I’m a new nurse working in rehabilitation and I have a resident with Parkinson’s and dementia. The resident also has wounds and has lost all mobility except in their arms (barely).
She takes her Parkinson’s medicine (Sinemet & Neupro patch) without issue, but consistently refuses all other meds (muscle relaxer, steroid, APAP, nerve pain med, and vitamins for supplementation and wound healing - a total of 8 pills every morning), stating that she takes too many pills (often arguing that we try to give her more than 8 at a time). She is not completely oriented to time/place, but she is always consistent regarding her medications.
Her family has tried to pressure me to administer her medicine without being forth-rite about it. For example, administering the meds in pudding without mentioning that there are pills in the pudding. The family wasn’t pleased that myself and the other staff comply with her refusals.
It seems wrong to ever be misleading to a patient or resident about the care that they are receiving and we know that our patients have a right to refuse. But what do you do when they potentially have altered mental status and their noncompliance puts their recovery in danger? (I’ve notified the provider already.) I’d be interested in hearing stories and advice from other nurses.
Specializes in RHIT with a crap load of medical experience..
Let her know that it is only 8 pills that she is receiving. If she still refuses, you document and let the physician know. It would be care planned how and when they come to a decision with the family on how to best administer her medication. Administer the most important for her first. If all else fails, you cannot force her. The care team will need to come up with a solution. MD, DON, MDS nurse, pharmacist, social worker.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
If you mislead her, you run the risk of destroying the trust, which is especially important in long term care.
Get creative. Find a way to decrease the number of pills. Bargain. Use positive reinforcement. Show your care and concern. Educate. Be so annoying that she takes it so you shut up. Find a way.
Thanks everyone for your sharing stories, your advice, your perspectives, and your expertise! This is exactly what I was looking for when I posted this and you did not disappoint. I've been reading your responses over the past few days and have been taking them into consideration.
The Nurse Practitioner has already implemented some of your suggestions. She is now on liquid supplements ("Vanilla Shake") that she is happy to take and that will help with healing her many wounds. The Care Team and family are aware of the situation and we are all trying different methods to get this resident to be compliant with medications.
I always plan to spend extra time with her during her med pass and bring vanilla pudding in addition to her supplements and some of the most important medications. I've begun to have success getting her to agree to take up to 4 at a time, and she has even begun to spontaneously request certain ones. I find that she is more likely to agree to take her medicine if I sit at the bedside and feed her pudding, "shakes," or a cookie. It takes an extra 5-10 minutes of my very full day, but it's worth it.
I've been sharing my tricks with my colleagues in report and have been documenting my actions thoroughly. I'm hopeful that the situation will continue to improve.
In talking to the resident, she often expresses a need or desire to have control in many situations unrelated to her medications. She talks about past events where family members pressured her to take medicine, or to go to churches she didn't want to go to, among other things. Although she is frequently unaware of where she is, what year it is, or even what she is physically capable of (she'll often request that we put things where she can get them, saying that she'll do things herself - at this stage in her Parkinson's, only an extremely limited ability to move her arms and neck remain, with no finger control), she seems to remember and be entirely fixated on events where she did not have control. Which makes a lot of sense given the circumstances, honestly.
Thanks again, everyone, for taking the time reply.
I’m a new nurse working in rehabilitation and I have a resident with Parkinson’s and dementia. The resident also has wounds and has lost all mobility except in their arms (barely).
She takes her Parkinson’s medicine (Sinemet & Neupro patch) without issue, but consistently refuses all other meds (muscle relaxer, steroid, APAP, nerve pain med, and vitamins for supplementation and wound healing - a total of 8 pills every morning), stating that she takes too many pills (often arguing that we try to give her more than 8 at a time). She is not completely oriented to time/place, but she is always consistent regarding her medications.
Her family has tried to pressure me to administer her medicine without being forth-rite about it. For example, administering the meds in pudding without mentioning that there are pills in the pudding. The family wasn’t pleased that myself and the other staff comply with her refusals.
It seems wrong to ever be misleading to a patient or resident about the care that they are receiving and we know that our patients have a right to refuse. But what do you do when they potentially have altered mental status and their noncompliance puts their recovery in danger? (I’ve notified the provider already.) I’d be interested in hearing stories and advice from other nurses.
You could be describing my mom. Save your right to practice and your license. If she refuses, she refuses.
The medication may relieve some symptoms and help her drag on longer, but this woman isn't going to recover. It's time the doc had a conversation with the family to educate them, as well as let them know that the nurses will not be forcing feeding the patient (pills). The poor woman may just be getting ready to pass on. That's the point my mom is at. This family sounds like they may not be open to any education. They may be in denial, and they love their mama/grandma. Nonetheless, 1) It's the patient's right to refuse, (does she have a POA that can make her decisions for her?) 2) If/when she passes, they could turn the whole story around and sue you. So, give good patient care, try to give the meds each time, but don't risk your own license in the meantime. Best of luck to you.
Thanks everyone for your sharing stories, your advice, your perspectives, and your expertise! This is exactly what I was looking for when I posted this and you did not disappoint. I've been reading your responses over the past few days and have been taking them into consideration.
The Nurse Practitioner has already implemented some of your suggestions. She is now on liquid supplements ("Vanilla Shake") that she is happy to take and that will help with healing her many wounds. The Care Team and family are aware of the situation and we are all trying different methods to get this resident to be compliant with medications.
I always plan to spend extra time with her during her med pass and bring vanilla pudding in addition to her supplements and some of the most important medications. I've begun to have success getting her to agree to take up to 4 at a time, and she has even begun to spontaneously request certain ones. I find that she is more likely to agree to take her medicine if I sit at the bedside and feed her pudding, "shakes," or a cookie. It takes an extra 5-10 minutes of my very full day, but it's worth it.
I've been sharing my tricks with my colleagues in report and have been documenting my actions thoroughly. I'm hopeful that the situation will continue to improve.
In talking to the resident, she often expresses a need or desire to have control in many situations unrelated to her medications. She talks about past events where family members pressured her to take medicine, or to go to churches she didn't want to go to, among other things. Although she is frequently unaware of where she is, what year it is, or even what she is physically capable of (she'll often request that we put things where she can get them, saying that she'll do things herself - at this stage in her Parkinson's, only an extremely limited ability to move her arms and neck remain, with no finger control), she seems to remember and be entirely fixated on events where she did not have control. Which makes a lot of sense given the circumstances, honestly.
Thanks again, everyone, for taking the time reply.
I'm happy that things are going better. You are one fine nurse and caring nurse with great insight. Bless you.
The reality of the matter is that working with the dementia population is an entirely different world than what the op is suggesting in terms of ethical dilemmas and whatever else they are attempting to imply.
So come back and instruct us about "ethical dilemmas" and whatever else you may have when you actually have some real world experience working in this area.
Hiding pills in food is a great way to get her to stop eating. I wouldn't eat anything you gave me if I found pills hidden in it.
Review her pills - does she really need all of them? And see if they can be spread out throughout the day rather than getting them all at once
Anyone who has ever had crushed pills in apple sauce or pudding will KNOW what it is next time. It tastes gross and residents learn to avoid anything resembling purée foods-especially apple sauce and pudding.
Anyone who has ever had crushed pills in apple sauce or pudding will KNOW what it is next time. It tastes gross and residents learn to avoid anything resembling purée foods-especially apple sauce and pudding.
I wouldn't say "anyone". I've seen the same people fooled over and over and over. The ones who figure it out are the minority, from my experience.
I wouldn't say "anyone". I've seen the same people fooled over and over and over. The ones who figure it out are the minority, from my experience.
I only wish mine were like that-had orders and POA approval to conceal the meds and after a dose or two I was usually figured out. One spewed them back out and I ended up wearing it for the shift. Another actually tried to punch me when I approached him, luckily I was faster than he was. I’m thinking some of them must of tasted really bad so they remembered it the next time. Prednisone is one I know first hand I would never want crushed. That one is bad enough swallowed whole.
Yes, misleading is wrong and paternalism/maternalism (trying to put beneficence before nonmaleficence and patient autonomy) is never a good thing.
Soooo, we should let the dementia patient suffer because they are incapable of giving consent because, let's face it, "informed consent" with dementia patients is an oxymoron.
Soooo, we should let the dementia patient suffer because they are incapable of giving consent because, let's face it, "informed consent" with dementia patients is an oxymoron.
Yeah, thanks for posting what I was thinking.
It's all just an ethics crossroads dilemma. lol It's one of those situations that look great on paper, but in practice... well, you know.
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Puppy Kisses
18 Posts
Let her know that it is only 8 pills that she is receiving. If she still refuses, you document and let the physician know. It would be care planned how and when they come to a decision with the family on how to best administer her medication. Administer the most important for her first. If all else fails, you cannot force her. The care team will need to come up with a solution. MD, DON, MDS nurse, pharmacist, social worker.