I have a resident who on average weighs over 300 pounds. She has an order by the NP to be weighed every morning before breakfast. I have to transfer her from the bed to a wheelchair, and then weigh her on the big scale in the utility room. This process takes a lot of energy for her to complete. It normally takes me 25-50 minutes (no lie) to get her out of bed, weighed, and then repositioned back in bed. Today, she told me that she was feeling tired and sick, and that she didn't want to get weighed this morning. I reported this back to my nurse, and she tells me that the resident still has to get up and weighed. I go back into my resident's room, to inform her of the bad news. She asks me, "Well, don't I have the right to refuse?" and I say "I would assume so."
Afterwards, I go to my nurse supervisor and tell her the situation. She says to me "She has to get weighed today. She has an order." After a few minutes, I now have the nurse supervisor, two floor nurses (mine included) and my fellow co-worker assisting me in getting this resident weighed. Despite all the help, it still took us 35 minutes to complete the task from start to finish. Along with being morbidly obese, my resident wears oxygen and loses her breath easily.
During the whole ordeal, I was under the impression that my resident had the right to refuse getting her weight done today. Not entirely, just this morning. She was willing to attempt getting weighed tomorrow. If the resident's have the right to refuse medications and treatments, then why couldn't she refuse getting her weight done today?
Yep, we have a lift that has a scale built into it, so we do most of our weights with that. I think all facilities should have something like that, because it's really difficult to get some residents' weights on a traditional scale, not to mention how hard it is on some residents to get to and from a regular scale.
"just get it done" or something along those lines is something I hear frequently if I go to a nurse trying to explain why something just isnt gonna happen, either because the resident is refusing or not cooperating or there just isnt time.
I've had a resident refuse to be washed up and dressed EVERY DAY, and would get physically and verbally abusive as a result. I wont even get into what shower day was like. Every day was a battle If I told the nurse they are refusing, the reply was they arent mentally competent to make that decision, that they need to be washed up and dressed, and thats all there is to it.
The person was usually oriented to person place and time, although a little confused. I would document the daily battle along with what the RN had to say about it every day to cover my butt. Why they never medicated this person Ill never understand, if these ADLs had to be done, but the person wasnt ever going to allow them without being physically and verbally combative, it seems to me thats when its time for some psych meds. Whoever is taking care of that person now definitely has my sympathy.
but as far as the weight is concerned, I'd be lobbying for a bed scale (fat chance huh?).
I think a bed scale is a great idea, and I will be sure to mention it in our 'suggestions' box when I get time. The work load would be much easier for me and my co-workers. Apparently, weights are being dumped on the 11-7 shift, because there is a huge assumption that all the residents, along with the staff are sleeping at this time.
Is she being weighed because she has CHF? If that is why, then that's a good reason to insist she do it as it can tell how much fluid she's retaining, but she needs to know the reason behind it.
I have never looked into her chart, and as a cna, the only diagnosis I normally get from a nurse pertaining residents are 'continent' or 'incontinent.' 'Confused' or 'Alert and Oriented'. Although I don't know my resident's ailment, the nurse did tell me that the NP wanted to keep track of how much water she was retaining. Possibly to see if she was a canidate for dialysis.
I would question if there was an easier way to do it. Lots of places now have the scale built in the bed or have a portable type scale (looks almost like a hoyer lift) and she wouldn't need to transfer or anything.
We have used a hoyer lift on her. She complained about pressure to her legs and found the process extremely difficult. She has used a chair weight. I had to transfer her from bed to the chair weight, then back to bed. That process normally takes me 30-45 minutes. Now, because she refuses the hoyer and because our chair weight has a low battery, she must be transfered to the big scale inside the utility room. My resident is usually compliant, but because of her weight, the simpliest of tasks for most is difficult for her.
Yep, we have a lift that has a scale built into it, so we do most of our weights with that. I think all facilities should have something like that, because it's really difficult to get some residents' weights on a traditional scale, not to mention how hard it is on some residents to get to and from a regular scale.
Our facility carries the hoyer weight. She finds the hoyer lift experience uncomfortable.
"just get it done" or something along those lines is something I hear frequently if I go to a nurse trying to explain why something just isnt gonna happen, either because the resident is refusing or not cooperating or there just isnt time.
I've had a resident refuse to be washed up and dressed EVERY DAY, and would get physically and verbally abusive as a result. I wont even get into what shower day was like. Every day was a battle If I told the nurse they are refusing, the reply was they arent mentally competent to make that decision, that they need to be washed up and dressed, and thats all there is to it.
The person was usually oriented to person place and time, although a little confused. I would document the daily battle along with what the RN had to say about it every day to cover my butt. Why they never medicated this person Ill never understand, if these ADLs had to be done, but the person wasnt ever going to allow them without being physically and verbally combative, it seems to me thats when its time for some psych meds. Whoever is taking care of that person now definitely has my sympathy.
Thanks for your response. This particuliar resident isn't combative or verbally abusive. I actually find her to be an intelligent, charming woman with a sweet heart. At the time, my resident simply didn't want to be weighed because she was feeling ill and tired. AND was willing to cooperate the following day. Why the nurses were so pushy, I can only guess. They were trying to save their behinds from punishment.
Yes, especially if they are in their right mind about the situation.
But then this can get complicated if it was a doctor order, who might be looking out for severe changes in her weight due to medication change and etc, you never know how high up on the list it is. It could be difficult, but not taking someone's vitals because they are feeling sick and tired are just as necessary.
I had pt's that I had to watch out for who were excessively losing/gaining weight soo...
It's just one of things that you chart about and have your charge nurse sign off on in case she opts to bring it up with the DON. It seems small and mundane but you never know how a family will react when they hear about the whole ordeal.
Yes she has the right to refuse; however, she also has responsibilities (they never look at that side of the paper). Hospitals and LTCs have these posted on the wall. I am all for a patient's right to choose, but I also believe those that want care should be active participants unless otherwise incapable!!! Also, one should not just let a patient say I don't want to and then say "ok". The nurse has a responsibility to ensure that the patient is fully informed of the consequences of their actions. After that, if the patient still refuses, so be it. (IMHO)
I believe that the resident has the right to refuse anything. I had a situation at a facility I was floated to, where a few resident were refusing to leave their room to go to dinner, one was refusing to get out of bed for dinner. The nurse made them go, and actually had a few CNA's pull the resident out of bed and force him to dinner. The nurse had two excuses as to why these residents had to be out of bed. One reasoning was that it was a rehabilitation hallway and so they had to get up. The other reason was that there wasn't enough CNA's to pass out room trays if we let everyone stay in their rooms for dinner. These were two separate days with the same nurse, that these incidents happened. One of my co workers from the staffing agency I work for, confronted the nurse, telling her that she was violating the residents right to refuse, I do not know what came out of that confrontation though.
Yeah the patient has the right to refuse, as has already been said, but I would also assume the facility also has the right to make it a requirement for living there that the person gets weighed. So if the person refuses to be weighed, the facility can tell them they need to find another facility to live in.
I remember a non ambulatory resident who weighed well north of 300 who claimed the DON informed them that if they didnt lose weight, they would have to go to another facility that was better equipped to take care of them.
yousoldtheworld
1,196 Posts
Yep, we have a lift that has a scale built into it, so we do most of our weights with that. I think all facilities should have something like that, because it's really difficult to get some residents' weights on a traditional scale, not to mention how hard it is on some residents to get to and from a regular scale.