Pride Goes Before A Fall

[Nurse SMS, MSN, RN]

Lately I have gotten quite a few aging gentleman patients who are disinclined to cooperate with fall precautions. Usually their families see the risk and back up the medical staff. But now and then you get a family member who is fiercely protective and relatively adversarial. Often in this situation they have been caring for the patient at home by their self and their answer is that because they do it alone, we should be able to transfer and ambulated the patient to the toilet as well, alone. Mind you, many times these are two to three person assist, even with a walker and usually the patient has had a change in condition since being at home.What I see happening is recognition by the RN that the patient is very unstable (weakness, tremors, rigidity secondary to a disease process, sometimes all of the above) and the patient refusing the bedpan or even a bedside commode, likely due to the sense of loss of dignity and independence. The family either tries to get them up themselves or gets angry when two to three people cannot be produced immediately to help to the potty. Iam getting pretty discouraged by situations like this. With the emphasis on customer service now, there is always tension inside me. I know what the priority should be but feel very conflicted by what it actually is. Staffing rarely allows for this kind of assistance, especially on weekends. I am sitting here ruminating over this and feeling just...sad. What an awful conundrum this "patient satisfaction" bonus model has created.