Hello! I have a bit of an issue. There are certain patients I often take care of who have profound dementia--to the point of requiring hand-over-hand assistance for eating, unable to consistently reposition self in bed, etc--in a SNF.
They regularly refuse care, though clearly have no concept of what they are refusing (e.g. attempting to reposition in bed is met with "Go back to sleep before I spank you") Some will become physically violent if this avenue is pursued. Others will protest the action directly, but again only because they think the caregiver is someone they are not, they think they are somewhere they are not, or they don't understand their physical situation.
So here's my dilemma... On the one hand, my staff and I need to care for these people. On the other hand patients have the right to refuse. On yet another hand, they have no idea what they're refusing--I had one patient refuse their medications once because they thought the water cup was the pill they had to swallow and began screaming that staff was attempting to assassinate them by trying to make them choke to death with huge pills. The company regularly reinforces the fact that we cannot force patients to do something they don't want to do. However, sometimes families get upset and say "They don't even know what they're doing. Why can't you just ignore it and roll them/change them/get a medication patch they can't refuse/whatever?" Staff gets frustrated with the situation when they truly want to care for people, yet these dementia patients sometimes lie in their own incontinence for hours on end. We try to medicate them, they refuse so it does nothing. Due to "right to refuse" we cannot give an injectable or topical/patch for the purpose of bypassing their right to refuse. Then they refuse to be repositioned, then develop a pressure sore, and we get blamed for it because "there is never an acceptable reason for a pressure sore." It's a helpless feeling, and then to get blamed, be told our "numbers" are bad, have to do audits, mandatory training, etc to atone for injuries sustained when the only solution is one the patient themselves refuses...it's a horrible feeling.
I guess I'm just frustrated because if this is truly the way it is, perhaps the "right to refuse" pendulum has swung too far.
Does anyone have any constructive advice? Perhaps there are better ways to go about this? Any ideas for increasing compliance? Anyone care to add to my rant?
For the record, I try most standard approaches, and this is geared more for those that you can re-approach over and over in standard ways and will still refuse to be touched for hours. Please help me care for these patients who cannot care for themselves! ...or at least help me find some peace with myself in this situation--a new outlook or something!
