Family member issue......

[dedream]

Okay so here goes..... I work for a multicare facility and I float, a couple of days ago I had a relatively tough assignment; myself to 12 residents, half of which were self care and the other half was split between total care and assist x2. Anyways one resident in particular had me a bit puzzled or rather her daughter who is "involved" in her care. Her personal belongings are arranged in her drawers in outfits that are labelled with the days of the week and wrapped in plastic bags and the aides are instructed/warned not to dress her mom in any outfit other than the one that is labelled for the day. Now this resident had an accident on this day and since we are to follow this rule she was dressed in a gown and put back to bed in the middle of the day per the nurses orders. This resident is semi alert and sometimes has no clue what is going on and this day she was visibly upset and I felt very bad about this:cry:. I questioned the nurse about this and she told me that the residents daughter gets angry if her wishes are not followed. I debated :argue: this situation with the nurse and in the end it was basically "get over it that is what the family wants". I understand about wanting to be involved but at what point does it stop becoming care and becomes control?

[asun21ta]

Yes. Brining this up to a social worker would be an excellent idea. I would do that, then leave it alone. She is a good CNA to be so concerned for this patient's well being. So many times simple things like this are overlooked.

[dedream]

Lets face it, sometimes you can't get back to that room every hour. I think the issue here is not the fact that the problem wasn't solved. It's a dignity and respect issue. Why is this resident wearing hospital gowns when she has clothes? Clearly is affects her because she is upset. For this reason alone, I feel someone should make the daughter aware of how mom is feeling. I would want to know if it were my family.

I 100% agree with u.. my problem with the situation is exactly as stated; dignity and respect of the resident. This resident is on toileting q2hrs and despite my heavy assignment I did take her every 2 hrs; it was just one of those days when an accident can and did happen I mean she's human, it happens. Anyways we had an inservice on residents rights and such; being that the state is coming soon and I found it ironic that the instructors were the same folks that were present during the aforementioned situation. I guess its just that I am green and expect too much.

[jb2u, ASN, RN]

First, I am happy to hear that you care so much!!! Second, this is what happens when "customer service" is connected with healthcare!! The fact is there are more nursing homes, hospitals, doctor's offices, etc to choose from. This daughter may just like to control the situation because she feels that it is the best way to protect her mother from all the horror stories she has heard about nursing homes. Maybe the daughter is just a pain. Only the daughter knows the reason why she does the things that she does. That being said, it is HER mom. You are responsible for the care, but she is the daughter. I would not say putting her in bed is abuse. If you did not turn her q2hours, that would be abuse. If the daughter said, "if she has an accident and wets her clothes for Monday, just leave her in them all day. It will be fine," and then you proceed to comply with her wishes....that would be abuse and should not be followed. My point is sometimes you will have difficult family members and the nurse should advocate for their patient if there is a problem. They may have already tried to talk to this daughter and she flat out refused to bring in "extra" clothes. NO, you can not just put her in another outfit if that is not the families wishes. It could get you fired and lose the nursing home a resident. You may be able to live with this consequence, knowing that you stuck to your beliefs; however, the number crunchers of the facility will definitely not see it your way. They will, SADLY, see a lost "customer."

[pagandeva2000, LPN]

The social worker can be contacted for two reasons, one to try and gently suggest to the daughter that maybe a second change of clothing should be made available in case of soiling. Another reason is to see if there are any extra clothing brought by volunteers or otherwise that can be labeled for this patient for those 'just in case' days.

And, out of curiousity...does the daughter come and see her mother daily? If she came upon this situation and saw that her mother has on different clothing and an explanation was given, is there proof, so to speak that she will blow up, even after staff tried to comply, keep her comfortable and clean?

[dedream]

Good news pagandeva I was on the floor again yesterday and the residents daughter happened by and saw her mom in bed very upset and "demanded" to know why her mom was in bed in the middle of the day. The aide who was assigned to her mom explained the situation similar to mine except this time she was taken to the beauty parlor and she was soaked by the shampooing of her hair ( resident has a tendency to sit up in the middle of a shampoo) so the aide had to take her to her room and place a gown on her. Daughter was ranting for a while until a senior/regular aide stated that her mom has no extra clothes and this is the procedure that we follow. The daughter demanded to know who decided on this and she was paointed in the direction of the CN who then explained the bigger issue. Last I heard a meeting was scheduled with the social worker to discuss alternate ways in which to preserve her moms dignity and to keep her happy, for a minute I felt as if I were in an episode of the twilight zone.....I mean I guess it had to take a situation where daughter walked in on to realize that maybe a compromise was in order. Anyways I am glad it worked out.

[pagandeva2000, LPN]

Good news pagandeva I was on the floor again yesterday and the residents daughter happened by and saw her mom in bed very upset and "demanded" to know why her mom was in bed in the middle of the day. The aide who was assigned to her mom explained the situation similar to mine except this time she was taken to the beauty parlor and she was soaked by the shampooing of her hair ( resident has a tendency to sit up in the middle of a shampoo) so the aide had to take her to her room and place a gown on her. Daughter was ranting for a while until a senior/regular aide stated that her mom has no extra clothes and this is the procedure that we follow. The daughter demanded to know who decided on this and she was paointed in the direction of the CN who then explained the bigger issue. Last I heard a meeting was scheduled with the social worker to discuss alternate ways in which to preserve her moms dignity and to keep her happy, for a minute I felt as if I were in an episode of the twilight zone.....I mean I guess it had to take a situation where daughter walked in on to realize that maybe a compromise was in order. Anyways I am glad it worked out.

Isn't it funny how things work out? It seems that the daughter was a bit inflexible and had unrealistic ideas, and here it is, she walks into a situation where it was plain to see that alternative plans needed to be made. Now, maybe instead of being a hinderance, she can become a help. And, if she doesn't, I would still continue to do as what happened...she cannot remain in wet or soiled clothing, so, something must happen. Great news.

[asun21ta]

Great. I'm am also glad something was done. I knew eventually something was going to happen this way. It happened too frequently where I used to work. I agree with Pagandeva2000. The daughter seemed to have unrealistic expectations. The daughter blamed the staff initially until she realized the staff were limited because of her rules. Now your resident can go on live the best quality of life that she can. Hopefully the daughter will be more flexible in the future. I also hope the staff continues to inform the daughter if situations like this in the future. You see....what goes on in the dark, comes out in the light!!:wink2:

[pagandeva2000, LPN]

Some families can have horrible expectations. When I was a CNA, I had a patient who was severly contracted and the family insisted that she wear two piece pajamas which were very difficult to fit on due to the serious contractures of her arms. I would see frustrated CNAs literally sweat to put these pajamas on her as per family's request, and even though the patient was suffering from dementia, I can see her wince while sometimes, 2-3 assistants fought like the dickens to follow this insane request. When I was assigned to her, I placed on the hospital gowns to give the poor thing a rest. Whether she was in her right mind or not, I could not see how this woman could have been comfortable with this arrangement.

The family never came when I was on duty, not sure if they even came at all, to be honest, but, again, sometimes, people make these decisions based on impossible realities. I also felt that to save a bit of pain and dignity to just change what I did. The difference between myself and the OP was that I was never confronted by the family. If it had happened, I would have expressed the same, or would have let them witness the trouble it took for both, the patient and the assistants to dress her the way they wanted. Better yet, I would have been sorely tempted to get them to dress her to see how taxing it could have been to both. Glad to see positive results out of this!

[asun21ta]

Some families can have horrible expectations.

Yes! I once had a resident who weighed 300 lbs. We had to use a mechanical lift to toilet her because she was dead weight. Well, when her daughters saw this they had a fit! They were horrified at how the machine looked and demanded someone carry their mother to the bathroom instead! It was insane. Evidently, the admissions coordinator advised the family we had to honor their every request...including getting 3-4 members of staff to pick this resident up and take her to the bathroom every 2 hours!!! This request was obsurd. That was most of the staff on the floor! The DON had to speak with the family who couldn't understand why no one wanted to physically lift their mother. The DON had to sugar coat it as nicely as possible. I remember her saying something along the lines of it being for resident and staff safety. Well, they didn't like what the DON said so they discharged their mother the very next day.

The sad part was, the resident was so nice and understanding. She got along very well with the staff and had become quite comfortable. She realized why she needed a mechanical lift. She was admitted after a laundry list of surgeries. She couldn't stand or weight bear. She didn't want to give anyone a hard time. It was her daughters who gave all of us a hard time. I felt so sorry hearing her apologize for her daughters behavior. I know it made her feel even worse.

[dedream]

Asun21 sometimes I feel like the guilt the families go through by having to put their loved ones in a nursing takes them to the place where they impose these unrealistic and sometimes unattainable goals....its as if they still see their loved one the way they were versus the way are right now. I understand this but coming to terms with a family members unique situation or diagnosis helps staff give great care and positive feedback. JMO.......

[asun21ta]

Agreed. The guilt gets the best of them sometimes. No, it's not an excuse for them to make everyone's life difficult. Sometimes they want to blame for someone for something to hide the real issue at hand. I realize that some families never come to terms with their loved one becoming ill. Although someone may be in obvious declining health, a loved one may deny it or refuse to see it for what it is. Because many of them are not health care professionals, they have no clue what to expect. This is where the confusion on both sides come in.