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.
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
Re. the whole "baseline level of function." I used to do agency work in nursing homes in the area and I saw many, many pts who had everything done for them by the CNAs b/c it was faster that way. It got to the point that pts actually believed that they couldn't walk, that they had to wear diapers, that they couldn't set up their own meal tray, etc, etc, etc. I've been in the hospital setting for a while now and we get nursing home pts who honestly believe they can't do a thing until we show them that they can. We'll have some of them pretty much independent in a few days (which makes me wonder why they're in a nursing home in the first place) and when they come back to us months later (from the nursing home again), it's the same thing all over again. Just wondering what's up w/that.
Worked in LTC and for the most part there is just not enough time or employees to give optimum care (or even the basics) for the large population. There are, of course, other factors involved, but that is the simple answer.
irishnurse67
83 Posts
Re. the whole "baseline level of function." I used to do agency work in nursing homes in the area and I saw many, many pts who had everything done for them by the CNAs b/c it was faster that way. It got to the point that pts actually believed that they couldn't walk, that they had to wear diapers, that they couldn't set up their own meal tray, etc, etc, etc. I've been in the hospital setting for a while now and we get nursing home pts who honestly believe they can't do a thing until we show them that they can. We'll have some of them pretty much independent in a few days (which makes me wonder why they're in a nursing home in the first place) and when they come back to us months later (from the nursing home again), it's the same thing all over again. Just wondering what's up w/that.