Patient's right to have a decubitus ulcer ?

merricat · Sep 23, 2004

our DON told us whenever someone becomes combative to absolutely leave the situation and give them space for half hour or so because they are probably overstimulated. sometimes i get them as comfortable as i can --blankets-- and turn the television off and come back in a half hour. seems to work pretty well. of try to time stuff for 20 min or half hour after they've gotten their meds. most of the time it works. i had someone who was combative when i was trying to put her in pjs on the toilet. i got her off the toilet and put her in her wheelchair and then she was willing to put her pjs on. who knows why-- all i care is it worked. we do have one woman who gets combative to the extent of spitting and cursing at us and nothing seems to work. shes not usually "mine" so i dont know with her. sometimes it seems like talking to them can work as a diversion can work. sometimes i say, "i can't let you stay in wet pants! what kind of person would i be if i let you stay in wet pants!" for whatever reason this seems to work.maybe makes them feels sorry for me.

kathy_79 · Sep 23, 2004

you are responsible for your action and what is in your cna competencies. you are there for pt and you are making decision what is good for them. you need to use your judment if what you plan to do is right or not.

well, being on shift you need to be able to change your pt at least once. you do not know if he will not refuse doing something again on next shift.

what i do, is i talk to pt if he is not cooperative, i leave him for about 20-30 min and go back again. if he refuses again, i go talk to charge nurse and supervisor. i usually ask nurse to go with me and talk to him again together. if this does not work, i make detailed report and exactly state what pt says, what nurse says, and notify next shift cna that i was not able do it because... usually if you talk to pt and try to encourage him or her to participate in care they will cooperate but if not try to ake effort next shift will help him or when i caome back next day (if i work), but i make sure at least every two day my pt is bath regularly, it does not have to be shower i know how busy cnas are so i just give my pt complete bath every other day, but regular hygiene every day so they are clean and neat and feel comfortable. also you can ask other cna for help so there is witness of any abuse from pt to you, i do not think you want to do any harm for any of your pts.

i hope you will find your way too, it is hard to deal with pt sometime but put yourself in their position. i beleive they just pretend that they do not care but really they love when you are there for them.

good luck, no judgment just advice. :)

southern_rn_brat · Sep 23, 2004

I work in LTC and we have a few residents who become combative when you try to change them. I am curious as to what others do at their facilities. Do you allow them to refuse to be changed since that is their right to refuse? Or do you get 3-4 people and change the person anyway so they don't get decubitus ulcers? Thanks :)

I would think this would depend on their level of orientation.

If they are A&O and make their own decisions about their care....doing anything to them against their will would be illegal. It should be well care planned if they continue to refuse care and document document document!

If it is a confused patient....this behaviour should be well documented and care plan interventions in place to handle this behaviour so that care can be provided. Sometimes there is nothing else you can do but get other people to help and change them anyway. Some dementia patients will fight ANY type of care, esp baths or peri care.

purplemania, BSN, RN · Sep 23, 2004

if they develop an ulcer it will be construed as the fault of the facility (or you) without consideration of the patient's autonomous rights. Wounds lead to infections that put others at risk. Recommend to DON that an inservice be done on how to handle these situations so everyone has info to share.

Blackcat99 · Sep 24, 2004

:) Thanks all for your messages. I am the LPN night shift nurse at the LTC. I know in the past at this facility that they had a patient who would refuse everything. She got a bad decubitus ulcer and died. Her family sued and they settled out of court with a huge settlement. At this place they give inservices saying all residents always have the right to refuse. However, when the CNA's try but are not able to change them then those CNA's get in trouble by the next shift for "leaving the residents wet and dirty." I will have to check with the DON and see exactly what she wants the CNA's to do. The ones who refuse to be changed are usually confused.

merricat · Sep 24, 2004

everyone has probably already heard that the federal government -- feel stupid but cannot remember name, just woke up-- is going to start fining nursing homes for their residents wounds-- my DON was talking baout it in meeting--

Blackcat99 · Sep 25, 2004

That's interesting to hear that the gov't is going to fine homes for their resident's wounds. I don't like to violate "patient's rights" but I do tell the CNA's to go ahead and change resident's even if they don't want to be changed.

Sheri257 · Sep 25, 2004

That's interesting to hear that the gov't is going to fine homes for their resident's wounds.

Wow. I thought most states already did this. In California facilities get hefty fines for decubitus ulcers. If a resident is totally uncooperative and develops a pressure sore, it has to be heavily documented so the facility can cover themselves with the state. At least that's what they teach us in school.

:uhoh21:

CoffeeRTC, BSN, RN · Sep 25, 2004

Psych consult if needed. We have quite a few of these folks alert and demented that refuse treatments and care. If its a med its most often d/c'd if its a treatment, we try to use a dressing that needs changed less often. As far as care...it needs to be done. Maybe not as frequenlty, but it still gets done. Ohh....a lot of documentation/ teaching/ reinforcing and family involvement.

louloubell1 · Sep 25, 2004

In ICU even, we get lots of folks who are A&O and will refuse things like turning or NT suctioning when it is needed. I always educate them re: the rationalle for the intervention, and ask them again if they will allow me to help them in this way. If they still refuse, I will tell them that I have provided them with the education, and I can not force them to do it, then I chart, chart, chart. "Pt refuses turning. Educated re: rationale including risk of pressure ulcers. Pt demonstrates verbal understanding of education, but continues to refuse care at this time." Then I will wait a while, and ask the patient again, and if they still refuse I chart that again. I am not about to force a treatment or intervention on an A&O pt. That's assault brother! What can you do? It all really depends on the patient's status of being confused or not confused. Sometimes I will have another nurse come in and talk with the patient too. This often seems to help, I guess because the patient can see that the intervention must be important if other nurses are pushing it too. I know that things must be different in long term care though. Those are difficult situations when you really want to act in a patient's best interests and they won't let you.

Blackcat99 · Sep 25, 2004

Yes it's a difficult choice to make. Despite the fact that the resident was confused and physically assaultive to anyone who tried to change her and that charting was always documenting those facts still the family got that huge settlement. You're damned if you do and damned if you don't. If the skin breaks down you're the "bad guy." If you insist on cleaning up the resident to prevent skin breakdown you violate the "patient's rights" and then you're the bad guy for violating his rights. The other night there was a police car at my job and I was worried that maybe he was looking for me to arrest me for "assault." :crying2: