3 or more staff forcefully providing care to cognitively impaired residents

[cstober]

I work at a LTC (RPN) on a dementia unit. Several residents frequently refuse care. Because the residents are very strong and physically aggressive towards staff, it is normal for PSW' s to report to nurses that a resident refused care. All refusals are always documented. I always try to assist the PSW's with care of these residents, but due to their (i.e. Residents) aggression ( hitting, kicking, scratching, and biting e.t.c), providing care is impossible. On one occasion, a resident twisted my hand, which lead to two days of pain 5/10. Another resident bit a PSW on the hand, causing deep teeth indentation marks on the PSW's hand. Staffs are afraid of these residents. Our DOC & administrator wants staffs to forcefully hold these residents down and provide the necessary care or it would be considered neglect. According to DOC/Admin., because the residents are demented and can not decide for themselves, staffs must use force (i.e. If necessary, 3-5 staff must hold resident). If staff adhere to DOC & Administrator's order or direction, is this not ABUSE?

[dishes, BSN, RN]

Yes, forcing is abuse, see CNO Abuse prevention: One is one too many.

[dayandnight]

I know it's very difficult when a resident is being aggressive etc, but care should never be forced. Therapeutic communication with a gentle calm approach (having care giver the resident is most comfortable with is a good tip) should be tried first and your Director of Care or Manager should know this. Somebody definitely needs to talk to the Manager.

If not, have the family member talk to the patient, but to be honest the medication should be discussed with the doctor to make sure the patient is not acting too aggressively. We all know over-medicating elderly is a huge issue but the issue is if the aggression gets worse it affects all other residents residing there. I have seen so many caregivers (and experienced this myself since I worked as a care aid back in the day) get punched, kicked, and slapped by the residents and dementia patients. This should not happen as well. There needs to be a fine balance but unfortunately in LTC it is so difficult to figure out how to maintain this.

[BuckyBadgerRN, ASN, RN]

Tell your DON that s/he is welcome ANYTIME to come and perform cares. Yes, cares should be performed daily, but not at the risk of injury to staff and residents themselves

[joanna73, BSN, RN]

Leave and try another approach later.

If I witnessed any staff member repeatedly forcing care on residents, and after having a discussion with the staff (s) the behaviour continued, I would report them.

[erniefu, BSN, RN]

This sounds like something that a geriatician or a geri psych clinical nurse specialist should be involved in.