A Valuable Lesson

elizabethmeiereRN · May 29, 2015

Thank you for this post! It means a lot to know that there is someone out there caring for theses adults. My brother has Angelman's Syndrome and will eventually end up in a group home. It can be a scary thought, but knowing people like you are out there puts my mind at ease. Keep it up and good luck with the new job!

jojo489 · May 29, 2015

Thank you. :) I'll keep you posted.

I've noticed in group homes, there are more good staff than bad, and you always have the stellar one in each home. Plus, you can surprise visit any time you want. Haha.

JuliaRNMSN · May 31, 2015

I too worked with intellectually disabled adults living in group homes. Unfortunately, I did not have the same experience with the organization's political atmosphere.

My question for you: Have you ever experienced an adult in this population clearly tell you that they had something put in their "butt?" In other words sexually/physically abused?

Thanks for any input.

jojo489 · Jun 1, 2015

I've actually never been in that position. I have had them come off with some very off the wall things that after lots of questions and a long talk were eventually grounded in reality.

Was this individual high functioning? Was it possible they recently had a doctors visit or colonoscopy? A lot of my residents didn't handle those or proctology exams well at all. Or even possibly a suppository placed for constipation or nausea?

Sometimes they don't understand something that has happened and will ask questions or talk about it a little bit.

I might be able to give you a better idea if I knew a little more about the situation/person.

If you want to talk about this more, PM me.

And as always, if you suspected abuse I hope it was reported.

JuliaRNMSN · Jun 2, 2015

Thanks yes it was reported. I was written up for not calling the Director. Without making the reply too long:

1. Individual had been with us only a week. 30 yrs old Chronic end stage renal failure d/t toxic lithium levels. This is the only history we received from the SS staff responsible for acquiring health history from past facilities and physicians.

2. I worked off "keeping an open mind" yes he could have been abused or not.

3. He and his sister wanted me to observe the area and I planned to but was side tracked. In the meantime his sister took him out of the group home for lunch. I did not get a chance to assess that day.

4. The following weekend, a report was written that he had bruises on his back, buttocks and legs. While noting the bruises reported per policy I was to look at the bruising and determine any problems associated with them. I noticed that his buttocks had golf ball sized bruises red purple at the area on his buttocks where the orifice would be if one would spread the buttocks apart.

jojo489 · Jun 3, 2015

Wow, that is horrible.

Was the sister aware of the bruising when she brought him in? Or did they show up later?

That is pretty terrible though. If he's claiming someone did something to him and the bruises look like what I think they look like, I'd be convinced of abuse.

It's really difficult to face a situation like that head-on. I've had some minor things happen with my residents, but nothing along those lines.

A lot of mine did have some terrible stories from their past. I had a few who had been molested, I had several who were treated worse than dirt for most of their lives. I had some real heartbreakers. But the way that I always looked at it was that now they were somewhere with people who care and want to enrich their lives. I can improve the quality of their life from here on.

I am very sad for you and this gentleman. And I sincerely hope that whoever did that to him is now no longer allowed access to him so it may never happen again.

jdd112 · Jun 3, 2015

I love how passionate you are, and I'm happy for you that you have found your way back to this population! I saw you commented on my post a while back. This field has a high burn out rate because it can be so demanding and has a lot of non-nursing duties that go along with everything else we do, so it's that much more important for our clients/residents/consumers to have people that are going to stick with them and love them for the long run.

Also, let's keep this discussion board active! I LOVE being able to bounce ideas off of others, and I'm all by my lonesome in my organization!

JuliaRNMSN · Jun 3, 2015

I appreciate your thoughtful response. The entire situation was hard to figure out and it made me very sad. I remember breaking down and crying to my boyfriend after work (w/o breaching confidentiality). Since I was the only RN on, I responded to it using the nursing process. I assessed and then my plan was an ER visit on the hopes that there would be an examination. When I saw him that second weekend, with the bruises on his buttocks, I did call the Director versus the w/e before I spoke w/ supervisor (not a licensed person keep in mind). The Director said the state had been notified to investigate and that was basically the end of it. I did not hear another word about it. I did leave the Director a message asking her to inform me of the outcome and provide advice for the future. She did not get back to me.

To answer your question was his sister aware when she brought him in for admission....that I do not know. A body check is required for all admissions and this was completed by the other RN. I saw no info about bruises in her notes. What I did by documenting all details was start an investigation. Reporting suspected abuse was unclear in the policies meaning no clear if this do this. I really had to wing it. He was diagnosed as bipolar and exhibited psychotic behavior. Without background information there was no way to compare past to present patterns. Before he was admitted I said this and stated I believed I could not provide professional care without more information. The posts on this are a way for me to debrief. I have not found any education offerings on possible abuse when the person is new, psychotic, intellectually disabled. Imagine the consequences of saying"he was sexually abused while at the facility" without some hard evidence. Sure he had bruises but he also used to fall on his back side for reasons we had not uncovered.

jojo489 · Jun 4, 2015

I love how passionate you are, and I'm happy for you that you have found your way back to this population! I saw you commented on my post a while back. This field has a high burn out rate because it can be so demanding and has a lot of non-nursing duties that go along with everything else we do, so it's that much more important for our clients/residents/consumers to have people that are going to stick with them and love them for the long run.
Also, let's keep this discussion board active! I LOVE being able to bounce ideas off of others, and I'm all by my lonesome in my organization!

I loved your post. I also think an important thing for this population is to have some stability with staff, especially in the group homes because when you work so close with them they really get attached and when a staff finds a new job its like losing a family member for them.

I definitely want to keep this board active. I'd love to have someone to talk to or bounce ideas off of that is familiar with the population. I saw in one of your posts that you're DDNA certified...is it difficult to get that? What requirements do you need to meet?

jojo489 · Jun 4, 2015

I appreciate your thoughtful response. The entire situation was hard to figure out and it made me very sad. I remember breaking down and crying to my boyfriend after work (w/o breaching confidentiality). Since I was the only RN on, I responded to it using the nursing process. I assessed and then my plan was an ER visit on the hopes that there would be an examination. When I saw him that second weekend, with the bruises on his buttocks, I did call the Director versus the w/e before I spoke w/ supervisor (not a licensed person keep in mind). The Director said the state had been notified to investigate and that was basically the end of it. I did not hear another word about it. I did leave the Director a message asking her to inform me of the outcome and provide advice for the future. She did not get back to me.
To answer your question was his sister aware when she brought him in for admission....that I do not know. A body check is required for all admissions and this was completed by the other RN. I saw no info about bruises in her notes. What I did by documenting all details was start an investigation. Reporting suspected abuse was unclear in the policies meaning no clear if this do this. I really had to wing it. He was diagnosed as bipolar and exhibited psychotic behavior. Without background information there was no way to compare past to present patterns. Before he was admitted I said this and stated I believed I could not provide professional care without more information. The posts on this are a way for me to debrief. I have not found any education offerings on possible abuse when the person is new, psychotic, intellectually disabled. Imagine the consequences of saying"he was sexually abused while at the facility" without some hard evidence. Sure he had bruises but he also used to fall on his back side for reasons we had not uncovered.

Yeah, that's a really hard situation, especially with his diagnoses and the falling business.

Trust me, I've had many a days where I've come home and cried to my boyfriend about something I've had to deal with at work.

The hardest thing I've had to deal with thus far was still before I was a nurse. I had a little man in one of my group homes who I had built a very good bond with. I was also on first name basis with his family, they were great. And the day that we had found out that he had B cell lymphoma, my supervisor had initially broken the news to his sister....but she ended up calling the home and cried to me on the phone for hours. The hardest thing was to help her, give her options and not let her hear the tears that were burning my throat as well.

I don't know, you end up with such a wide variety of situations working with this population and a lot of times it is not easy. And the burnout can be high. But I think this is one of those areas of nursing that you need to love to be able to stay in.

Are you still working disabilities or have you moved to another area?

SoontoBNP · Jun 5, 2015

Hello, I am so glad I saw this post! I've been working as a RN delegating nurse-case manager for over a year now for a DDA agency and I love it! When I saw the job offer I knew I had to apply. At the time I had another offer from a home health company that was 15k more per year, and I turned it down. I am so glad I did. The biggest reward is the ability to develop long term relationships with my clients and their families. My little sister has severe developmental disabilities, and I think that's why I have such a strong interest in this field.

My company takes on a lot of clients who are very difficult behavioral cases that other agencies wouldn't. I currently manage the psychiatric care for all of them, through about 7 different psychiatrists, and it can be difficult. I've been hurt at work, but it's extremely rare. I think the most difficult part is communicating with parents who have unrealistic expectations, or believe their child will outgrow autism/disabilities with treatment.

I really love my job, and one day I hope to help with research into autism treatment as a psychiatric nurse practitioner. I guess that it is a hope of mine, that I can continue working with clients with disabilities until I retire! Learning how to triage non-verbal clients with only objective data has been a challenge. There is also a lot of agency/regulatory/administrative duties that are time consuming.

I have found that most of the people who work long-term in this area love their job and the clients, because it does get exhausting. There have been days where I came home crying because a physician and I couldn't figure out what was wrong with a client, but can tell they are in physical pain. There have been times I've scolded doctors on the phone for not assessing a client or giving them sub-par care because of their inability to speak for themselves (if you work in this field, you know, it happens).

I guess what makes me love the job, even though there are so many challenges, is the ability to advocate for the client and made a difference. Sometimes as a case management nurse I am advocating for the patient to the family, to management, or to the doctor. In the end, I try to keep their needs in mind and I know I make a difference. I love disabilities nursing!

As far as abuse goes, it does happen, but it's not as common as people think. Since I've been working in a very LARGE agency I've only seen a few cases of suspected abuse and the suspect was the family, or another client, not staff. Then again my agency has cameras in every living space of our group homes. There are sick people everywhere though, which is why we have to be so careful to monitor for signs of that closely.