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?

[lovingtheunloved, ASN, RN]

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.

Shame on Suesquatch? No. Read her original post again. She doesn't want to drag anyone out of bed. She wants suggestions for alternative, compassionate methods of caring for this person. And some of the other replies on the first page were CLEARLY in jest.

It's one thing to express your disagreement with other posters, but your reply was simply rude.

[SuesquatchRN, BSN, RN]

lovingtheunloved, it's okay. ALmanager is obviously reading a different thread whan we are.

[junebug50]

Regarding the posting from ALmanager. I worked long term as both an aide and lpn and I disagreed with the way that residents get taken care of. And do you know where it got me? Fired! In some facilities when you buck the management they find a way to get rid of you. I suggested to my cna's to try once if they don't get anywhere then go to another resident and then go back. It works with some and not for others. Maybe getting onto the residents way of thinking may help also. Good Luck to all involved.

[AR_RN]

I understand and agree with the general feeling about this issue, and I'm glad to hear that there are some facilities that are trying to do something about it. Where I'm a CNA we have a few residents that have similar issues. One in particular will hit and cuss when you get her up, regardless of when it is. Of course on the flip side, she'll hit and cuss you when you try to put her back to bed too. She doesn't want to be dried while in bed, (read hits and cusses), but is unable to get up to toilet either. The point to all this is to say that as CNA's, under the existing structure at the facility, we often are in a no-win situation. State says she doesn't have to get up if she doesn't want to, but she has to be dried. She'll be equally upset by being dried or by being gotten up, and we'll get written up for leaving her in bed without special permission, so she gets up. And because of the cussing and hitting and name calling, many of the CNA's tend to be less understanding with her than I think they should be. But at the same time, sometimes it is as hard or harder if you try to be slow and gentle.

I also hope never to have to live in a LTC, but if I do, I hope the facility has figured out how to cater more to the resident. Would it be the end of the world for her to stay in bed every now and then?

[BertinaRN, ASN, RN]

When I was a CNA we never dragged anyone out of bed, but if a client refused to get out of bed the charge nurse was involved. We also traded clients if we found a CNA who could get the difficult ones up. Finally our facility had a new CNA position, and this aide was responsible for the clients who took a long time to care for. There was 4 of us per shift, we floated from unit to unit caring for the hard cases. We were also responsible for the walking, and range of motion care. There are other ways to care for the clients who can not care for themselves, it just takes time, teamwork and a little thinking.

[nightmare, RN]

Perhaps if ALManager would read to the end of the thread she/he would see that some very good suggestions have been made in what is a very difficult situation.

[Psychtrish39, BSN, RN]

Absurd, yes but this a state run mental institution with a special center for older adult services and there are statutes and laws we have to abide by.. besides JCAHO and CMS...however that said we do a complete bedcheck twice each night every patient gets checked and changed if needed and I as the RN am there helping too and I kid you not we have no skin breakdown on these folks even the total bedridden ones its just hard on this particular patient and whats funny earlier in the shift at 0230 she does not fight being changed... But this ward has a complete program for these dementia patients and we do alot for them and with them...

I was hoping by posting I could get some ideas on what to do and I have seen some good ones.. I don't make state laws and policy I work under them but I have to say our patients have the good bottoms to show for it.. I just feel empathy for what they go through... and feel as a nurse that I could make it easier for the ones that suffer though...

[SuesquatchRN, BSN, RN]

So "Bathing without a Battle" came last week and "Gentle Care" came today.

I'll report after I take NC 4.

:)

[dianette]

This is not the way it has to be! I feel your pain. We have some residents like her. The food and activity ideas are good ones. Another thing we have tried are new incontinence products designed to be used for 8-12 hours. They have a special powder in them that turns to gel when wet. If she can fight getting out of bed, can she make slight adjustments in her position to stop skin break down? We have had really good luck with these briefs over the last year. They are slightly more expensive than regular supplies, but not when you consider that you use fewer of them. Also, the human cost is immeasurable.

Thank you for your fight for her rights.

[adrienurse, LPN]

deleted

[BoopetteRN]

i have spent my entire nursing career in ltc. i have seen many changes and the need for even more. demented residents are at times difficult to handle, and at times even the gentlest approach does not seem to help. i have gone home many times beaten from a resident. i am glad that my facility has never gotten residents up before 7am; we have never had a get up list for the night shift. i never thought much about it until i started training new staff and the noc cnas asked me about the get up list, they had to explain that to me.

i have worked other facilities as a part time job throughout my career. my facility is not perfect, but we try. currently we are working on the pilot for gentle awakenings, and changing the night routine as not to wake the residents up every 2 hours. we are striving to make it a better place. i will be showing the video for bathing without a battle and start using some of those techniques more often. for our residents who do not sleep, we have developed a “sitter” on one of the neighborhoods who does activities and provides snacks to residents who stay up all night. we have had less falls and behaviors since we started that program last year. it just made sense to have 1 cna watch the ones up then to have cnas on all the neighborhoods trying to do rounds and watch our runabouts.

[nightmare, RN]

We use Attends "garments" on a lot of our residents with Dementia who are incontinent.We do a 4 day frequency volume chart to assess how much they pass overnight and then hopefully they are given the correct size of pad.They are all checked at least 3 times a night and changed if required.We have not had any dec.ulcers in a long time except when they come back from hospital with them! Experience and really getting to know you residents usually helps with the poor souls who are always combatant ,we find ways of helping them that does not cause distress and document in their daily plan of care so that following shifts can also try that approach.Mind you what works one day doesn't always work the next!