Is this abuse?

Nursing Students CNA/MA

Published

I am a CNA student and today at clinicals I witnessed a situation that I feel was not right. The CNA I was assigned to and I were changing a resident's diaper. The BM was everywhere and very unpleasant. After the CNA had removed the old diaper, the resident started having a BM again, to which the CNA responded "Why do you do this to me?" (Note- all quotes are approximations. I don't remember the exact words.) As the CNA was wiping, the resident commented that the CNA was being too rough. In response to that, the CNA said "Why are you always so negative? I am trying to help you and you never have anything nice to say. etc, etc" After that, any time the CNA needed the resident turned on her side, she would pull the resident's arm with no warning and it was visibly uncomfortable for the resident. The resident was able to turn on her side using the bed rail but I guess it was not fast enough for the CNA. At the end of the changing, the CNA held the bag with the dirty diaper near the resident's face and said "Look at what you did." Furthermore, the CNA wiped back to front on the female resident. (The BM was in the front already however.)

Is this abuse and should I report it? Besides being uncomfortable during the turns, the resident didn't really seem bothered and was even smiling at one point. Previous interactions between the CNA and resident didn't seem strained either. I couldn't tell if this was just the humor of the CNA or not. I think I should have been more confrontational during the changing, but unfortunately I freeze up in situations like that (something I need to work on). Also, I will be working with her for two more days and didn't want to strain our relationship (although if this is worth reporting I know a resident's comfort is worth some discomfort for me).

If I do report this, what would happen? Could the CNA possibly take it out on the resident?

There was another situation with this CNA and a different resident earlier in the day. The resident has dementia and as far as I could tell is pretty out of it. While we were getting her up for the day, the CNA was pretty rough with her, nearly causing the resident to fall at one point. The resident was screaming and saying things like "You're going to hurt me" which I think is normal for a resident with dementia. Whenever the CNA would turn her back, the resident would reach out a hand to me to get my attention and then mouth/whisper unintelligible words to me, in what seemed like an attempt for help. She seemed very relieved to get away from the CNA when I walked her to the dining room. The CNA had warned me that this resident could be cranky if she woke up too early. In this case, it seemed like the resident was trying to get help from me, but I wonder if she is just confused because of the dementia? Also, in the dining room, the resident would point to random people and say "Oh look, watch this" as if she was showing me something bad was happening when in fact nothing was happening. So maybe she is just paranoid.

Any advice is most welcome. Also, please let me know if anything in this post is a HIPAA violation.

Specializes in MICU, SICU, CICU.

I disagree. If I see something that concerns me I am going to confront it.

There is no reason that a CNA in a training program can not do that as well. I would hire that trainee in a minute.

Specializes in Psych.

Report it immediately. Something similar happened during my CNA clinicals. It was viewed by two of my classmates who reported it to our instructor. That CNA was investigated and fired. She had no place dealing with patients.

Specializes in Neuro/ ENT.

That is absolutely abuse and should be reported. It is irrelevant if the resident smiled and didn't act all upset. I mean, if you were being treated that way and had enough mind to realize that you can't really defend yourself, would you cause a ruckus and possible incur further abuse? Imagine that being you some day. It could be. Would you wish for someone to help you? Things like this should be written down immediately so that you can confidently testify if need be.

You are brave to post all of this online, knowing you haven't reported it..reason why I say this is because if you suspect abuse, technically you are suppose to report it......be careful. I have heard this time and time again. It has been drilled into my head the suspecting and reporting abuse thing that is.

Specializes in ICU, ER.

As a student I would do as others advised and talk to your instructor... thats very sad & Im very sorry for the resident and you. Im glad that your concerned about it though. If you were a co-worker, rather than a student then I would report it to a supervisor.

Sadly, this is a good example of being exposed to a CNA that you dont want to be like. Hopefully youll see more that you do wish to be like... hang in there and keep your code!

Specializes in Med surg.

Absolutely no need to be anything but gentle and considerate when someone helpless is in your care. I would certainly report this with careful diction and remain an advocate for the patients. Never assume that dementia equates to being okay with rough-handling. This makes me so sad that a CNA could do that to vulnerable people. Best of luck to you.

Reporting it is the easy part. However, people should be more confrontational. If you have a concern or issue with someone, it needs to be brought to their attention and corrected immediately.

Specializes in Psych, Addictions, SOL (Student of Life).

I concur that this is abuse. Report it to your instructor. That being said I wonder if your instructor has taught you that when you turn a bedbound patient on their side the motion almost always stimulates a BM. So it's best to wait a minute or two before proceeding with the change. Also can we please drop the word diaper from our vocabulary when we are speaking about dependent adults? The term brief or protective undergarment is appropriate. Diapers are for infants!

Hppy

I think I just saw that scenario twice this shift. ;)

Is it abuse. Yes. Should you report it. Yes.

Will it get you abused once you're a real nurse on a unit, Yes.

And if you're not ready to take the hit, can I suggest something in real estate? ;)

Specializes in SICU, trauma, neuro.

Yes it's abuse, and yes it needs to be reported. And really if you know about it but do nothing, you become complicit in the abuse. These people are dependent on others for the most personal of care, and they have the right to be treated with dignity and respect. I'm sure you don't want abuse to happen, because you seem like someone who cares.

Also going to agree with previous posters' take on the word "diaper." Attends, brief, absorbent underwear, protective underwear all fine..."diapers" are for babies. That was something my CNA instructor drilled into us when I took the class 18 years ago. We weren't to say "bibs" either. :yes:

As just about every other poster has said, that is definitely abuse. My opinion would be that you should report it to your instructor and he/she will take it from there.

Also, calling them "depends" or "briefs" will make your patients feel more dignified :)

Specializes in Adult Cardiac ICU.

When in doubt, always report. The patient's safety always comes first. Your status as an almost-CNA is irrelevant as anybody of any discipline is capable of having common sense.

I would (objectively) report to a supervisor or administrator of some kind and allow him/her to take care of things from there. Unfortunately what you described is fairly common, so it is up to the facility to decide what measures should be taken. Regardless, reporting should not negatively impact you or the patient in any way! It is better to be safe than sorry, and don't forget that an bystander is never innocent.

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