Is it wrong to tell patient that they might physically hurt you

jdub6 · Oct 1, 2017

It's LTC. I'm not sure whether he's still getting PT or not, but I do need to check into that. The thing is, he's still continent... so the sit-to-stand or Hoyers that we use with incontinent patients haven't come into play, and aren't practical for say, just going to the bathroom quickly to urinate.
And I totally agree that we're not meant to be big people moving machines...

Why can't you sit to stand him to use a urinal?

If he is declining and not recieving and/or unlikely to benefit from PT someone needs to have a hard discussion with him and his care plan changed. You are NOT getting a back brace to move him. Even if you did at some point you won't be able to do it even unsafely with the brace so might as well deal with it now.

"Mr X, we've noticed you're having more difficulty with weakness and the MD/PT have said it won't get better right away [or ever, or whatever]. Unfortunately it is no longer safe for us to help you as we have been. Because of the risk to you and to the staff we need to start doing things differently. When people have these troubles getting up these are the things we can do" and then give his options (urinal in bed, urinal using stander, condom cath...). If he objects that Betty helped him yesterday and it worked and all you have to do is xyz, reiterate that all staff have noticed he's having more trouble and he's been lucky so far but you are no longer confident you can do it without him falling/getting stuck/getting hurt/hurting staff.

His care plan should be modified and all staff informed so you don't have a few people manually lifting while others refuse (even if they [think they] can do so safely this puts an unfair burden on them and makes the others appear to him not to care or to be less skilled.) I still recall a resident years ago with severe unilateral deficits from stroke "wait, I'm a 2 assist" and a CNA lifting her alone replying "you have to understand some people are better at this than others." To an extent she was right but that should never be tolerated for multiple reasons.

The fact that the man is nice makes it sad for you (been there, done hospice) but should have no bearing on his plan of care (I'm sure you wouldn't refuse to transfer a nasty but capable man!) If applicable get PT, OT, and his doc to opine on his capabilities.

Here.I.Stand, BSN, RN · Oct 1, 2017

pts usually dont care if you get hurt. They know there will be other employees to take your place.

We aren't required to care about a pt's displeasure (esp if he is being a narcissistic donkey), but we have every right to care about our own health.

allnurses Guide · Oct 1, 2017

I never hesitated to tell a patient when their desire could result in my injury and therefore was not a viable option. Never, ever compromise on these types of issues.

Apples&Oranges · Oct 1, 2017

I don't think the OP ever answered the question about type of facility. If this is LTC/rehab, I can't help, I know your guys have different standards and practices. In acute care, my answer is always, "We cannot/will not lift you. You need to do all of the work. We can only support you if you are unsteady."

If you need more than that, it is a PT issue. I'll help, for sure, but they are the people moving experts.

I say this very pointedly in front of the NAs and (usually new) nurses who I see bracing themselves to dead lift a pt to stand. Nope. I am the biggest, most vehement advocate for EVERY patient up and out of bed every day, but I have suffered a neck/back injury before, and won't do it again.

Also, PT knows that if they get a max assist pt out of bed to the chair, they need to be available to get them back in. So stop back before you leave, PT friends!

amoLucia · Oct 2, 2017

pts usually dont care if you get hurt. They know there will be other employees to take your place.

This is pretty much true.

There's a new device that I saw in one of those Health Catalogs that is a grip thing that the pt uses to pull himself up with as the nurse/other person just holds the device to be a counterweight.

I don't know if any PT/OT have utilized it, but it seems to me to be a rather handy-dandy device for some pts just needing that little bit of help to umph-up.

It would be just for MINIMAL help.

DesiDani · Oct 2, 2017

I'm aware that you should never compromise your body. Yet, how do you tell a pt without them thinking that you just don't want to help at all or that you are just lazy.

allnurses Guide · Oct 2, 2017

I'm aware that you should never compromise your body. Yet, how do you tell a pt without them thinking that you just don't want to help at all or that you are just lazy.

This is a just say no situation. I don't particularly care what the patient thinks when it comes to keeping my body intact so that I can continue to financially support myself by being able to continue working and not live in chronic pain from a back injury. They can think I am lazy all they like. I know the truth. Management knows the truth. Somewhere inside the patient knows the truth, but whether they want to acknowledge it really isn't our problem.

JKL33 · Oct 2, 2017

I'm aware that you should never compromise your body. Yet, how do you tell a pt without them thinking that you just don't want to help at all or that you are just lazy.

Have a plan and discuss it with the patient, describing it so that they understand and have some feeling of security with how things are going to proceed. If they protest and suggest you using your body to move or steady/stabilize them, just say "We need to use proper mechanics and follow the policies so that we both are safe."

DesiDani · Oct 2, 2017

Hchapp cares

jdub6 · Oct 12, 2017

I'm aware that you should never compromise your body. Yet, how do you tell a pt without them thinking that you just don't want to help at all or that you are just lazy.

I read a survey of British patients and was disheartened by multiple comments along the lines of "those heartless lazy nurses wouldn't even assist my mother when she had to use the restroom; she wanted help to walk but they hoisted her in a mechanical lift like a cow."

We need to make sure patients and families understand that manual lifting is not safe for patients unable to bear a certain percent of their weight. This means we should not tolerate coworkers lifting patients whose care plan is Hoyer or the like-even if they think they are strong and skilled enough it sets a double standard and the patient will think everyone else is lazy, plus eventually that staff member will get hurt.

Nursing, PT etc need to establish a plan for each patient/resident, stick to it and clearly explain to the patient. Explain that we have learned over the years that manual lifting causes staff injuries and thus shortages, causes patient injuries with falls or staff lifting by unsafe methods (for example brachial plexus and shoulde injuries from pressure on arns) and that during their PT eval they were not able to safely be manually assisted. Try to put a positive spin on the assistive devices "instead of leaving you bedbound we have this lift so you can get up safely and easily."