What does it mean when we wake up a sleeping, elderly, demented woman at 0300 in order to place a catheter in her bladder for a UA? When the woman is yelling and can't possibly understand what is going on or why? When in reality she is dying anyway? What is the point of waking people up at 0600 in order to give them a medication such as Prilosec or Synthroid (Tylenol?) - then telling them to "go back to sleep"? (This is done because pharmacy recommends med given at least one hour prior to eating - eating is done at 0700 for the convenience of the kitchen staff.) Where is the sense in placing a frail, 90 year old in an uncomfortable twin sized bed with a plastic covered mattress, in a room with three other people in the same condition? How enjoyable is life when you are hooked up to a feeding tube and cannot taste food or lie flat to sleep because it will kill you? Why must we send a person who is peacefully dying to the ER to undergo some more torture before they finally pass? Why, why why? Where is the gentleness?
The families are not present to see these things - they want "everything done" for their residents - everything except for comfort and dignity and peace. The "corporation" and management only care about what is done on paper, how it will look to the "state", and how many dollars are coming in and also how they can cut staff to the bone to decrease costs and increase their own bonuses. The doctors and nurses must go along with the program in order to not be sued.
I've worked in long term care a long, long time and there is nothing that is right about it and it is all so wrong! I am obviously going crazy at this point and it is obviously time to retire from this madness. Tell me, geriatric nurses, how do you endure?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
Side note: as a person with low thyroid hormone which Synthroid replaces, I wake myself up one hour early to take that med even after working a 14 hour day the day before and heading in to another one. Food drastically decreases that med's effectiveness, and life with low thyroid hormone = feeling like a cranky, depressed, slug with mono. If a patient refuses to be woken up in time to take the meds inactivated by food AND they're mentally competent to make their own decisions, I'll respect that....and inform their doctor, who might want to know.
LTC staffing & timing often makes "extra" med passes such as those before meals hard on everyone, residents and staff alike.
Synthroid is usually titrated to effect. Take it on a full stomach, take it on an empty stomach, just do it consistently. I can assure you I'm not waking an hour early to take mine and then trying to go back to sleep. It just isn't happening.
Gonna go out on a limb and say that pp failed to tactfully say that death is inevitable and it's frustrating when people are afraid to let it happen and then say it's for religious reasons. I swear if my family ignores my wishes and keeps me alive but not cognizant, I WILL find a way back to put THEM on a vent.
ktwlpn: It is illegal to do a procedure on a resident without at least trying to inform them of what you are going to do. No such thing as "in and out before they are all the way awake". Nonetheless, obtaining a urine specimen from a resident who is resisting, demented or not, is an assault which we nurses are required to do. It is just plain scarey. Also, if urine is kept in refrig, it is good x 48 hours (my old lab experience).
I worked the night shift in LTC for a long time and agree with everything you said. It finally got to the point that I'd had enough and couldn't deal with young Nurses and CNAs who would rather play on their cell phones than care for residents. Luckily I'm in my late sixties and just called in one day and told them that was it. There had been other problems building up besides the care of residents. Since I was "old" and apparently didn't have a life, the young nurses were catered to and I got stuck with picking up the slack in addition to giving up my time off to accommadate the young ones even though I was the senior nurse. I'm now retired but quite bored and checking into some part time work away from LTC.
So we poke them to draw blood, stick a tube in their urethra to draw urine, prop them up to do x-rays, strap them down to do CT scans, put stickers on their fragile skin, and squeeze their arm every 30-60 minutes... all while laying on an uncomfortable gurney in a bright, loud place.
Then, if the family is really clueless, poor old granny may get to have people pulverize her ribs in a vain effort to "save" her.
More so when I did subacute care but even now I sometimes think, "What terrible thing did this person do to you that you choose for us to inflict so much upon them?"
Having seen hospice up close and personal - and with experience in multiple emergency departments - all I can say is, Amen... and too bad it's such an underutilized approach to aging and end-of-life.
Thank you. I am a hospice nurse. I also have a 79 year old mother who is in a lock-down dementia facility and a father-in-law with dementia still living at home.
My dad had emergency surgery for a colon cancer which he ignored (a large bulge in his abdomen) until the pain became excruciating and he called an ambulance. Necrotic bowel and a colostomy - then a heart attack as he left the OR. Coded, but had extensive brain damage. Dad told the staff he didn't have any family because it was the middle of the night when he got into the ER. He didn't want to wake us up. So, we didn't find out about his heart attack or surgery until the morning. My younger brother was his legal representative and could not make dad a DNR. "If I do that, then I'll be responsible for killing him".
People really do think this way. I persuaded him to give me the legal right to do so (but it took 3 days) and he did - so I made dad a DNR. We started with just lowering the BP meds and that was enough. He died within 6 hours. Peaceful and pain free.
We are trying to get the word out with docs about hospice and it is better than the 1980's. Call us sooner - not at the very end of life. We can help.
Specializes in LTC,Hospice/palliative care,acute care.
ktwlpn: It is illegal to do a procedure on a resident without at least trying to inform them of what you are going to do. No such thing as "in and out before they are all the way awake". Nonetheless, obtaining a urine specimen from a resident who is resisting, demented or not, is an assault which we nurses are required to do. It is just plain scarey. Also, if urine is kept in refrig, it is good x 48 hours (my old lab experience).
Regarding the storage of specimens-our policy is based on the recommended procedures from our lab. End of that story.
As for the cath-yes, it's possible to get "in and out" with a minimum of fuss..I never said I don't tell them what I'm doing. It IS an awful thing especially for a resident with dementia. We often will try to obtain a clean catch, some of the physician's will order an antibiotic for comfort without submitting the resident to the whole process.We often use 3 staff,1 for the positioning,1 for the actual procedure and one to hold the resident in their arms and talk quietly to them,sing their favorite song-or whatever works.
Specializes in Gerontology, Med surg, Home Health.
"Holding a resident in their arms" sounds like unlawful restraint. Catheterizing a resident who is saying no, demented or not, is assault, goes against the resident's right to say no, and, frankly, is abusive.
If it were me, I'd call the doctor: "Dr Smith, I can't get a clean catch urine on Mrs. Jones. She is too confused. She will freak out if we try to straight cath her. Do you want to treat her with antibiotics or encourage fluids?"
"Holding a resident in their arms" sounds like unlawful restraint. Catheterizing a resident who is saying no, demented or not, is assault, goes against the resident's right to say no, and, frankly, is abusive.
If it were me, I'd call the doctor: "Dr Smith, I can't get a clean catch urine on Mrs. Jones. She is too confused. She will freak out if we try to straight cath her. Do you want to treat her with antibiotics or encourage fluids?"
I totally agree with this. If a resident says "no", there is no way in hell I'm holding him or her down to cath... not happening. But then, I don't force meds, either.. I've had nurses tell me, "you just have to tell them they have no choice".. no, I wont tell them that. I'll explain why they are getting the med and it's importance, but in the end, I let them know they have a right to refuse it if they don't want to take it. More often than not, they take the meds.
Ruby Vee, BSN
17 Articles; 14,051 Posts
Synthroid is usually titrated to effect. Take it on a full stomach, take it on an empty stomach, just do it consistently. I can assure you I'm not waking an hour early to take mine and then trying to go back to sleep. It just isn't happening.