Should nurses care for their own family in LTC setting?

[duckie]

Several weeks ago we received a new resident on my unit. This resident clearly belongs on our Alzheimers unit. In the past 4 days we have had multiple episodes of her walking down the hall with her clothing down to her knees for all the world to be mooned. She has multiple issues to address and cannot complete any of her own care due to severe cognitive impairment, but is ambulatory and gets around very well, also going into other residents rooms and trying to follow staff into areas she should not be in. I have seen many residents moved after just one display of such behavior as most of my residents still are alert and oriented. The biggest problem in my mind is that the an LN on another shift that works this unit full time is this ladies grand-daughter and the clincher is that she is the administrator's mother. I do not feel her behavior belongs on our unit and would be better suited on a unit where such behavior is not deemed inappropriate and many of the elderly with Alzheimers do this. So far no talk has even suggested she be moved. Well last night after another episode, I made the suggestion that she should be moved, to her daughter, the Administrator. I think the family is too close to the situation to make the decision and I don't think she should have been placed on a unit where her grand-daughter is her nurse. I know it is often difficult to decide to move a family member to an Alzheimers unit, it is difficult to admit that this has happened to someone in your family. My own mother has Alzheimers and I would absolutley never consider being her nurse. This has placed a lot of demands on the other nurse and I have even seen her hiding to get away from her grandmother, as she tends to shadow the staff, more so her grand-daughter. Am I wrong for thinking that she should never have been placed on a unit where her grand-daughter was a fulltime nurse thus making her ability to make some judgements difficult?

[mustangsheba]

This patient should be in an Alzheimer's unit where she can be cared for appropriately. It's unfair for everyone concerned to place her in regular LTC. Alzheimer's units are designed to accommodate the unique needs of dementia patients especially concerning safety.

[Q.]

I feel for this nurse. Besides the stress of having an ill family member, to have it at work also must put a significant strain on her and the other nurses.

It's too bad because obviously this patient would be better treated on a floor that is appropriate for her needs. What kind of treatment is she getting if she is on a unit that is not designed to treat this kind of illness and if her own granddaughter is ducking away from her? This saddens me.

I guess I would also wonder why her attending MD would not step up and recommend that she be placed in an Alzheimer's unit?

I really am leery against taking care of family members. I think at home that may be one thing, like assisting with ADLs and such, but then anyone could do that. But I think you run into alot of complications and liability when you start to treat family members.

[res04lly]

I can really understand what this nurse is going threw. Several years ago(10) my mother in laws boyfriend was placed at my faulity, Man talk about additional stress. Everytime something did not go right or she felt he wasn't getting good care my phone was ringing off the hook at home and at the nursing home. I had the assistant administrator come to me about patient's right of this person and i just very nicely reminded them who had allowed my mother-in-law in on care conferences, pt evals and ect. I also reminded him that he could go home and sleep and not be bothered on a daily bases of what happened, what is going on, new med changes, aide issues ect. These things of course i refused to discuss due to his patient rights but i really feel for this nurse.the only suggestion i have is asked to moved to a different station or if they have a different faulity ask for a transfer. The peace of mind is well-worth it.

[night owl]

since this was posted on March 29th, has anything been done since then? I would think it would place a big hardship on the grandaughter and I'm suprised she let it happen. If that was myself, I would want my grandmother moved to the alzheimers unit. I'm also suprised that the administrator allowed her mother to be admitted to that unit instead of to a floor where she would get the appropriate care that she needed. In essence, she should not be on that unit especially if all of the other pts are A&O. Have her transfered if at all possible.

[Chellyse]

This is not the first time I have seen or heard about this going on. While the intentions may have been good (inable Mother to get good care because she is at my facility or I can make sure she is watched ect.) The complications are seldom easy. She seems inappropriate for skilled care based on your statements of assessment in behavior (mooning the ward) have you tried involving the social worker on this one? Approaching the administrator eventually will be part of the plan if she is listed as the contact person. Have you attended any care planning meetings. The denial of alzheimers is not easy to cut through with close family but maybe with enough documentation it is possible to show at the meetings she would be safer on a ward with less distraction and more individualized care. Or what might happen I have seen this too, it will come down to a situation where there is ultimately no choice, the administrator being the daughter and nurse as the grandaughter while legal is not prudent because too many emotions are involved. I enjoy it when my patients families are able to help out when visiting if they are health care workers, because this assists me in my job at times and makes them feel good. But this is more likely a hinderance to this patient's care. How long has she been there? and has it changed any after the transition of the move to this new residence?

Good luck in any case.

[duckie]

This resident stayed on our hall for a couple more weeks after I started this post. I finally decided to have a very blunt talk with my administrator, telling her about all the documentation of her Mom's behavior. I told her that I knew her Mom would be totally mortified if she knew how she had been acting and heard the mean remarks made by some of the other residents. Her behavior had gotten more inappropriate, once even going into the med room on day shift(My first thought was why was the door open) and urinating on the floor. This became an everyday thing of her urinating at the nurses desk or other places. We tried repeatedly to toilet her but then she would become combative, and she refused to wear incontinent products, ripping them off as soon as we out them on. The day shift nurse who is her grand-daughter was very torn and so I decided it was my responsibility to protect this resident from what the other residents were saying and to protect my A & O residents from being subjected to this constant behavior. I figured all they could do was fire me so I had a long talk with her. To make a long story short, they were going to arrange a move when the situation went from bad to worse when she took a knife from her Lunch tray and tried to cut her throat with it. She is currently in a Psych. facility for evaluation and treatment. I grew very attached to this woman because I felt much of her behavior was her anger at being admitted to the facility to begin with, plus her Alzheimer's, plus she was very depressed. There were times when she would kling to me and cry, it would just break my heart. It is so sad to know that people work hard all their lives then they change and are not the people we have loved but their behavior is such that we just do not know what to do or how to help them. I think I got more emotionally involved than I should have because of my own Mom and what I see happening to her. I hope she finds some peace and that they can find the right medication to ease her inner torment. Thanks for asking about her.

[Chellyse]

Duckie,

Sounds like you did the right thing by going directly to the administrator. You say she is now moved to psych, hopefully she will be evaluated and placed on the right medications to assist her,so she can live out as peacebly as she can. I know this must be hard for you as one of the primary nurses she gravitated to and the closeness of the situation to your own emotions. Still I am glad to see that the situation was talked about it says alot about your character as a nurse. There are those who would not have cared or been so involved and the transition to the psych unit still might have occurred but you were able to show not only the patients and co workers but even us bb'ers how you handled this difficult patient and your humanity through out. Thank you for the update.