How to handle this...is it neglect or stupidity?

[nocnurseiniowa]

The child I care for recently got a passy muir after 4 years with a trach (mom was never too keen on the idea). Now she will not let the nurses put it on, only she can, and she does not, at least not when the nurses are there. Nor does she work with signing with him, leaving that to the preschool in home speech therapist and the nurses.

There is no medical reason for him not to have the passy-muir.

As far as I can tell this is neglect, because she is harming his intellectual capacity. When I spoke to my main office at the agency they kind of poo pood it. Am I blowing this out of proportion?

thanks for the advice

d

[caliotter3]

Another example of the issue of control. The mother wants to remain in control. She will let everyone know that she is in control and plans to keep that situation the way it is. Communicate with the patient's doctor and with your agency nursing supervisor, in writing. Continue to document on this. If your agency conducts case conferences, discuss the problem at conference. Sometimes stubborn parents relent as time goes on.

[WI_home_RN]

what does your patient's plan of care say about wearing and using the p-m? i feel for the mom's wanting control but really you need to follow the poc. i agree with you in that its probably harming the child's learning abilities, intellect, etc. that's why you need to touch base with the child's doctor, get orders, get it into the poc and abide by it. if mom balks, tell her to take it up with the child's physician, not you.

[MOMACOCO]

I think this is a case of ignorance....

The patient has a bill of rights so they have the right to decide, but maybe the powers of persuasion and education will work...such as

1. Open discussion re her future goals for the child? How does she see him in the future...what accomplishments can she foresee for him/her..how can the P-M help in accomplishing these goals...

2. Give her options such as why don't you pick a time of day to use this and gradually increase the time, but let mom have choice in the hours of the day...esp during the day when strides can be made...maybe she fears that the child will do better or worse than she expects...let's face it some parents just dont want things to change...

3. If she still insists, then you can always say she is noncompliant and document all along your efforts to instruct and teach, contact md re this issue up front with the efforts you are making...if she wants to continue with outside nursing care then she needs to be compliant with recommendations or some mds and nursing agencies will discontinue the care....

[joprasklpn]

sometimes i think they are afraid of losing nursing hours if the child can tol the pmv and eventually be decannulated. not sure of your childs situation, but i had a mom who was too lazy to do anything for her child. lord knows some of these kids would be 100% better off if the parents would just listen and follow through.