i think several posts may be overlapping, because of 2 separate continuums that we're referring to:
nsg continuum - when residents refuse care, on one end of the spectrum are nurses who shrug shoulders and say "ok" and chart accordingly...to the other end of the spectrum, with some nurses wracking their brains (after hours) trying to come up with ideas in getting their pts to comply/cooperate.
resident continuum - those who are alert & oriented at one end, and those with total cognitive dsyfunction at the other.
reading through all these posts, you just don't know what type of nurse is talking about what type of resident.
i'm certain there are nurses who chart "refused care" with absolutely no effort on their parts.
just as i'm certain there are residents who retain a notable amt of cognizance, yet dementia is prominent in other aspects of brain function.
my experience has been that the most resistant of pts, will/do inevitably find that one person (title irrelevant) who they trust won't harm them, or who they trust to make the dreaded experience, as pleasant and timely as possible.
it may not be every week, sometimes showering once a month is the best you will get.
and finally, to me, honoring one's dignity entails NOT allowing a resident's condition to deterioriate to the point where they languish to the point where their physical and mental health are affected.
i have never, ever encountered a pt/resident where they refused care throughout their stay at the ltc facility.
eventually there was always at least one person they entrusted enough with care.
as nurses, we have to pick our battles wisely.
and i'll tell you quite frankly - if i had a resident that was known to refuse any/all care consistently, i for one had no problem dropping some lactulose in their drink and watched them swallow every drop.
same concept with mom.
again, this isn't for every pt but if it works for that particular pt, i'm good with that.
every pt and situation is unique, and you need to customize ea intervention that reflects the pts known strengths and weaknesses.
as long as we do everything humanly possible in honoring the pts needs of body, mind, and spirit, i do believe that's what counts.
we as nurses walk many fine lines.
in the end, it's finding that balance that dictates the desired outcome.
leslie
