving her if she'll be going home in a few days. Just make sure she knows to report any future occurances.

[Crash_Cart]

Consider in scenerio #1 that she may have been "incontinent" and used the CNA as the excuse why this may have occured.

Not saying it did ocur that way, but sometimes people are embarrased and they DO say things like that...

However, the approach I would have taken if you were concerned about her care is to speak with the charge person about it. It really not apropriate to remain silent if these are genuine concerns.

In terms of any "nurse retaliation" occuring to any of your expressed concerns goes, you are a nurse and you DO know how to document correct?

If patient retaliation occurs, take you documentation and report your findings to a higher authority. Patients do deserve and have the right to adequate "care."

Sorry to hear this happened...

My Best.

[chevyv, BSN, RN]

Compression stockings can be difficult to get on, but that is no excuse for rotten help (which is exactly what she is saddled with). No one should lay in urine through the night, ever. This could lead to skin break down and she'll be stuck there longer.

I gather she is in a rehab part of a long term care facility. She should be becoming more independent each day. Maybe you could ask exactly what therapy expects her to be doing. If they have her up with one assist, they should be doing just that. If she is up ad lib (up by herself), then she should be able to get up and around on her own. At night though, it is often more difficult to get up to the bathroom on your own. If you think about waking up with the urge to go, a recent surgery that is hindering your movement, a strange place..... all of this could lead to a fall.

My advice to you would be to visit as often as you can and don't be afraid to get involved. Ask what she should and shouldn't be doing. If some of the cna's are being less than respectful, let the nurse know. If it doesn't change, take it to the nurse manager or Director of Nursing. Unfortunately, there are times when you have to really advocate for your loved ones.

As a nurse in ltc, I would like to know if my cna's are being rude or whatever. I appreciate when family members come to me first. I can usually talk to my coworkers and tactfully make the situation better without causing any hard feelings. I also find out many times that it's really busy for them and I make it more of a point to help them out as much as I can. Good luck and keep us posted

[Batman24]

The CNA might have been helping another incontinent patient and simply had forgotten. Your grandmother should push the button again and not stay in it all night. While we'd all like to think no one will ever forget it sadly does happen because CNAs are often grossly understaffed as are nurses. I can't make the leap here that the CNA was negligent versus forgetful based on one situation.

The pinching with compression stockings can happen sometimes. It's horrible but when you are pulling sometimes you do pinch by accident. The CNA should have apologized when this happened and been extra careful and if they did pinch a little apologize each and every time.

If the aide left her in the bathroom how did she get back to bed? Did she do it herself or did she call someone else and ask? Did she fall when left alone in bathroom? Just curious.

You can report these things to her nurse and let them address it from there. Perhaps a reminder that you know they are busy but need to be gentle can go a long way.

[oramar]

By compression stockings do you mean TEDs? The have been proven useless and it is exhausting putting them and and difficult to do without pinching. It is a shame but it will be 20 more years before the actually practice catches up with the science and the government decides to stop paying for the things.

[leslie :-D]

incident #1- agree that cna may have been overburdened or just forgot...

your grandma could have used call light?

incident #2- stockings, this happens. everyone s/b trained on how to apply them.

what concerns me in this incident, is that she was left on her own in the bathroom.

how is she recorded w/her adl's?

independent, assist 1, assist 2???

i'm thinking she'd be at least 1 assist and if that's the case, then cna was indeed negligent.

however and again, she could have used call light in bathroom.

talk to cn and share concerns, esp being left alone in bathroom.

she will not be there too much longer.

wishing you and yours, the very best.

leslie

[NotFlo]

For the first incident, I'm not making excuses, but the CNA that initially answered the call bell might have been up to her neck in something else (like someone else's poo) and that's why she called from the door. I would advise your family member to put her call bell back on if someone doesn't come back in a few minutes. It's easier than you can believe to have to run to someone else and get distracted.

As for being left on the toilet, if your grandma isn't alarmed and isn't a fall risk the CNA might leave her on the toilet while she runs to do something else. What she should have done is asking Grandma to pull the bathroom bell when she was done. I would encourage her to do just that when she's in the bathroom. That way staff knows she's done and is ready to go back to her bed.

Yes, she is at rehab to get help, but mostly she's there to get independent so she can go home. If she's truly only there for two weeks they are probably expecting her to be doing a lot of stuff for herself. Exactly what her goals are and what her orders are (set-up for ADLS, OOB with A of one vs. up ad lib) should be clarified with PT/OT.

Ted hose are a *****. I wish there was a nicer way to say it. Esp. a nice fresh pair. They are so hard to get on. If your grandma is going to be home in two weeks or less how is she going to get these hose on when she's at home?

All that said, it sounds like some of the staff had a really poor attitude. No one deserves that. I would definitely talk to the charge nurse about all of these issues and let her know what your goals and expectations are for your grandma's stay. I would encourage your Grandma to discuss any concerns she has with her nurse and to call for help until she gets what she needs. I hope things work out well for her.

[justiceforjoy]

^ Well she definitely wouldn't be putting them on herself! I'm not sure what the protocol is, but isn't the hose d/c at discharge? Once the patient is OOB more often than not/ambulatory.