This is my first post. Love the site. I am a night nurse in a ltc facility. Nurse:res 35-42:1 CNA:res 20-25:1. We have a resident who is constantly falling. He can somewhat walk but has a very unsteady gait. The problem is he gets up in the middle of the night to use the BR by himself. He has been educated thoroughly and many, many, MANY times about using his call light, but refuses. He states I don't need it, leave me alone. We have done every intervention in the book. Bed alarm, he is so quick by time we get to his room he is either on the floor or already on the toilet. He is very close to the nurses station. Floor alarm, same prob. Side rails, putting his w/c by the bed, bedside commode, which he refuses to use. I and the rest of the staff are at our wits end.... any suggestions? :banghead:
i am not familiar with a "roll belt" but if that is something applied to the patient to keep them in bed, but allows them to roll, that wouldnt be allowed....and in some areas a low bed is considered a restraint, if the patient is AT
ALL able to stand....i think the only way around this one is to stop the freq void issue......uro consult, is he getting a diuretic too late in the day? etc
A few ideas - if it's a lighting issue, you may want to look into having your physical plant crew install a motion detector type light in the room.
This probably falls under the auspices of a restraint, but posey does make a tent like contraption that covers the entire bed. He will have to call to be let out. May not be totally appropriate, but given your description of how often he falls, it may very well be. Granted, i am sure he'd absolutely raise cain over it.
Sounds like he is very stubborn and no matter what you do, he will keep doing what he wants? Careplan and document everything. How about family? Would they be able to have a talk with him? Of course the consults for uro, what about limiting fluids at night and increasing them during the day?
The real problem here is his loss of independence and, dadgummit, now you
want to tell him where and how to pee!
This is one of the few things he can control so, however much of a danger it presents, he will continue to resist all efforts to supervise his nocturnal toileting activity.
He needs to have his nocturia assessed and treated by urology.
From an ethical point of view, he has the right to autonomy, if he is making an informed decision and recognizes his individual risk for falling but chooses to to walk anyways his choice needs to be respected.
What fall and injury prevention strategies is the patient interested in? Let him decide.
Thank you all for the responses. I have suggested the placement of furniture as a steady hold for him, which he thinks he does not need...lol. We already have a very low bed for him so we put a thicker mat under the safety and fall mats. this had helped as long as we are able to get to him, barring everyone is not super busy. Once again I have me and 1 CNA in his hall. He has seen a uro and nothing is wrong, he does not have lasix or any type of diurretic. Also, he does not drink at noc anyways. Our facility does not really use bed restraints and his family does not want them anyhow. I have been documenting like a mad woman. No falls in two days, HORRAY! Still refuses to use the call light, but the low bed and built up mats, but not so tall he trips or falls off, are giving us more time to get to him. Thank you everybody again for all of your input. this has been very helpful and I greatly appreciate your interest and advice. :)
Thanks for the update on the client. Prevention of falls in the elderly is a big concern for all healthcare professionals and it can feel like a big responsibility for night nurses. Does your facility have fall and injury prevention best practice guidelines? If not and since there are patients falling, you may want to assess with colleagues and management if there is a need for a guideline, then review current available guidelines and consider adapting one to suit your facility. Here is a link to a guideline that has been adapted by some facilities in Ontario.
hmmm no lasix, no large amount of liquids.....does he need to urinate freq during the day, does he urinate at all at noc, or just feels the need and gets up?....does he perhaps qualify for/need a med for bladder irritation (the dx escapes me at this point, but you know what i mean, "gotta go, NOW,lol)......since he can get up, make sure the bed is high enough that it isnt causing him a problem.....does he get enough exercise during the day, both to "tire him out" and to maintain muscle mass? does he use slippers, or barefooted? if barefooted will he tolerate going to bed with "grippy socks" on? if not perhaps laying down strips on the floor between his bed and the toilet would help........good luck
:banghead:
UM Review RN, ASN, RN
1 Article; 5,163 Posts
Now I'm getting curious. Just how often is he getting up at night?
Think he needs a UA or a uro consult?