How do *you* tell your patient "No"?

[anonymous1919, LPN]

I've worked in a nursing home for about 2 years and have seen a lot of residents request for me to do things... they really can do for themselves. Generally I do what they've asked, but it seems like I am just enabling. Recently, I've been trying to think of ways to tell them "No" with out offending/hurting them and possibly helping them in the process. I realize most of them just want someone to be there and give them attention. I don't blame them for that. If I was a 90 year old woman with only 1 visitor a week I'd probably be on my call light all day just to have company. I hate being alone. At the same time I don't want them to lose their ability to do that certain task because people keep doing it for them. So how would you appropriately tell the following patients "No" but at the same time help them? *Keep in mind that each patient has the ability to do requested task.*

1.) Resident is requesting for you to stop what you're doing and walk to the kitchen to get her syrup for her pancakes.

2.) After escorting the Resident to the restroom he is now requesting for you to wipe his behind after having a bowel movement.

3.) Resident wants you to open their blinds.

Thanks for the input

[kimbo-lpn]

Just remind them that you are there to promote quality of life and independence. if you have the time accompany the resident to get the syrup, or give the resident the toilet paper and say here you give it a try. talk them through things make them feel confident in the task at hand...always works for me!!!

[Nascar nurse, ASN, RN]

I would go get the syrup.. I'm sure I can walk a lot faster there and back & I personally HATE cold pancakes. They would surely be cold if I walked like most 90yo

I would also just open the blinds - No big deal.

Wiping the butt.. I would encourage them to do this if at all possible & let them know I will be glad to finish what they can't do.

[PostOpPrincess, BSN, RN]

I don't understand.

Why not just say, "no?".

[BellaInBlueScrubsRN]

You say they have the ability to do it themselves? I would def make them do as much as they can, but not fret about if they really refuse.

My go-to phrase is "I want you to do as much as you can by yourself, then I can help you do anything you can't"

That doesn't really apply to pancakes or blinds though. The butt wiping stuff though, definitely! :)

[anonymous1919, LPN]

I don't understand.

Why not just say, "no?".

I dunno. Because I'd be their nurse and I want to be helpful. I'm not saying no just to say it. It's because I don't want to enable them. And I want to do more then just tell them that. Meh. I dunno.

[anangelsmommy, ADN, BSN, RN]

perhaps you should tell them that the excercise is good for them (walking to get the syrup). Or that you are worried you are doing too much for them and is this something he/she could do for themselves? Explain that you dont want them to lose their indepence. In the case of the syrup and if the pancakes might get cold because they walk slow, you can always make a deal with them that if you get the syrup now, they have to walk around the unit once after breakfast for example? I know it may take away from your time giving medication, but if you are able to plant the seed that your real concern is for their keeping their indepence, it may prove to work better in the long run.

anglesmommy

[island40]

why don't you ask your DON/supervisor for input so that you can avoid being 'talked to' about your attitude when a resident complains.

[PostOpPrincess, BSN, RN]

I would just say, "No, please do it yourself."

*shrugs*

[RNOTODAY, BSN, RN]

Sorry, but isnt that kind of what you are there for? I know its annoying, but obviously you wouldnt do any of those tasks , say, before giving a med or a treatment....but how can you really say "no"? This is one of the many many reasons I do not work as a nurse in this type of setting.. I just dont have the mind set, or the patience for any of that nonsense.

[anonymous1919, LPN]

why don't you ask your DON/supervisor for input so that you can avoid being 'talked to' about your attitude when a resident complains.

That's also a good idea and I for sure would.

Edit: Oh and that's why I'm asking on how to say it. I want them to understand it's not because I don't want to help it's because I want them to be able to do as much as they can on their own, and anything they need help with I'll happily be there for them

[ktwlpn, LPN]

1.) Resident is requesting for you to stop what you're doing and walk to the kitchen to get her syrup for her pancakes.

2.) After escorting the Resident to the restroom he is now requesting for you to wipe his behind after having a bowel movement.

3.) Resident wants you to open their blinds.

Thanks for the input

What YOU think they can do and what they can actually do may not be the same thing. We do want them to maintain the highest quality of life as possible for as long as they can and that means as much independence as possible. BUT in LTC we tell them when to get up, when to eat,to bath, and to go to bed so we really allow them no independence.

It's LTC,not rehab. They have degenerative joint disease which makes movement difficult,CHF and COPD which makes them short of breath on exertion amd a host of other maladies including depression and maybe undiagnosed psych issues. The majority of them are not getting better and going home.

IMHO-a resident is not permitted to go to the kitchen for their own syrup due to infection control. As for wiping the bum-I'll give them the paper and encourage them to make a preliminary attack and then I'll swipe a few times. I'll also open the blinds as long as I'm in the room.Experience brings the ability to discern manipulation from true need. The requests you talk about seem to be reasonable.They are not asking you to align their hairbrushes on the nightstand or remake the bed so the linens hand exactly even on each side.