Insight Dialogues: What Would You Do?

Published

Let me start off for those of you who don't know me:

I work at a LTC facility that is run by state. This facility cares for individuals with mental and physical disabilities. The population ranges from profound to slight mental-retardation. Behaviors range from PICA to SIB to over violence. (Not all of them have these behaviors of course.)

Recently I was given an in-service, or "Insight Dialogue" asking me what I would o in a particular situation. Now I'm curious as to how you would react in the situation given:

(NOTE: I'm not quoting word for word, I'm just rebuilding a similar scenario.)

It is time for an individual, that you were assigned to, to take his shower. When you approach the individual to tell him this he asks you if it would be okay to smoke a cigarette first. You don't see a problem with this so you go outside to monitor the individual while he smokes his cigarette. Before he lights it, however, you notice that he has urinated himself. You ask him to come back inside to change and wash up before he smokes his cigarette. He insists on smoking his cigarette and this request causes the individual to become agitated. You know he has a history of violence toward staff when he does not get his way. What do you do?

The correct answer may or may not surprise you. It didn't really surprise me... but then again I've been working at this place for about 3 years now... nothing... and I mean nothing phases me anymore lol.

Up Vote Up Vote ×
Specializes in IM/Critical Care/Cardiology.

Ask a co-worker for back-up. If policy neccesitates the pt to return "inside" after urinating on himself, safety first. Did h/she know they had urinated? Was it gently discussed? Safety first IMO.

Up Vote Up Vote ×

I'd let him smoke first then go in for his shower. Safety first - is it necessary to make a huge deal out of incontinence?

steph

Up Vote Up Vote ×
Specializes in pediatric and geriatric.

I would think he could smoke his cig. first. Pee pants won't kill him and why agitate him.

Up Vote Up Vote ×

Hmm... will having urinated himself cause more of a threat to his health than further agitating him, Sharona?

Up Vote Up Vote ×
Hmm... will having urinated himself cause more of a threat to his health than further agitating him, Sharona?

(thanks for deleting the answer . . .I was just going to tell you that so we could discuss it further and see what other folks think).

steph

Up Vote Up Vote ×
(thanks for deleting the answer . . .I was just going to tell you that so we could discuss it further and see what other folks think).

steph

yerp no problem

Up Vote Up Vote ×
Specializes in Education, FP, LNC, Forensics, ED, OB.

Looks like to me you've already given in for one request and with the hx of the patient, why not give in to the second? Unless there are other unseen issues involved here.

Up Vote Up Vote ×

You figure on one hand... here is the individual sitting in his own water... outside..., dirty as he is because he hasn't taken his shower yet... in the elements...

But on the other hand... if he doesn't get his nicotine fix he might start yelling or he might tell the supervisor that you hit him (this has happened before... and it happens all the time) or something bad like that.

Also take into consideration that if the individual is allowed to smoke his cigarette there is a chance that other staff on grounds will see this individual with urine on his pants... maybe some supervisors! How would you explain yourself?

Up Vote Up Vote ×
Specializes in Education, FP, LNC, Forensics, ED, OB.

What outside elements?

A couple minutes cig isn't going to be detrimental to his health (and, I'm not talking about nicotine and health-related issues - I'm speaking of time taken to smoke causing health concerns as they relate to urine-soaked trousers).

Up Vote Up Vote ×
Specializes in IM/Critical Care/Cardiology.
Hmm... will having urinated himself cause more of a threat to his health than further agitating him, Sharona?

I guess I misunderstood your "situation". You mentioned that you asked the pt to come in before smoking the cig. No, of course I don't think that incontinence is worth the hassle of agitation, but that wasn't expressed in your question. That is why I asked if it was discussed and brought up the policy issue....maybe more info needed to be given. I gave a response to the info given with concern for your safety as you OP did say the patient has a hx of violence, I've never worked in your work setting, but I would think there are times when back-up with violent patients would not be uncommon.

So, let s/he smoke and then proceed with shower hopefully without event!

Better answer for you? I read your answer and totally agree with it, document and CYA. Same as anything else,eh?

Up Vote Up Vote ×
Specializes in IM/Critical Care/Cardiology.
You figure on one hand... here is the individual sitting in his own water... outside..., dirty as he is because he hasn't taken his shower yet... in the elements...

But on the other hand... if he doesn't get his nicotine fix he might start yelling or he might tell the supervisor that you hit him (this has happened before... and it happens all the time) or something bad like that.

Also take into consideration that if the individual is allowed to smoke his cigarette there is a chance that other staff on grounds will see this individual with urine on his pants... maybe some supervisors! How would you explain yourself?

Good question, how would you?

Up Vote Up Vote ×
+ Join the Discussion