Dragging 'em out of bed

[SuesquatchRN]

Demented resident - we'll call her Mary - is always cold, often combative with care. She's freezing when she first wakes up. Incontinent of bladder. Her saturated chuck gets nice and warm.

She. will. not. get. up. The other nurse - I will NOT do this - tells the aides to get her up regardless. She's fighting and cursing and an aide ends up hurt and Mary ends up weeping in the nurses' station and asking me, "Why did you let them do this?"

She thinks she's been beaten up. Well, she kinda has been.

Now, I know she can't lie in her own waste all day and needs to get up. But how do we do this? (My co-nurse is pissed at me for suggesting that fragging her out of bed isn't the way to go. "They didn't DRAG her out of bed!" Of course they did, numnutz.)

Any suggestions?

[adrienurse, LPN]

there is a video called bathing without a battle, creating a better bathing experience for persons with alzheimer's disease and related disorders by ann louise barrick phd, joanne rader ms, rn, and phillp sloane md, mph from the university of north carolina at chapel hill which provides a wealth of information to help deal with dementia and the problems it presents. keep the spirit up, we are living in a wonderful and adventurous time in long term care, we are changing the way elders are being cared for to make it better for all.

this is very good, it's in print as well. i highly recommend it.

[withasmilelpn]

So many issues here- just how oriented in this patient- is she able to make her own decisions? Can she be bargained with- We will go our of bed for only one hour (and make sure u keep ur promise) Does she have family that have an opinion ( "Oh leave granny alone she was always like that"..._Does ur SW have an opinion? Is she depressed and will an antidepressant help her- seek psychiatric help for her,.....

I have the opposite problem - 93 yr old very obese women barely able to stand sits all day in a (padded) chair and refuses to rest in the afternoon so she is 12 hours at least OOB- recently her protein levels dropped (too much Hershey's not enuf KFC) and she refused protein additives to her diet (we started putting the egg powder in her chocolate pudding and that helped) but too late she developed a Decubitus Ulcer on her buttocks 2inches by 1 inch stage two not infected. We wanted her to rest in the afternoon to help relieve the pressure and she refused. It has become a daily battle- we never fight just persistantly remind her till she gives in and grumbles for the 2 hours that we keep her in bed. Its helping her skin integrity but she is miserable. we tried bringing her books and other stuff she likes to help pas the time- even a volunteer to sit with her but all she does is *****. I guess it aint easy being old- May we all enjoy good health and live as long as we want!!

It's so hard isn't it? You have to strike that balance between kindness and good nursing care and that can be very difficult! I had a gentleman exactly like your lady. Insisted on getting oob at 6:30 am every day and back to bed after dinner, developed a sacral decub. His routine for years, alert and oriented and completely able to make bad decisions on his own. He didn't see the need to change his routine. It had gotten to a medium bad (I say that because I've unfortunately seen much worse) stage 4 with necrotic tissue. I sat down with him and asked him if anyone had actually described to him what his wound was like, how it developed and how it could get healed. I told him that I didn't want to scare him (but truthfully I did a liitle- scare some common sense into him!) and gave him worse case scenarios to think about like sepsis, etc. He had lost a lot of feeling because of the depth and remember he couldn't see it, so had no true idea what was going on and why we were being so 'bossy.' It totaly worked, he's cooperative now. I make sure that I tell him how it's progressing so that he stays hopeful and cooperative as well.

As far as the op's post, I think dementia is so tough. Sometimes these poor people are so unaware that they fight and get agitated when we bring a spoon to their lips to feed them. I don't think you can neglect them though, even allowing for resident's rights'. It is best that they do get out of bed and changed etc. Reapproaching, bribery, music, distraction keep trying til you find something that works. Some coworkers are simply better than others as well and have a natural non-threatening approach. Just remember to support your coworker, who is muddling through like the rest of us. You can approach disagreements in care positively by saying I feel so bad for -----, do you think we could try ---- instead. Our job is so tough, we need to support each other!

[withasmilelpn]

Well not really that great because we have 7 residents who require one on one supervision because they have abused another resident, staff have to monitor them closely. Today on day shift we have 51 CNAs with a census of 237 residents. On pms we generally have 26 CNAs and on nocs we have 16 CNAs. Since we are just beginning our adventure with this movement we are still learning, from everything I have read, permanent assignments help the staff know the residents really well and retention and morale actually goes up, I hope so because we are short all the time.

Where do you work! We have a census of 120 with 8-10 cnas on days and eve and 4-6 on nocs. Are they med techs or perform other duties like accuchecks etc.? What about nursing ratios?

[BoopetteRN]

There are 4 nursing units, each can have 75 residents, but we currently only have 237 residents.

Here is how it breaks down

Administrative Staff:

DON

In-Service Director (who also is the infection control person, relieves on PMS and NOC when there is no supervisor, helps do care plans on occassion, and any other things that come up. Currently the faciliator for the pioneer movement)

2 RN restorative nurses

1 MDS coordinator

B unit Medicare - 49 residents - only unit medicare certified. There are also long time residents there (intermediate care) All tube feeders and trachs are put on this unit

1 Unit Coordinator RN (manager) Manages the unit, does MDS and care plans, run the care plan conferences, assesses new residents.

3 nurses - called teamleaders. They do all the accuchecks, pass meds, do treatments, assessments, fax Dr. ect. It doesn't matter whether they are RNs or LPNs so currently 1 RN and 2 LPNs

C unit Intermediate care 49 residents

1 Unit Coordinator RN (manager)

2 LPNs

D unit Intermediate care - many dementia residents was at one time an Alz unit

1 Unit Coordinator RN (manager)

2 LPNs, but when we have enough nurses the unit runs with 3 LPNs

E unit Intermediate care - many alert residents who are aware of their loses

1 Unit Coordinator RN (manager)

1RN, 2 LPNs

PMs

House Supervisor - supervises the entire facility, takes call offs, handles problems. Usually the only RN here

B unit - 2 LPNs

C unit - 2 LPNs

D unit - 2 LPNs

E unit - 2 LPNs

NOC

House Supervisor who also is a nurse on C.

B unit - 2 LPNs

C unit - 1 LPN and house supervisor

D unit - 1 RN (who relieves the regular house supervisor and when she is house the second nurse on C unit comes over and does half the unit

E unit - 1 LPN

[sprocket]

can't you try a toiletting regime with her? Might not work every time but may sometimes! What about rolling and changing her while she's still in bed?

One things for certain, if you drag someone out of bed against their will, the law regards that as abuse...though with patients with demetia i can appeciate how hard/impossible it is to reason with them.

[Psychtrish39, BSN, RN]

Amen to all that you said in your post mljrn97 I work in a dementia unit in a Northwest state hospital and thats what I try to remember about my most challenging dementia patients.. they were and are human beings and I hate that we have to get them up at 0530 but its state law and my unit practice and I am new but I am bringing it up in the next staff meeting.. its just really this one patient who it is so hard on and I hate to do it and so do my aides but we have to... she was once a college Chemistry professor and she still has some of that intelligence if I could just reach her somehow and let her know we are making her dry not hurting her....I go back Tuesday night I am trying something different if I can with her...

[adrienurse, LPN]

I don't understand the part about it being state law

[lovingtheunloved, ASN, RN]

...I hate that we have to get them up at 0530 but its state law ...

You're kidding, right? I've never heard of such a thing. Absurd.

[nightmare, RN]

We're not supposed to get anyone up before 06.00 but we have one resident that wants to get up just after 05.00.Because she is in her right mind we get her up and document the request.

[BoopetteRN]

We are starting a pilot program here where residents get up on their own. The staff have a list of questions that are being asked to determine what their routine was before coming to LTC. I know that we are going to have difficulty with the demented residents, however hopefully their family members will help us with this. It will be interesting to see the outcome of this, many of us are very skeptical; however it has worked at other facilities and has improved staff moral and retention. CNAs have consistent assignments and know their residents well, which is the groundwork for such a program

[junebug50]

I have been there too many times. My heart goes out to all involved. Not only the aides could get hurt but, the resident could also get hurt. I also agree it sucks to get old, even more in the LTC. All the things offered to try to get her up would be worth trying. Good luck to all involved.

[ALmanager]

This thread incensed me SO MUCH that I went through the hassle of getting my password just to respond. Reading the 1st page of these responses, I am MORTIFIED at how some people responded- no wonder nurses get bad names!!!!!!!!!! I'm all for honestly expressing yourself, but the cold heartedness of your responses makes me boil- and SCARIER was the responders who had good, decent suggestions didn't bother to call their colleagues on their callousness! Shame on you. And shame on the person who wrote the initial email, who seemed to resign themselves to "dragging her out of bed" despite numerous good suggestions. At least they did on page 2, which is as far as I could stomach reading.

I am printing your responses to show my team- and make clear my expectations that this type of response will not be accepted. pathetic.