Over-Restaining Patients

achot chavi · Jul 26, 2006

I'm thrilled that others feel as I do and I applaud IMISSCOCO for her foresight and efforts, I wish her all the luck.

Educating staff is always the key but what do you do with CNA's who are overworked, terribly underpaid, unmotivated due to burn-out and other problems in their lives. I gave an inservice where I tied up all the CNA's and wouldn't let one cola-guzzler go to the bathroom (I only made her wait 7 minutes) and it was successful....for one or two days. Lets face it- it is easier to put on the diapers and restraint than toilet and moniter people properly.

One CNA did the split-second-race across the room to catch and prevent a fall and in the process unfortunately let a 4 letter word (not so professional) out of his mouth. A family member heard and wrote a complaint to ADM leading to a long meeting, and a complaint was registered in his file. Guess who became a fan of restraints?

st4wb3rr33sh0rtc4k3 · Jul 26, 2006

I try not to use restraints often. Usually, I redirect patient do to something else, if they can... Like read, color, etc. We have a great Activities staff that keeps them occupied for the most part.

What I can't stand is when a CNA puts them in the restraint without telling me. They don't seem to have the knowledge of why they need the restraint, or don't even have an order for that matter. Or, sadly when a nurse leaves a patient in one all shift long! You tell the nurse you are working with about it, but they just don't do anything. Most stay for 15 minutes for rest periods.

We use the floor pads for residents who crawl out of bed. Some have the bed rails as well, but the can get stuck in them or try to get out. It is definately a sticky situation.

nursespike · Jul 26, 2006

A good toileting plan often helps too...hipsters have been proven to help prevent hip fractures...if you can get the patient to wear them

chadash · Jul 26, 2006

I gave an inservice where I tied up all the CNA's and wouldn't let one cola-guzzler go to the bathroom (I only made her wait 7 minutes) and it was successful....for one or two days. Lets face it- it is easier to put on the diapers and restraint than toilet and moniter people properly.
One CNA did the split-second-race across the room to catch and prevent a fall and in the process unfortunately let a 4 letter word (not so professional) out of his mouth. A family member heard and wrote a complaint to ADM leading to a long meeting, and a complaint was registered in his file. Guess who became a fan of restraints?

What a wonderful idea! This would be a good dose of empathy.

And the family member who complained about the four letter word, of course, we should never let them slip, BUT give me a cursing aide that catches my mom and prevents a hip fracture any day over a polite one who doesn't.

imisscoco · Jul 26, 2006

A good toileting plan often helps too...

Yes it does, but with understaffing for both skilled and unskilled nursing staff, it's easy to leave people for longer periods of time in restraints. unless you really have your eyes open and have a good staff, patients can really be left in those restraints almost indefinitely it seems. For those who were previously able to ambulate, sitting all day adds to deterioration of ambulation ability, muscle wasting and it just goes on and on. It's really so sad. Whoever decided that a falls free environment was better than a restraint reductive (I didn't say free) one has spent more time looking at documentation than poor little old elders sitting in straightback chairs all day, or geri chairs unable to turn over.

imisscoco · Jul 26, 2006

What a wonderful idea! This would be a good dose of empathy.
And the family member who complained about the four letter word, of course, we should never let them slip, BUT give me a cursing aide that catches my mom and prevents a hip fracture any day over a polite one who doesn't.

I love it. They always say "walk in another man's shoes". I totally agree about the 4 letter words vs a hip fracture. I hope someone explained that to the family that complained.

nursespike · Jul 26, 2006

I agree...but for as long as I can remember there have always been staffing issues no matter where you are at...LTC/SNF seem to be chronically short handed in one way or another due to state laws and nurse/staff to pt ratios/greedy hands, but unfortunately it is very difficult to see or use as an excuse for not toileting, even though it is- if that makes any sense:uhoh3: In the past few years I have come to call it "challenged"...at least it sounds a little more positive...lol

imisscoco · Jul 26, 2006

I agree...but for as long as I can remember there have always been staffing issues no matter where you are at...LTC/SNF seem to be chronically short handed in one way or another due to state laws and nurse/staff to pt ratios/greedy hands, but unfortunately it is very difficult to see or use as an excuse for not toileting, even though it is- if that makes any sense:uhoh3: In the past few years I have come to call it "challenged"...at least it sounds a little more positive...lol

I didn't say it was a GOOD excuse, it's not. If you have a good staff, even if they are short staffed they try to overcome the "challenges", but burnout is a big risk and I think accounts for the chronic staffing issues in LTC.

nursespike · Jul 26, 2006

I still agree...I think I was trying to say the biggest "challenge" is the staffing issues...never seem to be enough...agree completely.

imisscoco · Jul 26, 2006

I still agree...I think I was trying to say the biggest "challenge" is the staffing issues...never seem to be enough...agree completely.

Right, when the state comes in to do their annual survey they don't want to hear excuses like understaffing, but I think that's why they overlook some things and not others. Anyone who has worked in LTC for any length of time knows that understaffing is a terrible problem. But so is apathy. People start to get hardened to the plight of elders after a while. Especially with low pay, and some places showing their appreciation to staff on "Nurses day" with a dried muffin and a dead carnation.

nursespike · Jul 26, 2006

Hey..I got a lunch bag:lol2: ...I know...but I do love it...one day things will change, hopefully..

imisscoco · Jul 26, 2006

Hey..I got a lunch bag:lol2: ...I know...but I do love it...one day things will change, hopefully..

One year when I was clinical coordinator on a very challenging floor, we were expecting the state to come in. So I stayed hours and hours extra for weeks to make sure documentation and everything on the unit was up to snuff. We got the first Deficiency free survey in years, and the administrator, to celebrate, took out all the management staff to this great seafood place and left me behind to "watch the place". I was literally in tears. The DON felt bad afterwards when she found out I was hurt so she gave me a gift certificate to the restaurant out of her own pocket, but it wasn't the point. Just a little show of appreciation at the time would have meant a lot to me. And you wonder what makes us stay. Actually I didn't, I went back to school.