[color=#808080]hi, i'm new here (first post) so i hope i'm posting this in the right forum!
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[color=#808080]i realize that in nursing we will encounter a lot of grey areas when it comes to ethical/moral issues but i'm hoping y'all can help me with two scenarios in particular.
[color=#808080]1) we have a resident "paula" in our ltc facility who is orientated x3 but has what a psychiatrist has termed a drug-induced paranoia that has been going on for over a month. the doctor tells us to be patient and it will wear off therefore he chose not to send her to a psychiatric facility. she will often refuse to eat saying we are trying to poison her and is refusing peri-care and won't wear an incontinent system although she is frequently incontinent. she wants to smell everything (blankets/clothes/towels, etc.) before they come in contact with her and will often refuse to use them or make us get another clean one. she will no longer sit in a lounge/recliner chair and is refusing to get into bed at night (saying it burns her) so she sometimes sits all day and sleeps through the night in her wheelchair. she has parkinson's so her mobility is impaired. when we try to gently coax/reason/plead/be firm with her she says she pays to live in this home and she knows her rights and we can't force her to do anything. i understand that she has the right to refuse but we have a responsibility to care and this whole situation leaves me feeling very inadequate as a nurse. we, lpns and rcws on the floor have addressed our concerns to our supervisors many times but there has been no real response other than to "be patient with her." that would be understandable for a few days but this seems to be an ongoing issue and it's very unhealthy. either we neglect to provide the care necessary or we do cares against her wishes while she pushes us away -this does nothing to improve her paranoia that we are trying to kill her. honestly, i feel she should be in a psychiatric facility where they are better able to monitor, assess, address these issues with a comprehensive care plan, but that's not my decision to make. depending on the rn in charge we will either be told to let her refuse or to force her to comply. our interventions are very inconsistent and that only makes the situation worse.
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[color=#808080]2) another resident, "mary" is unable to ambulate herself and depends on staff for total care. she is orientated x3 but her judgment is impaired. she frequently asks for the cordless telephone to call her daughter, but her daughter has indicated that her mother was abusive and she doesn't want her mother calling her. she visits occasionally on her own terms. mary knows her daughter's phone number and where she works. when she asks for the phone we (staff on the floor) are told to tell her that the phone isn't working/can't be found/is charging, etc. this could go on for the better part of a shift and mary knows she's being lied to... she'll say, "why are you doing this to me? why won't you let me use the phone?" mary suffers with depression and i realize it would be hurtful to tell her that her daughter doesn't want to be contacted. (in fact, i'm guessing her daughter doesn't want us to say that to her and would rather we distract/lie to her.) but that leaves us in a very uncomfortable position: lying/denying the phone to someone who knows very well what is going on.
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[color=#808080]can you offer any insights here? what would you do?
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[color=#808080]i realize these aren't black-or-white issues but feel very uncomfortable with the care plans (or lack thereof) for these individuals.
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[color=#808080]thanks, michelle