Human nature...

[jaelpn, LPN]

I have been an LPN for the past two years. I've been working as a nurse at an assisted living facility that specializes in dementia care. Last night I had an experience that I never encountered before! I had noticed earlier in the day that two of my residents- a male and a female were holding each other's hands and just walking around.... harmless companionship. These two have some mild form of dementia but not severe enough to show any slight cognition deficits. Anyhow- last night I went to the male's room to give him his hs pill, and he wasn't in his room so I thought maybe he was in her room watching tv. The door was locked (as sometimes the residents do lock their doors because of "wanderers"... no answer- so I unlocked the door (I have a master key for each room) and there they both were- butt naked on the couch- her legs around him! They both yelled "close the door and get out!!!"... so I did close the door. I wasn't sure what to do- between patient privacy, rules and regulations, between both having some form of dementia- would the family approve... was it anyone else's business? ...do you let them "finish" or does the nurse need to remove the male from the room? I waited a few minutes- knocked on her door- and had asked if so and so was in there... she said yes- I had asked if he could please come out so I could take him to his room to give him his meds.... he was finally dressed and she was in a shirt and underwear at that time. What would be the most appropriate action to take in this situation?

[JeanettePNP, MSN, RN, NP]

I would do what you did and let them have their privacy, unless I had reason to believe it wasn't safe for one or the other of them.

[jaelpn, LPN]

I spoke to the administrator/RN about this subject- she said to separate them. I then had spoke to the dtr because she was wondering why her mom was acting upset about some guy having to "leave" her room. I explained the situation to her. Then one of the CNA's who is also a "team leader" (gets paid an extra dollar an hour- not a manager by any means) was like "You mean you DIDN'T call the family when it happened?" I said no... I was wanting to wait for the family to get here to talk face to face. She said Oh but that's a lawsuit right there if you don't call the family the time it happens. Since I had spoken to the females family- I went ahead and called the male residents family too- and had let them know what had happened. It's just one big mess. I think I'm more upset about it than anyone else- the administrator shrugged it off. I want to be a good example of a nurse. I absolutely do not want CNA's thinking that I didn't do the right thing. I don't like cna's to tell me how to do my job. I may be half their age, but I'm not an idiot. It's a very gray world out there in nursing. Any comments on this situation????

[noreenl]

if they are both mentally competent then they are 2 consulting adults and its nobody's business but their own. Human sexuality doesn't die on the steps of a long term care facility. Our responsibility is to protect those who could be taken advantage of due to a lack of mental competency. for this particular couple, as a nurse I might sit them down together and ask them about their relationship and explain that your responsibility is to be sure that all your residents are safe. If their happy, then maybe setting up a "signal" for privacy would be one of my suggestions so interuptions would not happen again!

[CrunchRN, ADN, RN]

I would want/request my employer to have a written policy that applies to this situation and then follow that policy.

That is probably the only way to handle this situation without it biting you in the butt some day!

[jaelpn, LPN]

The "sticky" situation is that both residents are under the "dementia/alzheimer" unit of which I am the nurse. So- they may "know" what they're doing- but is it still ok to allow it? Last night he said he "fell" in love with his "girl" (of which he's only known her for the past 5 days) and they were both going to get married. They were even talking about finances! I mean- I don't want to let their hopes and dreams come crashing down- but it's not a reality that they both will move out and get a home and start all over. This has been a headache for me the past few days- I want to protect my license- and I want to make a safe environment for my residents. The managers aren't really saying much (apathetic toward the whole situation). Hopefully the situation will just blow over and I can just continue to take care of my residents with the best of my abilities.

[SGT>Moody68w]

i'm in agreement with noreenl and crunchRN. and as far as the CNA situation.... Last time i checked, CNA stood for 'certified nurse AID'. they have no room in telling you how to do YOUR job, because you are more qualified than they are. You're a NURSE, And its your LICENSE on tha line, not the cna's "certification" to wipe pt's rear ends or change bed pans. They dont have to worry about anything, cause if they screw up it still falls on tha nurse or tha doc>. So you shouldnt worry about what they think, just do your job to tha best of your ability, and and as justly and morally as possible.

[TampaTech]

So, I must say one thing as a CNA myself I would never tell a nurse how to do her job, I would say something like; "maybe if you call the family and let them know what happened they might be more inclined to come down and discuss the situation and will be more calm about it". However, onto another note. SGT>Moody is it? You need to learn to watch your mouth. I wonder what area of nursing you work in where you dont require the aid of a "certified rear-wiper, and bed-pan changer"?I think you need to learn some respect, I agree with you not to let CNA's tell nurses how to do their job, it is insebordination at its best. So next time when you are drowning in the poop I hope the certified "rear-wipers" arent around to help your mean a** >

[bagladyrn, RN]

I'm not sure I understand the overwhelmingly negative reaction to this couple. Sexuality and the need for closeness continues throughout the lifespan. It appears that the "act" in question was consensual and what harm could arise from their activity? I'm assuming that from the location she is well beyond the age of an unplanned pregnancy.... Really doesn't sound as though either was taking advantage of the other.

Quite frequently the reaction to this sort of situation has it's roots in younger people, both staff and adult children, being "grossed out" by the thought of old people still having sexual urges.

As long as they aren't going at it in the day hall why not give them what privacy they can have to have a last relationship in their decline?

[jaelpn, LPN]

I am not concerned about the "relationship" more than what the reaction of management and nurses duty to inform or not to inform the families. I think everyone needs someone to love- to hold. The situation has blown over so far- the two have been out and about holding hands but nothing sexual. Maybe it was just a time for passion. It's the dementia/alzheimers specialized community that we are working under that really makes the situation a little more confusing- we can't just allow whoever wants to have sex in their room to go at it...or can we? These are the things they DON'T teach in nursing school...This particular couple did seem to both know what they were doing, and it was also kind of like they were reliving their younger days. I guess we'll just have to wait it out and see how everything goes...

Onto another note- I was a CNA for 3 yrs- so I really respect my CNA's. I know what it's like to be paid at a minimum rate and have to do a TON of hard, back breaking work- it's tough taking care of older people. It's also tough being an LPN- I'm the only nurse on evenings- for 104 residents. It's assisted living- but it's still really difficult because there's always someone falling and I have to stop my med pass to go assess my residents. Without the help of my cna's and caregivers- the whole place would really be a nut house. I rely on them to be my eyes and ears for my residents- especially when they do notice a difference in one of my residents or see a skin tear, etc. Sometimes, I do get frustrated because a cna will call me and tell me I need to go do this and I'll let them know that I am on my supper break- and they'll say "well I need help giving this person a shower if you want it to get done!" ... it's really disrespectful because for one, I am the nurse and I have a ton of responsibilities, and because they expect me to stop my break to help them. I am told I am their favorite nurse there (out of the 4).... but I have to learn to show them respect like they have to learn to respect me. It makes for a more peaceful environment. :)

Anywho- I feel better- and thanks for all the comments! Sometimes we all just have to vent!!!

[SGT>Moody68w]

Just FYI "Tampatech" i am not above cleaning a pt's bm, or emptying their urinal or any of the dirty work. i've been a nurse tech before... and beleive me, in tha military you have to work your way up from the bottom, and still do tha grungy stuff so i get my hands dirty on a regular basis, so maybe you should think before you try to preach to me about something like that. Yes i might have been a little harsh about the CNA bit. but oh well.... sorry for your bad luck.