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.
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.
I am not sure if you read but I said these residents can do the following on their own. As in, I know what diseases they have and I know their limits. I am of course not going to ask a patient with degenerative joint disease to get up and walk to the kitchen themselves (but a person who CAN get up and probably should for their own health, I would encourage it and I'm asking what's the best way to go about that while making sure they understand that I am here to help if they need it). And I don't mean literally inside the kitchen, but at my facility next to the kitchen doors in the dining room is a table with condiements for residents to pick up if they choose.
The bathroom would be a no for me, unless the they have a bad back, get dizzy, etc. However, it depends on there limits per doctor. Plus would rather do a few swipes myself just make sure its done correctly to prevent future health issues if need be. If not you could be putting medicine on sores or whatever later. I think if any person could do themselves, they will.
Blinds, takes 20 seconds, just do. Consider it a favor like your wife or husband asking you while he/she is watching t.v. and being lazy.
The syrup, if not to busy I would just do. Like someone said before, cold pancakes suck.:) Then get on the food service for not bringing it with the food. Don't they get packets that peel open?
But the best advice I heard in this is to ask your supervisor's opinion. Should be a short conversation really, but real helpful to you! It may be a known problem about the bathroom person and patient may need a talking to to encourage him/her to do himself by yourself or supervisor.
When I get a patient asking me to do something when I'm already in the middle of something else, particularly when its a simple task they can do themselves, I usually just tell them, "sure, as soon as I get a chance I'll do that, but you're welcome to grab an extra blanket (or whatever else they've asked for) yourself if you can't wait"
The bathroom would be a no for me, unless the they have a bad back, get dizzy, etc. However, it depends on there limits per doctor. Plus would rather do a few swipes myself just make sure its done correctly to prevent future health issues if need be. If not you could be putting medicine on sores or whatever later. I think if any person could do themselves, they will.
I was very nice when I first started my job. Always wanted to help. Thought it would be kind to do something for my residents just to make their day a bit easier. But these people you care for can be manipulative and take total advantage of you if you let them. If you start off saying yes to much, it's hard to begin to say no. You just have to say no in a professional manner. And sometimes you really have to insist in a not so nice way:
1. Resident: Can you pass me some regular sugar?
Me: No I cannot. You are diabetic and I am not allowed to give you extra sugar. If there's a problem, discuss it with your doctor.
2. Resident: Can you rub this cream on my foot?
Me: I'm sorry but that cream is not ordered by the doc. I know your wife bought it for your fungus, but I cannot put it on. Maybe she can or you can try yourself.
3. Resident: Can you hang up these clothes for me?
Me: Now Mr. So & So, You can hang that up yourself. I am here to help you in anyway, including helping you maintain your independance, so that you don't lose the ability to do it on your own.
4. Resident: Can you loan me a dollar? I'll give it back?
Me: No I dont give out money.
Resident: But I will give it back tomorrow. I promise!
Me: Nope, sorry, but if I give you money I have to give to all. And its against rules to give out money.
Resident: But I won't tell anyone.
Me: No, no, NO!
I can go on all day, but you get the point. If you give your kids everything, they will be spoiled. And you don't want a spoiled resident on your hands, so just say no when needed. They will get over themselves. And if they don't, too bad. And to the above person who thinks if people can do something they will, that is not the case. Some of them think it's your job to cater to their personal needs that they can do on their own. You have to be able to know each person, their abilities, limitations, and proceed from there. Good luck to you.
Nah, ya'll are missing the point. the OP is saying these people can do these things on their own, and we are doing them no favors by performing basic ADL's that they need to perform when able.
our job as nurses is not to enable... but encourage to be able. Feed a person that should do the task of performing it for themselves... NOPE, NEVER.
"you can do this, you need to do this, pick up the fork and try, I'll help you with what you need".
"how do you wipe your behind at home?" Well since you do it at home, you'll do it here... here is the washcloth.
I NEVER enable... this is not what a nurse does, we do everything, everything to optimize our patients independence and encourage it... anyone that sees it different, does no good for their patient. A year or two in you noobies, you'll know what is right.
I wish that I could in a few words tell you of a 19 year old, hip hop new caregiver that did not have patience for patients. She looked at them as friends and expected them to do what they should do and not depend on her. A partially blind wheel chair bound lady, after 3 months of being "helped" by this caregiver. Would walk from the 3rd floor to the dining room, using the wheel chair as a walker. At night putting her own night gown on and putting herself to bed. She looked at them as plain out human beings and not people that needed to be told no in a very special way. She was sincere. Sometimes ignorance is bliss.
This is more of the continuing debate we seem to be having about the nature of nursing. We used to believe it was helping the patient reach mutual goals to make them the best they can be. Now it's all about "customer service." Sure, a "customer" could walk to the kitchen table and get pancake syrup, but if we are supposed to be a waitress, no we can't ask them. We will never take back nursing until we have some direction, with administrative support, that nursing is MORE than customer service. We all have to be on the same page with this. And we had better get there soon, or the flood of older people of my generation (in their 50s) who have always been somewhat selfish and demanding compared to our parents, is going to create a nursing shortage the likes of which we have never seen, as any nurse who can runs for the hills to get away from indentured servitude.
Specializes in LTC,Hospice/palliative care,acute care.
LTC is not acute care or rehab.These residents have the right to do as little for themselves as they wish. We have to try to find ways to get them to be compliant and chart like crazy when they are not but we can not make them do anything and you run the risk of being verbally abusive if you encourage them to strongly. It's not about enabling or being manipulated-it's their right. I often hear staff say "Oh so and so could do this or that" They are in LTC because they could NOT or WOULD not take care of themselves.We are not going to change that.
Nah, ya'll are missing the point. the OP is saying these people can do these things on their own, and we are doing them no favors by performing basic ADL's that they need to perform when able.
our job as nurses is not to enable... but encourage to be able. Feed a person that should do the task of performing it for themselves... NOPE, NEVER.
"you can do this, you need to do this, pick up the fork and try, I'll help you with what you need".
"how do you wipe your behind at home?" Well since you do it at home, you'll do it here... here is the washcloth.
I NEVER enable... this is not what a nurse does, we do everything, everything to optimize our patients independence and encourage it... anyone that sees it different, does no good for their patient. A year or two in you noobies, you'll know what is right.
I completely agree... LTC or not a human is a human, and yes some have diseases that may slow them down, but not completely hindering from performing ADL"s for them self that you know they are capable of doing....and many many residents will try to manipulate staff members into doing things for them. sometimes it has little do with promoting independenc but giving them a feeling of dignity or self-worth. you know your patietn and there capabilities and you can tell when they are really having a bad day, pain wise or just feeling crumby and if you wanna help them out then with little things here and there by all means do so. but you know who is the one that is completely independent and moves just as welll as a 30 yr old but is LAZY LAZY LAZY!!! but its not a bad idea to ask your supervisore everything can get twisted around!!!
A year or two in you noobies, you'll know what is right.
Ha ha.. We seem to have somewhat of a difference of opinion on this & I have to tell you... I'm far far far from a newbie! I've been in LTC for 25 years or more. And who said anything about feeding someone - we were talking about getting syrup for pancakes from the kitchen. I maintain that I have never been 90 but I sure as heck hope someone will just go get my some
gosh dang syrup so my pancakes don't get cold when I am.
I completely agree with encouraging independence, but somethings are just kindness towards a person in need!
Also keep in mind, there seems to be a real cultural shift that I am seeing recently. I have seen really good nurses fired for pushing this to far (even with the best of intentions). The resident insists they needed help, the nurse "encouraged" & refused to do and was later fired due to "abuse & neglect" of residents. I am NOT saying I agree with this, but I have seen it happen twice in the past 6 months.
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anonymous1919, LPN
249 Posts
I am not sure if you read but I said these residents can do the following on their own. As in, I know what diseases they have and I know their limits. I am of course not going to ask a patient with degenerative joint disease to get up and walk to the kitchen themselves (but a person who CAN get up and probably should for their own health, I would encourage it and I'm asking what's the best way to go about that while making sure they understand that I am here to help if they need it). And I don't mean literally inside the kitchen, but at my facility next to the kitchen doors in the dining room is a table with condiements for residents to pick up if they choose.