I work in the Special Care Unit of a long-term care facility that has a policy of resident's rights to be free from all restraints, including chemical restraints. Our 'Unit' as they call it, has 12 residents and 2 aides on staff until 8:30 pm, by that time most of the residents have been bedded down for the night so only one aide is needed. One of our little ladies (Ms. S) is a woman suffering from dementia which makes her a danger to herself and others because she is not able to comprehend simple directions such as 'please sit down here until I can come back and help you.' She speaks in a constant stream of random words strung together incoherently. If left unattended she will make threatening gestures to and get into altarcations with the other residents. She's unsteady on her feet and needs to be supervised continuously. Her oxygen saturations are in the 40% range unless she is on 5 liters of O2, yet she constantly takes the cannula off. She refuses to stay in one spot unless they tranquilize the consciousness right out of her. Today was a case in point. From the time she was awake this morning she was disruptive of everything that was going on. Every time she got up from her seat I had to drop everything I was doing and run to her side so she wouldn't get up and walk around unsupervised (this happened innumerable times today). I was of little help to the other aide for the entire shift because I was doing nothing but 1:1 with this helpless little lady who also cannot feed herself or do any self-care.
The last 2 days were exactly the same as today, the only difference was that at some point when the exasperation level got too high we'd call the nurse for a prn dose of Ativan or whatever so she could be subdued enough for us to be able to attend to the other residents who needed toileting or bathing, etc. Once the medication hits, she falls dead asleep -- allowing us to get things done and take care of other residents who are also fall risks. The most stressful thing on my shift is when the other aide is with a resident, I'm doing 1:1 with Ms. S and cannot leave her side -- suddenly I hear an alarm down the hall from another resident who is trying to self-transfer for the 40th time today and I can do nothing but wait for the other aide to take care of the chronic alarm setter-offer. Ms. S cannot be distracted with music, movies, activites, crafts, or any simple diversions because she just cannot focus.....you name it, we've tried it. The only thing she responds to is heavy doses of CNS depressants and anti-psychotic drugs. I ask you.....is this not using a chemical restraint? Not that I mind.....without it we would have to staff one person to do nothing but stay with her 24/7. I guess what I don't understand is, what's the difference between sedating a psychotic person and using a chemical restraint?
