Range of motion or patient abuse?

[Alnitak7]

When I was new on the hospital floor, a girl that was orienting me was taking the shirt off a

patient with severe arthritis and she was screaming and in pain. This girl was giving me an attitude.

Our supervisors were right in the general area and did not seem to be concerned.

The more I learned about arthitis and contractures, the more I started thinking that

this treatment was not proper. I think I should have reported this and now am sorry I didn't.

Range of motion only helps when you do it gently.

[CoffeemateCNA]

Maybe I'm just not getting the picture, but what does undressing a patient have to do with ROM exercises?

But yes, the CNA (or whoever) should have been more careful.

[annacnatorn]

ROM..should not be painful,

However when a person is contracted, has arthritis, is in pain..it is difficult not to cause more pain when removing clothes.

Especially when the patient has not been exercised for a long time.

Yes, we need to be careful, gentle but sometimes pain is involved in removing clothes...

As for the attitude, can't explain..maybe this particular person screamed at the removal of socks.

Live Long, Laugh Often, Love as if your life depended on it.

[BackfromRetirement]

Most facilities have a physical therapy department. They would be willing to do an inservice on your unit as to this question.

[Davey Do]

A lot of caregivers have an "attitude" when they feel inadequate or uncomfortable with themselves in a given situation. They usually haven't found a way to deal with their feelings of inadequacy. The easiest method they've found is to roll their eyes and blame the patient for the uncomfortable situation.

In his book, "Stumbling on Happiness" Daniel Gilbert, addresses the "blame" issue. Basically, Dr.Gilbert asserts that we feel better in a painful situation if we can pin the blame on someone else.

As far as your concern about the supervisors' indiference, I could only speculate. Sometimes it's desensitisation.

Perhaps an endeavor in gaining empirical knowledge would be beneficial to you.

Sorry. I gotta go now

[leslie :-D]

i had a pt one time, whose contractures were so severe, he was literally in a knee-to-chest position.

even the very thought of us moving him, would be enough to send him into screaming...

of course rom w/contractions, is going to be severely painful.

the most helpful intervention, is gaining the trust of the pt...

that his/her treater, isn't going to purposely hurt him/her.

gently explaining every move you're going to make, is helpful, so the pt can anticipate your next move.

pre-medicating might help, although i tend to doubt it.

not sure if it's "patient abuse" when a pt screams, but there are gentler methods of one's approach.

some could say that it's pt abuse, to NOT do rom, professing that will make the contractures worse.

re doing adl's, cna's need to be inserviced as to the best way to inflict the least pain.

leslie