The patient is in her late 90s and is here for rehab following an accident. She has absolutely zero cognitive deficits-sharp as a tack. She also has no diagnosed psychiatric history. Her medical history is surprisingly minimal, and her prognosis is great once she completes rehab. I'm willing to bet she will make it to 100 at least. However, she is at high risk for a pressure ulcer because of a behavior.
She is absolutely insistent on sitting on the bed pan for as long as physically possible, even when she does not have to go. She is mildly incontinent of urine but only ever wore menstrual pads for this at home. It is worse due to her current situation. She has briefs, and our call bell response time is usually about 1-3 minutes (not bad given our ratios; everyone's a team player, even the director of the facility will answer call lights when making the rounds). She denies urinary urgency.
She states that sitting on the bed pan makes her feel prepared. She has no fear of involving staff in her care, as she makes very frequent use of her call bell.
I think she is struggling emotionally with needing what she considers to be a diaper. She has, however, refused all psychiatric consults including psychotherapy. Attempts to bring up the subject gently or casually have failed as well.
She has been educated ad nauseam and in many different ways that she is placing herself at very high risk for a pressure ulcer, and what the consequences of an ulcer would be. She has also refused any and every intervention, even those strongly focused on her dignity. We have thought about taking the bed pan away as an option but the ethics of that are quite thorny. After all, since she is a totally competent adult, that would be paternalism.
I am documenting, documenting, documenting so legally I think we are in the clear. It's just the ethics/morals of the whole thing. I hate seeing someone set themselves up for so much pain and a worsened prognosis.
