Blindfolding: Is this an intervention or abuse?

[dicecream]

I have been wondering about one of my residents who has advanced alzheimers and hits very hard any time anyone but her husband touches her. She also scratches, grabs, and squeezes, and has come very close to breaking my fingers. She is bedridden but still has very strong arms, and cannot speak but yells very loud. I've tried talking to her many different ways, even singing to her which sometimes helps for a few minutes (holding her hands and singing "say say my playmate" is a good way to make her smile) but I can't do that and give care at the same time. For a while her husband would hold her hands while we changed her but this became too stressful for him. I've learned to stay out of her range and cover her arms when I need to get closer.

Recently another CNA suggested putting a blindfold on her so we can get in close to give care without restraining her or getting hit. Does anyone know if this is considered abuse? I've tried it (I just lay a pillowcase over her eyes) and it makes such a difference. When she can't see us, she can't hit us, at least not accurately. She still yells at first, but I can actually take care of her without getting punched or smacked. It also seems to make her a little calmer after little while when she can't see us. Of course I take it off immediately when I'm done. I also think a factor in her behavior is annoyance at having the light turned on to change her, so covering her eyes actually makes her more comfortable.

I'm afraid to ask my DNS (it's been a long time since she did anything hands-on) because I don't want her to tell me not to do it, but I still want to know. I really do want what's best for the resident, but I have to consider my own safety. :redpinkhe

[nursel56]

Blindfolding a resident could be considered a restraint, as would covering their mouth. I was just looking and I found a journal article that stated a blindfolding a patient with dementia can cause visual hallucinations, and it may be scaring her, even though she seems more peaceful on the outside.

I know it's hard, but you've got to involve the DNS and the patient's doctor in a decision like that. Your DNS needs to know about this. She should already know, but you can be the one to help by reporting the details of your interactions with her, such as light sensitivity. You have the absolute right to be safe!! Hope it gets better for you.:)

[eveningsky339, LPN]

I will admit that I am straddling the fence on this one.

On one hand, it is technically considered a restraint to "blindfold" a resident for any reason, and therefore it is against the law. On the other hand, this is a quick and simple solution to a major problem and personal safety issue.

As for letting your DNS know... If your DNS is like most in long term care facilities, she has no concept of reality on the floor, and will tell you to stop covering the resident's eyes.

I think it would be best if you worked to find another solution to this problem, as hard as that may be.

[ghillbert, MSN, NP]

Would you want someone to blindfold your mother?

If not (and I hope not!) then you need to advocate for the patient and talk to your boss and her dr about more appropriate ways to manage her behavioural issues.

[CoffeemateCNA]

Think of it this way:

Would you do this if a state surveyor or the resident's family members were present?

If not, then it's probably not a good thing to do in the first place.

[KaroSnowQueen, RN]

I too am on the fence with this one.

Yes I know it is most likely considered a restraint by the state.

However, I am claustrophobic. When I had to have an MRI, I nearly lost my mind just thinking about it.

BUT!!! they blindfolded me (laid a thickly folded towel across my eyes, not tied on or anything), and as long as I didn't see the close quarters, I was able to keep calm and endure the test.

So, if this keeps the lady calm because she isn't seeing who's doing what.....and I suppose she would be able to move the towel off her face if she wanted to, is it really a restraint?????.

[JDZ344]

I'm leaning towards the 'abuse' angle. If she is still hitting out, blindly, then the blindfold isn't doing much. she is probably still scared.

I take three people in with me with the kickers/punchers. One person holds both arms whilst we do the care. It just means that someone may have to wait a little while until 3 people are free. Taking care of people with dementia can be hard, but there are always ways to manage the aggression without restraints. (restraints are illegal in care facvilities in the UK- the dung would hit the fan if we even placed a table by a chair so that the person couldn't get up and walk of their own free will!)

[Poi Dog]

I personally would not put a blindfold on any of my residents. There has to be another less ...(I cannot think of the word) to provide care. The blindfold just seems wrong to me.

Like KatieP86 suggested, take in backup with you.

Let us know how this was resolved.

[fuzzywuzzy, CNA]

What if you turn the lights down low? Put rolled washcloths in her hands? Give her stuffed animals to hold?

[eveningsky339, LPN]

Just got an idea: Is there a photograph of this resident's husband that you can give her to look at while you do care?

[dicecream]

Thanks for your replies. I thought of the picture idea too, and I'll ask her husband for one. I worked with this resident again last night and got some input from another CNA and a nurse. The CNA was from an agency and had some good ways to get the resident's attention and make her laugh. She really is mentally almost like a young toddler, and can sometimes be distracted by a silly face or simple humor. I will keep trying these things, and see if I can get her to trust me. The nurse said she didn't see anything wrong with covering this particular resident's eyes very gently since the light does upset her and she can take the pillowcase off. I think it's better to do as much as we can with other interventions.

It's so hard to know what the resident is really thinking or feeling. I haven't met anyone else I would even consider blindfolding, but for this particular resident there are certain situations when I really feel like covering her eyes is safer and less intrusive than holding her down (Isn't holding her arms also restraining her?) or crowding her with lots of people. I am always her caregiver when I'm working, so hopefully I can find some more solutions and pass them on.

[caliotter3]

Just got an idea: Is there a photograph of this resident's husband that you can give her to look at while you do care?

For that matter a photo of anybody or anything that she finds interesting may be enough distraction. Tom Selleck or Paul Newman in their younger days, depending on if she liked blue eyed men or brown eyed men more!