How to handle a resident like this?

[TurtleCat]

I was wondering how to best deal with a resident that is non-compliant and refuses care. I posted a little about this particular resident I'm having difficulties with before, but felt compelled to ask for help again as I'm still having issues.

Last night, I worked the NOC shift and enjoyed it for the most part. I found it less stressful and more relaxing than the other shifts, it's just checking on your people every 2hrs and getting them up towards the end. I have a tendency to get anxious and stressed out on the other shifts due to the hectic pace sometimes, something I'm still trying to work on.

However, there is something that is bothering me and it's the fact that I was unable to perform cares on this woman due to her constant refusal. The woman in question is very bossy and difficult, especially with new people, it seems. Her mind still seems to be there but her body is crippled. All night long, I kept checking on her to make sure she was OK and she kept insisting she was fine and didn't need to be changed. Towards the end of my shift, I checked on her again and she still insisted she wasn't wet; I tried to check her brief to make sure and she resisted and absolutely refused to let me touch her. I reported it to the nurse and told her that she wasn't allowing me to perform cares. The nurse gave her a talk without much luck. When the day shift aide came in, I explained the situation and she was able to change her and get her up for the day.

I'm just not sure what to do when a resident is stubborn and absolutely refuses care like this? Other than to report it and document it every time, which is what I've been doing. Some residents I've had difficulties with I've been able to get through to w/ sweet talk, being very gentle, specific approaches, etc. but nothing seems to work well with this woman. And when I have 10+ other residents to care for in a shift and am still working on getting my speed down, I don't have half the day to spend just trying to get her to cooperate with me. It's frustrating because I want to give her good care but just don't know what to do. I'd ask the other aides for help, but they don't have time to do one of my residents for me when they have their own assignment and responsibilities. I'm just worried that if this keeps up, she'll develop a bedsore or other complication from not being changed enough. Also, I'm not entirely sure what the policy is on cases like this. On one hand, incontinence care is something that a patient needs but I also know they have the right to refuse care, especially if they are still of sound mind. I just don't know.

[i_love_patient_care]

With those types of patients, I usually explain to them gently that I am here to help them. Please let me check to make sure that they are dry. It is good that you got the nurse involved. If she is incontinent, and needs to be checked, one way or the other it will need to be done. I'm not saying force her to do something, but you were right to get the nurse in charge involved. Maybe ask another CNA who has worked with her before what the trick is.

[mstearns09]

One of my favorite ladies is this way at night and during the day. The best way we have found to handle it is to schmooze her. Chat her up a little and then offer the toilet. It seems to work fairly well with her. I haven't had an issue with her in a couple of weeks. Unfortunately, an agency aide made the mistake of telling her one night that she stunk like pee. I'm surprised he's still living after doing that. Everyone who has worked with this particular resident knows that she will refuse the toilet and to be checked but telling her that the has to be checked and saying that sort of thing to her is just asking for trouble. I am also not above bribery. I will admit I have bribed this lady with her favorite candy and it has worked. I would ask the other aides what works with her and try offering the toilet rather than telling her you need to check her. Often, it is all in how you say things to people.

[marsy82]

Unfortunately sometimes you just have to do as the patient/resident wishes despite it not being in their best interest. No matter how hard you try, you will always come across people who will refuse help/medication/intervention - just as long as you explain the consequences of refusing the intervention and document their refusal, you are doing all that you can. I have had residents refuse food and water insisting they just want to die, obviously you cannot force feed somebody but once they refuse something essential to life, it is out of our hands and needs to be referred to a doctor.

[morte, LPN, LVN]

I was wondering how to best deal with a resident that is non-compliant and refuses care. I posted a little about this particular resident I'm having difficulties with before, but felt compelled to ask for help again as I'm still having issues.

However, there is something that is bothering me and it's the fact that I was unable to perform cares on this woman due to her constant refusal. The woman in question is very bossy and difficult, especially with new people, it seems. Her mind still seems to be there but her body is crippled. All night long, I kept checking on her to make sure she was OK and she kept insisting she was fine and didn't need to be changed. Towards the end of my shift, I checked on her again and she still insisted she wasn't wet; I tried to check her brief to make sure and she resisted and absolutely refused to let me touch her. I reported it to the nurse and told her that she wasn't allowing me to perform cares. The nurse gave her a talk without much luck. When the day shift aide came in, I explained the situation and she was able to change her and get her up for the day.

.

do to what I bolded, is she in pain? and limiting the number of times she is moved about?

[Glycerine82, LPN]

If the patient is alert and oriented all you can do is respect her wishes and report it to the nurse. sometimes there are underlying reasons why the patient doesn't want you to touch her. Sometimes its a matter or trust, expecailly if she doesn't know you, sometimes its because shes been hurt before by other aides and doesnt want to go through that again. So, the nurse may have to try to figure out what all is going on with that patient. Maybe a different aide would have better luck, maybe she just needs to be re-assured you will be gentle. Could be any number of reasons. Each case is different and the bottom line is if she says no, you don't do anything but report it.

[TurtleCat]

This thread is a bit old and I've since left the facility but I wanted to add something. Even though the resident kept refusing cares from me, the nurse told me that I had to wash her up anyway or else I would be written up. So I was basically expected to force cares on the resident.

[JDZ344]

This thread is a bit old and I've since left the facility but I wanted to add something. Even though the resident kept refusing cares from me, the nurse told me that I had to wash her up anyway or else I would be written up. So I was basically expected to force cares on the resident.

In this case, I would go up the chain and speak to your manager. It is abuse to do something against the express wishes of another adult in most countries and states.

[janeybirdRN]

Here's an interesting article about a man who refused care.

http://www.medscape.com/viewarticle/774911