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?

[SuesquatchRN, BSN, RN]

Again, thanks.

I think she's just going to have to be distressed. We'll tell her it's time and tell her again and then just get her up. Quickly.

txspadequeen, I FEEL the same way you do but she simply can't lay there in her own urine while her skin is macerating for the entire day.

Well, this helped a lot. It simply has to be done and she just has to be distressed for a bit.

Thanks again, all.

[nightmare, RN]

We have a gentleman who is just like this,he can be very agressive if he doesn't want to get up.So we just leave him,9 times out 0f 10 if you has disturbed the bedding he will start to feel cold and will get up himself.You then quickly nip in wash and change him and the bed and everyone is happy.

[dollbaby]

Instead of forcing her to get up and stay up why don't you go in a little earlier and dry her up and get her completely dressed. Place her back on the bed after it is made so she can take another early morning nap with more clothes on so that later when she is awakened for breakfast she doesn't have to get up with thin bed clothes on and feel cold and aggravated to boot. She will be warmer and this time won't have to be involved in so much activity (drying and dressing) all at once. The staff can save her for last when taking residents to breakfast so that she can be allowed to sleep for as long as possible. After breakfast she can be dried again since she was dried so early in the morning and has probably wet again.

[meownsmile, BSN, RN]

Is there any insight the famiily can bring. Maybe this person was a nightshifter all her life and isnt a morning riser. In that case is it going to be the end of the world if she doesnt get up till 10ish. OK maybe shell miss breakfast, but how hard is it to get a piece of toast and cold cereal? Just wondering if she stayed in bed late before she went to LTC. Sometimes the older habits are the ones they tend to keep up. Just wondering.

[lovingtheunloved, ASN, RN]

Instead of forcing her to get up and stay up why don't you go in a little earlier and dry her up and get her completely dressed. Place her back on the bed after it is made so she can take another early morning nap with more clothes on so that later when she is awakened for breakfast she doesn't have to get up with thin bed clothes on and feel cold and aggravated to boot. She will be warmer and this time won't have to be involved in so much activity (drying and dressing) all at once. The staff can save her for last when taking residents to breakfast so that she can be allowed to sleep for as long as possible. After breakfast she can be dried again since she was dried so early in the morning and has probably wet again.

:yeahthat: A couple of bath blankets fresh out of the dryer on top of her while she's being changed might make a world of difference.

This sounds, um, bitter, but lots of CNAs (at least where I work) seem to think that in order to change someone, all the blankets must be whisked all the way off the resident and placed in a chair across the room. I'd beat their a$$es too.

[CHATSDALE]

waking her up several times and making her last was a good idea, at least she knows what is going to happen and the aides can get their job done without complaints from oncoming

[achot chavi]

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!!

[SuesquatchRN, BSN, RN]

Instead of forcing her to get up and stay up why don't you go in a little earlier and dry her up and get her completely dressed. Place her back on the bed after it is made so she can take another early morning nap with more clothes on so that later when she is awakened for breakfast she doesn't have to get up with thin bed clothes on and feel cold and aggravated to boot. She will be warmer and this time won't have to be involved in so much activity (drying and dressing) all at once. The staff can save her for last when taking residents to breakfast so that she can be allowed to sleep for as long as possible. After breakfast she can be dried again since she was dried so early in the morning and has probably wet again.

If she'd let us do that we wouldn't have an issue.

Oriented to self, somewhat to place.

Was a big drinker & smoker. Hellraiser. Lots of fun.

Not enough short term memory to bargain.

Don't have a dryer for toasty towels. Great thought, though!

One problem the other day was the other nurse KNOWS Mary hates a certain CNA and just ordered her and her partner in to take care of her anyway. Without supervising or helping. Then got pissed when I mentioned not dragging people out of bed. "They didn't!" Eff yeah, they did.

*sigh*

I gott get out of LTC.

[knockandhello]

maybe a behaviour chart withthe clients responses to different approaches so interventions to her behaviour can be asessed.The trick is though when you assess her responsesand find what she responds to best is to ensure that staff adhere to this and not do their own thing.Good luck.Its a bit like a mystery novel sometimes finding out what works and can be quite satisfying when a solution is found.

[prowlingMA]

As an Alzheimer's MA I have used the " the phone is for you Mary come and talk" has worked, by the time they were up they had forgotten about the "phone". Or " its so warm over here by the fireplace come join me" rubbing my hands like I'm standing by a fireplace, though there actually is none.

[prowlingMA]

and you can bet when i am old and don't have a good reason to get up early, the aid that wakes me at 7am is going to get an ear full. i'll take my breakfast around 10 thank you.

:doh:

[VivaLasViejas, ASN, RN]

and you can bet when i am old and don't have a good reason to get up early, the aid that wakes me at 7am is going to get an ear full. i'll take my breakfast around 10 thank you.

:doh:

that's my feeling as well.

as a long-term care nurse myself, i actually pray that i'll kick the proverbial bucket before i get stuck in a nursing home. the way we treat the sick and demented elderly in this society is a crime. at an age when they should have earned the right to get up and go to bed whenever they please, eat whatever they want, do whatever they want, we warehouse them and treat them like the children they once were, long before we were a glint in their eyes.

lord help anyone who comes in at some ungodly hour to haul my old bones out of bed against my will, on someone else's schedule, for someone else's convenience. (and if they gang up on me, armed with a 'silver bullet' and a packet of k-y at five am, they're really gonna get it!!) i can't imagine anything more frightening---or degrading!---than to be surrounded by a bunch of people i don't know, then manhandled, stripped, rushed through a cleaning, forced to change positions rapidly while my arthritic joints are screaming in pain, plopped into a chair, and then wheeled to another chilly room where i just fall asleep again, only to be awakened once more for a meal i don't want, at a time of day when my body is used to being in a comfortable warm bed. phooey!!:angryfire

yes, this poor woman needs to have her chux changed, and yes, at some point she should get out of bed. but why does it have to be done at six o' clock in the morning? and where does the staff get the nerve to be surprised when she resists care?

dementia patients don't stop being people just because their brains don't work as well as they used to. their former habits must be taken into consideration when planning their care, and if they conflict with staff convenience or a facility's lockstep routine, too bad---it's time to get creative and learn to think outside the proverbial box. the world will not end if mary or john doesn't come to breakfast at 8 am. but everyone concerned with them could save themselves---not to mention mary and john!---a lot of grief, hard work, and even injuries if they would learn to integrate residents' care needs with the residents' own preferences.

i've seen it done.........developed a lot of care plans myself.........and i know it works! with dementia patients, successful care hinges on their ability to trust their caregivers; how can we expect them to behave "appropriately" when we force them into routines they neither like nor are able to understand?

i'm sorry for rambling, but this is a subject i am absolutely passionate about, and it continues to amaze me that so many nursing homes and other ltcs utilize so little of the common knowledge that is out there about caring for residents with alzheimer's and other dementing diseases. it's not rocket science; i don't understand how professionals supposedly versed in geriatric care can fail to realize that someone with dementia just might feel threatened by being awakened too early by a gang of people, who then proceed to do things to her without her permission, and that she might take a swing at somebody to defend herself from what she interprets as an invasion.

to the op: thank you for caring enough about this resident to try to find a solution for her. she doesn't want to be combative or a "problem child"---she just wants to be left alone in the mornings, apparently. and to the person who 'suggested' using a pacer: my sense of humor is as warped as they come, but i didn't see anything even remotely funny about that post. again, i'm a ltc nurse, and i'm all about respecting and honoring this elder generation.