enemas and nurses

[makes needs known]

We have a new policy in our LTC/rehab facility that states the nurse is now responsible for giving the enemas. Apparently there was an incident where a elderly, confused lady was due for an enema. She resisted and sustained a fractured arm. I don't know all the details but now our policy from management is that the nurse gives the enema. What is next? Who wants an enema???? They can refuse. And it sounds like this lady refused, you don't have to be the nurse to make that judgement. Resident rights is something that all employees should be aware of.

[leslie :-D]

We have a new policy in our LTC/rehab facility that states the nurse is now responsible for giving the enemas. Apparently there was an incident where a elderly, confused lady was due for an enema. She resisted and sustained a fractured arm. I don't know all the details but now our policy from management is that the nurse gives the enema. What is next? Who wants an enema???? They can refuse. And it sounds like this lady refused, you don't have to be the nurse to make that judgement. Resident rights is something that all employees should be aware of.

i'm thinking if the pt sustained a fx'd arm, r/t the aide's 'insistence', then it should be delegated to nurses...

who KNOW that pts have a right to refuse.

even if everyone knows this, a broken arm could jeopardize a nurse's license.

not so much w/the cna.

the employer likely wants more accountability from the nurses, and the onus off of them.

leslie

[mentalhealthRN]

sounds like two seperate issues to me. Is your issue having to do the enemas or the right to refuse them your issue? Technically they are invasive and can cause tearing to the sensitive tissues in the rectum, so really a nurse should be doing them--just my personal opinion. The refusal of any care or treatment is a whole different ball of wax. I mean if a resident is not let alone and the CNA fights him/her to give a bath and it ends in an arm fx do we just sweep the bigger issues under the rug and say --okay nurses have to give baths now. Ummmm nothing a CNA or Nurse does should cause an arm fx so are we neglecting both a residents right to refuse as well as a possible issue with abuse? That to me is the bigger issue rather then WHO is giving the care (CNA vs. Nurse) Just my 2 cents.

[GHGoonette, BSN, RN]

Op, I'm busy trying to wrap my mind around the concepts that (1) the patient refused but was forced to submit to the enema, which constitutes assault, and (2) in the process suffered a broken arm. Not a perforated rectum or damage to the orifice, but a broken arm.

Just what kind of force was used on this lady? If that was my mother, I'd be in that facility loaded for bear.

You don't say what level of caregiver "administered" the enema. As far as I remember, in my country that is only in the scope of practice of an Enrolled Nurse (LPN) or higher. On the whole, I would not delegate that to an Enrolled Nursing Assistant (CNA) because of the risks involved.

So, do you have a problem with administering enemas?

[General E. Speaking, RN, RN]

I am not discounting the fact that a broken arm is serious. There definitely needs to be an investigation. However, anytime anything happens it always seems to fall back on the nurses.

Not to hijack the thread but only NURSING can remove the dietary trays from the patient rooms now because someone lost their dentures once. Only NURSING can strip the beds after a discharge because someone lost something valuable in the sheets.

Are nursing aides able to give enemas? I know at the hospital it is the nurses job but not sure about other facilities.

[JDZ344]

Some thoughts:

Aides at my work can not give anything that is prescribed (including high calorie drinks or surgical stockings) because we are not allowed to sign off on the MAR sheet. A nurse has to sign that the medication was given. The nurses, rightly, will not sign for something someone else has given (and this is also policy), so even if we were allowed to give an enema, they have to do it to sign it.

Second: HOW did the resident suffer a #arm? Seems like a case of assault. Is this being investigated? And a CNA SHOULD know that residents have the right to refuse any and all care. This is drummed into us. We CAN NOT do anything without consent, we have to pass it to the nurse.

I'm shocked that a resident was harmed like that. I can only imagine that some real force was used. I really, really hope that the bigger issue (assault and lack of knowledge about consent) are being addressed and not swept under the carpet.

[JDZ344]

I am not discounting the fact that a broken arm is serious. There definitely needs to be an investigation. However, anytime anything happens it always seems to fall back on the nurses.

Not to hijack the thread but only NURSING can remove the dietary trays from the patient rooms now because someone lost their dentures once. Only NURSING can strip the beds after a discharge because someone lost something valuable in the sheets.

Are nursing aides able to give enemas? I know at the hospital it is the nurses job but not sure about other facilities.

By nursing do you mean RNs or nursing staff? (nursing staff at our hospital also includes UAP who have direct contact with patients) If so, that is stupid. A CNA is perfectly capable of checking a tray for dentures, or shaking out the sheets to make sure nothing is left there. You don't need a college degree to do that, just common sense.

[wooh, BSN, RN]

Heck, one time there was a dietary department that served soggy toast, so then the nurses had to make toast!

Personally, I think that it's a band-aid solution to a bigger problem. It's easier to take away tasks than to teach them to be done correctly and hold those doing them accountable. Whether enemas should be a nursing duty or not, the bigger issue is why are we just throwing tasks at nurses instead of holding non-nurses accountable?

[roser13, ASN, RN]

"What is next?"

Umm, how about anything else that involves nursing care? I don't understand OP's concern that being required to give enemas will lead to greater responsibilities....

[NurseKatie08, MSN]

Am I the only one floored that an aide was giving an enema? I'm not sure how other places are, but that just wouldn't fly where I'm from.

As for the arm fx d/t resistance, I hope this is being investigated.

[makes needs known]

'A CNA is perfectly capable of checking a tray for dentures, or shaking out the sheets to make sure nothing is left there. You don't need a college degree to do that, just common sense. '

In our nursing home cna's have been allowed/trained to give enemas until this incident. We all attend inservices that make it clear to all of us that a parient can refuse whatever they choose, whether its attending an activity or refusing a particular medical tx. We have a bowel protocol, with the nurse giving 30ml mom, and if not effective the nurse giving a ducolax suppository, and now it just makes sense that the nurse should follow up with the enema. I gave enemas as CNA 15 years ago, and have no problem doing it now.

But more and more responsibilities are being shifted to the nurse.

[makes needs known]

Of course the lady should not have been hurt, the cna should have gone to the nurse, told her of the pts refusal, and then the nurse should have gone to the patient and explained the need for enema and the problems that could occur if her bowels did not move. If she still refused the enema the DR should have been contacted for advise. What do you think the DR would say? Probably attempt enema again.