Putting a mask on a spitter

Nurses General Nursing

Published

The situation is a dementia pt. in a LTC facility. Pt. is a peach much of the time but when pt. gets in a bad mood pt spits. Pt. has spit on multiple staff members, primarily CNAs (because it's usually during care/changing/repositioning/bathing that pt. gets upset) and also has been observed spitting on spouse.

Some CNAs decide that an appropriate intervention for this behavior is applying a mas over pts. mouth (standard surgical face mask). Pt. is unable to remove this mask on own so it blocks the spit.

So, is this abuse, an appropriate intervention, somewhere in between? There is disagreement among higher-ups about what should be done about this situation and what, if any, consequences the CNAs should face. Any opinions?

Specializes in school nurse.
This could indeed be considered abuse! The patient is in a nursing home, and putting a mask on her that she can't remove violates her dignity and her rights. I could see the State walking in and having a field day with that one.

I know it's pain in the rear, but if the staff wants to protect themselves from body-fluid exposure they will need to gown and mask themselves rather than the patient.

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I'm pretty sure the right for the patient to commit assault and battery doesn't exist, and how do you spit at others with "dignity" anyway?

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Specializes in LTC.

Can there be an order written to place a "restraint" ie face mask on a patient when necessary?

If not the facility needs to start investing in gowns, facemasks w/ eye shields, and hair coverage.

Why the resident has the right to dignity the staff has the right to safety. I'm curious is OSHA wouldn't have something to say about staff not having the correct protection in this situation.

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Specializes in Anesthesia.

My pt's get a mask and we're simply ruling out the flu. Personal safety trumps dignity. ABC's.

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The only thing I could see as being patient abuse is if the mask is kept on at all times. If you say this is something that is only a problem when they're turning or doing care with, then I would have to say that what *I* would do (if you're not met with loogies upon entrance to the room) is to place the mask just prior to turning / cleaning / etc. and making sure to take it off after you're done.

It's NOT a restraint, its NOT invasive, its NOT super uncomfortable, and it's saving staff from being exposed to bodily fluids.

FWIW we place face masks on patients when we do Central Line dressing changes to keep the site as sterile as possible, and nobody has a problem with it! Just explain what you're doing and get to turnin'!

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Specializes in Family Nurse Practitioner.

It is my understanding that this is a restraint and if there isn't an order as Casi suggested it could cause trouble, imo. I'm not saying this is a great situation but I would have staff wear personal protective wear instead of masking the patient Other than hygiene is there really that much cause to be within spitting distance of them anyway?

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Specializes in multispecialty ICU, SICU including CV.
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I'm pretty sure the right for the patient to commit assault and battery doesn't exist, and how do you spit at others with "dignity" anyway?

Can you claim assault/battery with a neurologically altered, demented patient? I am thinking no.

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Specializes in school nurse.
Can you claim assault/battery with a neurologically altered, demented patient? I am thinking no.

Of course not, but it does lend credibility to steps you take to protect yourself, i.e. a mask.

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I'm just throwing this out there, but there's nothing that would be able to 100% get rid of the problem ... being said, I think your best bet IS the mask. I don't really see how it's a dignity thing for them to not have a mask on. If you're KEEPING it on, then it's a problem. Dignity IMHO is more of a "not keeping the door closed when you're changing them", "not keeping them covered as much as possible", etc.

It doesn't matter what YOU don PPE wise, you're never going to be protected against this patient ...

Hair nets are not moisture impermeable, masks for yourself have holes, etc.

The only way I can think of is the face mask.

Someone said that it is considered a restraint, but I don't really agree with that (and I've never seen that on a "restraint" sheet as BEING a restraint). Heck we're allowed to place the big puffy mittens on patients now, and they're not considered restraints. The only thing they consider restraints for arms is tie downs... That being said, if you followed the "place when you're doing the cleaning turning, and take off IMMEDIATELY" you'll be less likely to cause an issue. If you were keeping it on 24/7, then you'll have more an issue...

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LTC's have different rules than hospitals. The State does care more about resident rights vs. CNA's or nurses rights.

The way they will see it is that if you can protect yourself without doing anything to the resident, you will have to do that. You have other options besides putting a mask on the resident.

Though I do agree if you put it on before care and take it off immediately, then you might be okay. But there will be a chance they will spit and fight you when you try to put it on, so it's best to put protective gear on yourself.

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it's not a restraint, its not invasive, its not super uncomfortable, and it's saving staff from being exposed to bodily fluids.

it is a restraint if you do not have pt's consent and pt is rendered incapable of removing said device.

fwiw we place face masks on patients when we do central line dressing changes to keep the site as sterile as possible, and nobody has a problem with it! just explain what you're doing and get to turnin'!

bolding, mine.

again, when you explain what you're doing, it is implied that you have gotten pt's consent.

anything that deviates from this method, is considered a restraint.

leslie

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Specializes in multispecialty ICU, SICU including CV.
bolding, mine.

again, when you explain what you're doing, it is implied that you have gotten pt's consent.

anything that deviates from this method, is considered a restraint.

leslie

is it, or is it considered assault/battery? i would think that.

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bolding, mine.

again, when you explain what you're doing, it is implied that you have gotten pt's consent.

anything that deviates from this method, is considered a restraint.

leslie

i'm a little confused by this as well leslie. are we saying it's not a restraint? or are we saying it is since the resident has dementia and probably really doesn't understand the mask thing.

thanks in advance for clarifying.

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