is this abuse?

flightnurse2b, LPN · Nov 17, 2007

Let me start off by saying this is my first semester in nursing school.
The other day I went into a nursing home and was sitting there doing my care plan.
A nurse went up to a resident that had broken her arm. It was now healed and she wanted to help her do some therapy. Well, she took off this black guard that was on her hand and was trying to move her hand. The lady asked her to stop several times. She then said "stop it you are hurting me". The nurse said "we have to do this" the woman started screaming stop. Finally the women screamed "i said stop! you are hurting me" another nurse heard her down the other hall and came to see what was going on. Only then did the nurse stop and tell her to move it herself. I have seen this resident in other situations and she is the sweetest thing. She doesnt scream or yell. I am confused as if this was abuse or not. She did ask her to stop several times.
I know physical therapy of previously broken bones can sometimes be painful....but these seemed mean to me. I am going to speak to my instructor on monday. Just wanted to know what you guys think.

of course all pts have the right to be treated with respect and dignity... and all patients have the right to refuse treatment, unless deemed incompetent or vegetative.... and if the patient was alert and oriented, she has the right to refuse tx... i dont know if it was abuse from the situation you described, but the nurse violated her right to refuse treatment.

The US National Academy of Sciences defines elder abuse as follows:

Intentional actions that cause harm or create a serious risk of harm (whether or not harm is intended), to a vulnerable elder by a caregiver or other person who stands in a trusted relationship to the elder
Failure by a caregiver to satisfy the elder's basic needs or to protect the elder from harm.

i would definately speak to your instructor about your concerns. kudos to you for being her advocate.

jennifers · Nov 17, 2007

The women was alert and oriented. I'm not sure what i should of done in that situation. I am going to talk with my instructor about it. Thanks for the reply :)

nyapa, RN · Nov 17, 2007

That would be my approach as well. The other thing you could do is ensure the patient has the number for the 'complaints' dept of the hospital, but again, I would suggest that you speak to the instructor first. You are in a difficult situation here...

CHATSDALE · Nov 17, 2007

however i have seen patients that refused tx [like for a stroke] and then the family c/o his lack of progress as compared to some other patients in the same facility

the doctor told them that some strokes are more severe than others and that you couldn't compare one patient to another

this is certainly true but i don't know if the family knew that that the exercises were not being done...doctor had to know because it was charted as refused

meownsmile, BSN, RN · Nov 17, 2007

Id say she failed to provide basic needs at least. She should have checked on pain medication as soon as the patient began complaining of pain with therapy. It could have been very simple to go get a couple pain pills and give her 20 minutes for the pain medication to start taking effect and then continue with the therapy.

I think comfort would rank in there with basic needs.

irishnurse67 · Nov 17, 2007

Let me start off by saying this is my first semester in nursing school.
The other day I went into a nursing home and was sitting there doing my care plan.
A nurse went up to a resident that had broken her arm. It was now healed and she wanted to help her do some therapy. Well, she took off this black guard that was on her hand and was trying to move her hand. The lady asked her to stop several times. She then said "stop it you are hurting me". The nurse said "we have to do this" the woman started screaming stop. Finally the women screamed "i said stop! you are hurting me" another nurse heard her down the other hall and came to see what was going on. Only then did the nurse stop and tell her to move it herself. I have seen this resident in other situations and she is the sweetest thing. She doesnt scream or yell. I am confused as if this was abuse or not. She did ask her to stop several times.
I know physical therapy of previously broken bones can sometimes be painful....but these seemed mean to me. I am going to speak to my instructor on monday. Just wanted to know what you guys think.

That nurse is lucky the poor little old broad didn't deck her.

caliotter3 · Nov 17, 2007

If the lady was objecting loudly enough to be heard by the second nurse down the hall and cause her to come see what was happening, then she was in enough pain for the attending nurse to take notice. Alert and oriented. Yes, she had the right to refuse. But her pleas to stop being hurt are more pressing an issue. Her nurse was showing poor judgement at the time. You are right in talking to your instructor about this. A little surprising that the nurse would do this in front of a student or any witness for that matter. Good for you for being concerned about the resident.

suespets · Nov 17, 2007

. the nurse did the exercisew/o concerning herself w/ the fact that a student was watching ,most likely cuz she did'nt feel she was doing anything wrong,i would have to have seen the situation, but it's possible,the sweet little lady could have a low pain threshold,as well as being manipulative (knowing the student was watching,wanting the attention) There is at times, a fine line b/tfollowing a tx order,let's say,for the benefit of the pt,and allowing pt. to be non-compliant,to his/her disadvantage.iv'e seen it all too many times!reapproach after pain mads is good. also trading work with another nurse who pt.seems to really like! i'd say as a student, always give the employed nurse the benefit, talk to instructor, don't judge w/o all facts

allnurses Guide · Nov 17, 2007

Id say she failed to provide basic needs at least. She should have checked on pain medication as soon as the patient began complaining of pain with therapy. It could have been very simple to go get a couple pain pills and give her 20 minutes for the pain medication to start taking effect and then continue with the therapy.
I think comfort would rank in there with basic needs.

:yeahthat:

siggie13 · Nov 17, 2007

. the nurse did the exercisew/o concerning herself w/ the fact that a student was watching ,most likely cuz she did'nt feel she was doing anything wrong,i would have to have seen the situation, but it's possible,the sweet little lady could have a low pain threshold,as well as being manipulative (knowing the student was watching,wanting the attention) There is at times, a fine line b/tfollowing a tx order,let's say,for the benefit of the pt,and allowing pt. to be non-compliant,to his/her disadvantage.iv'e seen it all too many times!reapproach after pain mads is good. also trading work with another nurse who pt.seems to really like! i'd say as a student, always give the employed nurse the benefit, talk to instructor, don't judge w/o all facts

Everything you said could have been true AND the basic fact remains that the patient asked her to stop and she didn't! Many times nurses lose sight of the simple basic right to refuse care/treatment; we are so caught up in schedules, doctors' orders and what we "think" is right for the patient that we cannot accept this simple fact. We sometimes feel we know best and that patients have to do what WE think is the best thing, whether they want to or not. Well, that's not true. Patients can say "no", they can smoke, overeat, do drugs, whatever and they have that right. We are present to assist others, not run their lives.

ktwlpn, LPN · Nov 17, 2007

A nurse went up to a resident that had broken her arm. It was now healed and she wanted to help her do some therapy. Well, she took off this black guard that was on her hand and was trying to move her hand. The lady asked her to stop several times. She then said "stop it you are hurting me". The nurse said "we have to do this" the woman started screaming stop. Finally the women screamed "i said stop! you are hurting me" another nurse heard her down the other hall and came to see what was going on. Only then did the nurse stop and tell her to move it herself. I have seen this resident in other situations and she is the sweetest thing. She doesnt scream or yell. I am confused as if this was abuse or not. She did ask her to stop several times.
I know physical therapy of previously broken bones can sometimes be painful....but these seemed mean to me. I am going to speak to my instructor on monday. Just wanted to know what you guys think.

You can go to the medicare.gov website and click on the "nursing home compare" link and learn everything you want to know about how nursing homes are monitored. There are quality indicators that will reveal if the home's resident's are receiving the proper care.Things such as the number of residents that have experienced a decline in the performance of any activity of daily living .We must show exactly what we are doing to address each problem-from new onset incontinence to wt. loss to restricted range of motion. A fracture is a "sentinel event" in any LTC which means it must be investigated and a report filed with the state department of health(within 24 or 48 hours).They will often audit that chart at the next inspection to make sure everything possible was done to attempt to restore that resident's baseline level of function..Often-especially residents with dementia- will become really agitated during their restorative programs.Some will scream before they are even touched.We can't just load them up with pain med without first assessing their pain and we have to be careful with analgesia in the elderly..So bear all of this in mind while reviewing what you saw.I would have instructed the restorative cna at my facility to stop immediatly-I would have called the MD and gotten and order to pre-medicate with EX tylenol/ultram or motrin prior to range of motion.I would have given the med and asked the aide to attempt the ROM again later and I would have observed and assessed the resident and taken any further action needed....However-I do know several residents that scream bloodly murder through the most gentle range of motion and it has to be done to prevent further contractures...Some of the aides will sing softly to try to soothe them with varying levels of effectiveness.When we have students on our units and something like this happens I will try to make it into a teaching op if I can-it would have been nice if someone had taken the time to show you what they were doing and explain why. Please check out that website-it will help you understand how tightly controlled we are in LTC....Also-yes,patients do have the right to refuse treatment BUT (especially in LTC) we can't just drop it there-we have to keep trying and trying and trying....and documenting and documenting and documenting