Laughingbuddha

Hi all,I was an LPN for 7 years before just getting my RN. (yay!)I continue to work in a skilled facility in Florida, most of my hours on a subacute busy rehab unit, but 8 hours on a long-term hall. I have worked with dementia patients in some capacity for over ten years, and have usually a library of tools and tricks of the trade to manage to do what is necesary for my patients without conflict and keeping them happy at the same time. But there is always one patient at every facility that has a problem with some aspect of care...as an LPN I used to 'go' with the philosophy of the facility I would be employed at to manage the resistance...as an RN, I want to set the RIGHT example for CNAs and LPNs who will be watching what I choose to do...Question regards: patient with medically necessary urinary catheter. Cath is occluded, but QS urine is leaking around it. At this time no distention. Female patient has knees bent up on bed and refuses to open. Unable to even visualize meatus much less do a sterile insert...Attempted to insert with two CNAs helping to gently hold the knees open-she fought, struck, attempted to bite, etc. Patient left to rest...re-approached after an hour,by myself-with gentle talk and explanations...still no luck. Patient has no anti-anxiety meds etc to help calm prior to procedures.What would you have your staff do that would be most appropriate?Contact physician regarding patient fearfulness/anxiety during certain procedures? Maybe to seek PRN order for essentially a chemical restraint?Contact guardian/poa for instructions regarding resistance to care that will adversely affect physical health if not done?What would AHCA want to see in this situation? Different facilities I have worked in over the years have wildly different answers to this, from massively physically restraining patient with up to four staff holding the patient still, to pre-medicating, to having intervention discontinued.What would YOU do?Thanks to all DONs/ADONs--I respect what you do but wouldn't want your job for all the world! :)