Older generation vs the Younger Generation! RANT!!!

Marie_LPN, RN, LPN, RN · May 13, 2006

I think she needs some kind of warning or needs to be told an hour or two before.

I'm not disagreeing with this, but also, she could be told, and immediately forget, too.

It's hard not to take it personally sometimes. Especially if you have the set group of people to take care of everyday, it's different than working with pts in a hospital that are there for a week at most sometimes, which is physically and mentally demanding in itself, and then you're seeing their condition worsen.

Perhaps creating a "shower bag" would help. I know that the residents usually have their own stuff for bathing such as soap and shampoo, but this separate bag, maybe this would make a good visual "reminder". Put a towel, shower cap, soft loofah, or robe and slippers or nightgown in it. Maybe have the word "shower" or "bath" ironed on the side of the bag, and this bag could be set out ahead of time, as a visual reminder of a shower. And when it's time to shower, perhaps she can carry this bag herself, while the CNA carries the shampoo, lotion and stuff.

(I suggested only soft stuff to go in the bag, because if your grandmother is having dementia, and has tried to hit people, she might try to use that bag.)

Amyjosonata · May 13, 2006

I know it must be very difficult working with patients and seeing them deteriorate, but my point is that, the whole focus should be on patient care not on CNA's feelings. You know what I mean? Like you have to expect that in geratric LTC that things may be less than congenial at times. It must be hard but taking care of the patients is the most important thing. I think the shower bag is a great idea. I think my point with that was, it was like when I was studying Early Childhood Education, We always told the kids that they had a timeframe for cleaning up their toys etc, like "we are going to recess in five minutes" or "cleanup is in 2 minutes" Instead of just taking their toys away and expecting them to cope well. Maybe she might forget but at least for the time being she is mentally preparing herself how she is able. Does that make sense? Thanks for the advice.

Marie_LPN, RN, LPN, RN · May 13, 2006

Yeah, what you're saying makes perfect sense.

Maybe suggesting to the DON provide inservices on how the staff should deal. Not as an attempt to focus even more on CNA or Nurse's hurt feelings, but as a way of addressing the problem outside of Rt. rooms, to prevent it from even happening out on the floors, and ideas for better coping skills.

fergus51 · May 13, 2006

Have you tried just asking the CNA/nurse to try giving her some warning and seeing if it helps? Or you could just go on one of her shower days, warn her beforehand and see if it helps. It may work, it may not but that way it doesn't have to be a big deal.

Honestly, my grandma was in LTC and I was grateful for the nurses who did have a friendly relationship with her. I don't feel it compromised her care in any way. It was nice to know that the people who worked in her home cared about her as more than just a patient.

imenid37 · May 13, 2006

Honestly, my grandma was in LTC and I was grateful for the nurses who did have a friendly relationship with her. I don't feel it compromised her care in any way. It was nice to know that the people who worked in her home cared about her as more than just a patient.

:yeahthat: I also agree that the shower bag is a great idea.

Retired R.N. · May 13, 2006

I know it must be very difficult working with patients and seeing them deteriorate, but my point is that, the whole focus should be on patient care not on CNA's feelings. You know what I mean? Like you have to expect that in geriatric LTC that things may be less than congenial at times. It must be hard but taking care of the patients is the most important thing. ...

In my opinion, you are absolutely correct! It is always wonderful when the patients and staff have a friendly relationship, but it is absolutely necessary for the nursing staff - and I especially include the CNAs in this term - to remember that mental changes can and do occur in geriatric patients. The patients are in LTC because they need respectful nursing care.

Retired R.N.

Kelly_the_Great · May 14, 2006

In my opinion, you are absolutely correct! It is always wonderful when the patients and staff have a friendly relationship, but it is absolutely necessary for the nursing staff - and I especially include the CNAs in this term - to remember that mental changes can and do occur in geriatric patients. The patients are in LTC because they need respectful nursing care.
Retired R.N.

I agree. However, I wouldn't (if it were my loved one) simply leave it up to the nursing home facility's administrative staff to educate their clinical staff. In a perfect world this is what would happen. But the truth is, that nursing home's typically have a 40%-(believe it or not) 400% turnover rate & the support the clinical staff receive from their administration is often less than desirable.

I always encourage my friends, family members of patients and others to advocate for their loved one's care. Often people feel unsure of how to go about doing this. This may, indeed, include speaking with administration. However, you may find that you, yourself, can be instrumental in instructing/changing the views of the staff which are involved in your grandmother's care.

You may want to start first with approaching the CNA and letting her know that you have appreciated the care she has given your grandmother in the past. While, I agree that patient care should be about patients, you can not negate the feelings of the ones who are taking care of them, as many are undervalued for their contributions by the facilities they work for - hence the turnover. And like it or not, right or wrong, everyone wants recognition. In addition, this will make her more receptive to your interaction with her and thus extend to/positively influence her interactions with your grandmother - and this is your goal, right?

Then, just have a conversation with her, you can work in your instruction within a casual context - this way the CNA doesn't feel threatened (like your putting her down, etc.). Maybe, say something like, "I've noticed grandma really has been having some frequent episodes of dementia," "I've noticed the interaction between the two of you have really changed," "She seems to become defensive when you have to shower her," "I think she's fearful of the shower."

BTW, Amyjosonata, this is a very, very common fear amongst individuals in nursing facilities who are experiencing dementia. You may ask about their bathing, personal hygeine policies. Are there other alternatives? For instance, most older folks really don't require daily baths - this is an intervention that can be delayed. How 'bout just covering the essentials - face, hands, underarms & bottom - maybe even doing this while on a BSC in her room where she feels safe. How 'bout distraction techniques - are there any being used? And also, as you mentioned, "routine" schedules with prompts, reminders, etc.

I hope this helps some. I know it's very frustrating & a hard adjustment when we have a family member who most rely upon outside (other than our own family) resources to provide care on a routine basis. There are so many educational tools available to us on how to parent our children but often it is hard to find help on how to go about ensuring that proper care is provided to the older members of our families.

Let us know how things go...:icon_hug:

Renashia · May 14, 2006

As a DON at an assisted living, I know how frustrating it is to teach carestaff how to approach residents correctly. Many of them come with preconceived notions of how to do it and cultural backgrounds that differ from ours. I'm not sure what state you are from, but in WA all carestaff is required to goto 2 days of Dementia and MEntal Health training and my facility has a follow-up dementia and mental health inservise weekly. IT is much more difficult in nursing home settings to provide the carestaff with inservices due to the high turn over.

Try a few of the following.

- Have her mental health re-evaluated by a GERATRIC Mental health provider (NOT THE PCP). She may have underlying conditions that require a change in meds. Sometimes a good Home HEalth Mental HEalth Nurse is avalible.

- Try switching staff, if she refuses to get a shower from one CG, she may do a shower from another

- LET HER REFUSE, she has a very specific reason for not wanting a shower, we just don't know why. If the CG push, most demented residents will push back.

-reaproach 2-?? times.

-Try being there during the showers to help guide the carestaff

- "Bag" the shower idea and try a bag shower (black plastic bag with non-rinse soup, hot water, and towels/washcloths) Not quite as good as a real shower, but better then nothing.

- Look into trasfering your Grandmother to a special care/Alzheimer's unit.

Hope this might help a bit.

Tracy

Trauma Columnist · May 14, 2006

What about if the family bathes the patient? I do not work in long term care but have had family members that were patients there. When placing a relative there, I always tell families that being close to the family is very important because it allows for frequent visits. When my mother was in a nursing home (20 years ago before I was a nurse), I would feed her every evening. Yes, I would bring my young sons with me (the older folks liked my kids) and in looking back on it, I probably was a pain in the neck, but it worked.

Amyjosonata · May 14, 2006

I think those are all good ideas. It is just a frustrating experience when you know that a loved one of yours is living in fear and feeling unstable about her surroundings. I think it is important that staff be friendly and caring but it is not a friendship, staff shouldn't EXPECT the resident to be friendly but treat them equally and respectfully if they are not friendly. There should be expectations for the staff not the patient. I think the sponge bath in her room idea is great. She has terrible osteoporosis and R.A. It just seems that in this specific facility, even though they are a good facility there is a ton of gossip which is kind of a HIPAA violation don't you think? For example my grandmother gained 40 lbs after the death of my grandfather. So my mother went in to talk to the dietician and about her portions. I think this is fine, if a person has chronic hemorroids, R.A. and Osteo, they extra weight on a small frame will create discomfort on lifts etc. She would cry everytime they would put her on a lift to go to the bathroom. So after ,my mom went in and talked to the dietician I guess they started some buzz that my mom was being a pain in the A** and didn't want grandma to eat. So get this, mom went in to see her the other day and a nurse who didn't know it was my mother said "yeah, she is a sweet old lady too bad her daughter doesn't want her to eat, she is trying to put her on a diet" Doesn't that violate some type of confidentiality law?

They have also used intimidation tactics with my grandma, like if she is being stubborn (we are italian and this happens alot) they will say to her "You just want until your daughter gets here then you will be in trouble'' Then when my mom goes in again grandma is scared and crying because she feels abandoned and that mom doesn't want to see her anymore. I just think it is really abusive.

My mom goes in everyday and advocates with her. I never thought I would be into geriatrics but I feel that it is an area where the patients need people who won't take crap and who stick up for them.

HeartsOpenWide, RN · May 14, 2006

I think she needs some kind of warning or needs to be told an hour or two before.

I understand that Dementia can be frustrating, my grandfather has it. I was visiting two summers ago. I was talkin to him in the kitchen in my P.J.s I left for five mins to put my day clothes on and when I walked back into the Kitchen he said "Who are you?" my simple changing of my clothes confused him. If they told your grandmother that they were going to bath her in one or two hours she would just forget.