The right to refuse has so many interpretations

Nurses General Nursing

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  • Specializes in retired from healthcare.

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Poochiewoochie

178 Posts

i wish families understood this.

that yes, even with a low bed, floor mats, bed alarms and continual supervision...

that the self-determined pt IS going to walk, whether s/he is able to or not.

and these pts are going to fall, be hospitalized, return only to fall again.

personally, i think there are many family members who suffer a lot of guilt after their parent dies...

and much of their angst is displaced.

yes, there are substandard nursing homes and i wish all families did their research before selecting a ltc facility for their loved one.

medicare has the public results of all state surveys that are done at ltc...

and one can plainly see the results/standing of any particular facility.

still, we nurses are blamed for everything - some, rightly so.

as long as each and every one of us can sleep at night, knowing we gave ea pt our personal and professional best,

Neglect is neglect. Whether falls are preventable they should be doing everything they can do to prevent them. In my Mom's case they didn't and I have the CMS survey results to back me up. She was a high fall risk and no fall prevention was put into the care plan.

The only guilt I have is not being able to take care of her until the end and having to put her in the NH in the first place. I did so because I hoped she would the care I could no longer provide.

CodeteamB

473 Posts

Specializes in Emergency.
Dementia patients are more than a chapter in some nursing book. People here seem to think they are experts just because they went to school. I don't begrudge you for doing so but if you REALLY want to be enlightened about dementia patients read the book

[h=1]The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss[/h]

Or try visiting an Alzheimers forum to get some idea what we family members have to deal with. A lot of us have put our lives on hold because we decided to take care of our LO. None of you that work in SNF or LTC are "special" to us family caregivers because in the long run you are getting paid to care of them. And yes, it might be Medicaid that is paying for their stay but it is OUR taxpayer money that is paying for Medicaid.

Unlike you in the nursing field people people like me who have or had to take care of a LO with dementia don't have the privilege of 8 or 12 hour shifts and are not paid for doing so. It's not a paycheck or a so-called calling(in which we feel the need to glorify ourselves to others because we think we are "special")that we do it for-it's because we love our family member. Our days are spent taking care of their every needs and our days don't end at a certain time. There is no lunch or dinner breaks to whine about not getting and many a sleepless night is spent wondering how much longer you can do it by yourself like I did. Every day is a battle whether it be getting the person to eat, bathe or take medication. They feel their freedom and independence slipping away because of the disease and it only intensifies the resentment when someone is there telling them what they have to do as if they are a child. You that work in LTC/SNF think you know what it's all about-you have no clue. Being paid to do something is a lot different than doing it because you love the person.

I don't think anyone here has claimed to be an "expert." Yes, school does provide some of our knowledge base, but much more of it comes from the 8 or 12 hour shifts spent working with many, many different people suffering from dementia. People who work long term care (bless them) do develop an expertise in this disorder, much as you developed expertise with your mother's presentation. And while you may not believe it, a little distance from the situation can help with objective observations which in turn lead to a better understanding of a disease

It sounds like you are really hurting and have a lot of unresolved feelings about your mom, I'm sorry for that, and I hope you work through them, but I think right now they may be clouding your perceptions of what is being said here.

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I've seen people working at the facility where my Mom worked at that had no clue about dementia patients and their behavior. Just because a person is a nurse or a CNA doesn't mean they are they most educated when it comes to the disease. Most family members who have become caregivers to a LO with the disease HAVE educated themselves on it. Just because you all went to school for 2 or 4 years or as in the case of a CNA 6 weeks doesn't make you an expert on it. Dementia patients are AFRAID of water-maybe some of the people in this thread should educate themselves on the disease.

As for not taking a shower my Mom didn't take one for several months at the facility-they did bed baths instead. So, yes, not taking a shower was not the thing that killed her.

I see a lot of pass the buck onto the patients family in this thread. IMO most of the people who worked at my Mom's facility were not qualified to work there. I can see why they aren't working at hospitals because their attitudes and the way they do things would never fly at a hospital.

Oh and for the record, I'm not saying it's wrong to gently persuade them to do something. What is wrong is lying to them about medication and badgering them into doing what you want them to.

I know that your experience with your Mom is very personal and you have very strong feelings about this particular subject. It is possible that those who cared for your Mom were not well versed in the care of dementia patients. Not all dementia patients are afraid of water but it was particular to your Mom.

I think that a majority of care givers try very hard to give good care. Yes there are bad in every corner of every profession...but I think that most want to right by the patient and the families. I think we have all bent the truth a little at one time or another to cajole a patient into taking a med that we know is the best for them.

Unfortunately there are time in this profession that we do force patients against their "will" to keep thme from harm. It is on no way meant to demean them or hurt them...but I can't let someone who is confused, intoxicated leave and play in the road or drive a car.

I think there are some out there that are mean and nasty and they should be removed from their position....but I do believe that most of us have the best of intentions to do the best by our patients.

chrisrn24

905 Posts

I don't think anyone here has claimed to be an "expert." Yes, school does provide some of our knowledge base, but much more of it comes from the 8 or 12 hour shifts spent working with many, many different people suffering from dementia. People who work long term care (bless them) do develop an expertise in this disorder, much as you developed expertise with your mother's presentation. And while you may not believe it, a little distance from the situation can help with objective observations which in turn lead to a better understanding of a disease

It sounds like you are really hurting and have a lot of unresolved feelings about your mom, I'm sorry for that, and I hope you work through them, but I think right now they may be clouding your perceptions of what is being said here.

I agree.

When I became a nurse I saw dementia through different eyes than when my grandfather suffered from it. Very, very different.

And poochie I've had a lot of family members thank me for caring for their loved one. Don't tell me that nurses aren't special to families of dementia patients. Maybe not all families think highly of the nurses but many, many do. And it's not that I do my job because I want a compliment. I do it for the residents.

leslie :-D

11,191 Posts

The only guilt I have is not being able to take care of her until the end and having to put her in the NH in the first place.

it is evident (to me) that you are struggling...

and hope you can forgive yourself, as that is when true healing will begin.

in the meantime, i am confident your mom knows how much you loved her...

and pray you will find the much-needed peace in acknowledging that.

only then, will your burdens be lifted and you can move forward freely and painlessly.

leslie

Esme12, ASN, BSN, RN

1 Article; 20,908 Posts

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
it is evident (to me) that you are struggling...

and hope you can forgive yourself, as that is when true healing will begin.

in the meantime, i am confident your mom knows how much you loved her...

and pray you will find the much-needed peace in acknowledging that.

only then, will your burdens be lifted and you can move forward freely and painlessly.

leslie

I agree well said Leslie...:)

BrandonLPN, LPN

3,358 Posts

Dementia patients are more than a chapter in some nursing book. People here seem to think they are experts just because they went to school. I don't begrudge you for doing so but if you REALLY want to be enlightened about dementia patients read the book

[h=1]The 36-Hour Day: A Family Guide to Caring for People Who Have Alzheimer Disease, Related Dementias, and Memory Loss[/h]

Or try visiting an Alzheimers forum to get some idea what we family members have to deal with. A lot

of us have put our lives on hold because we decided to take care of our LO. None of you that work in SNF or LTC are "special" to us family caregivers because in the long run you are getting paid to care of them. And yes, it might be Medicaid that is paying for their stay but it is OUR taxpayer money that is paying for Medicaid.

Unlike you in the nursing field people people like me who have or had to take care of a LO with dementia don't have the privilege of 8 or 12 hour shifts and are not paid for doing so. It's not a paycheck or a so-called calling(in which we feel the need to glorify ourselves to others because we think we are "special")that we do it for-it's because we love our family member. Our days are spent taking care of their every needs and our days don't end at a certain time. There is no lunch or dinner breaks to whine about not getting and many a sleepless night is spent wondering how much longer you can

do it by yourself like I did. Every day is a battle whether it be getting the person to eat, bathe or take medication. They feel their freedom and independence slipping away because of the disease and it only intensifies the resentment when someone is there telling them what they have to do as if they are a child. You that work in LTC/SNF think you know what it's all about-you have no clue. Being paid to do something is a lot different than doing it because you love the person.

And taking care of one demented family member is very different from being a nurse responsible for 30-40 demented adults.

Fall precautions only go so far when you have one nurse and two aides for 40 sundowning LTC residents.

Short of tying the residents to the bed or wraping them in buble wrap, falls are going to happen.

Out of curiosity, what measures do you feel this facility failed to take to prevent your mother from falling? Fall Alarms do nothing. Bedside mats are only good for immobile residents who roll out of bed. The mats are actually huge fall risks for ambulatory residents and staff. Toileting schedules help somewhat, but anyone who's been in this business knows darn well there's a thousand other reasons an unsteady resident might suddenly decide to get up.

The most effective way to prevent falls in alzheimers residents is to establish a firm routine and rapport between them and the caregivers. This isn't the kind of thing that can be easily shown in documentation. This is why facilities have fall alarms and fall tracking logs. Not because they are effective, but because it's something they can show the surveyors.

ktwlpn, LPN

3,844 Posts

Specializes in LTC,Hospice/palliative care,acute care.

I've had residents on ONE to ONE fall! In one particualr case the staff was sitting right in front of him,he jumped up and practically shoved her backwards and dived OVER her.It happens.

Many of us in dementia care have persued certification and are educated in that area and also in dealing with family members as they go through their stages of grieving. We GET IT.

I also get that there is nothing to be gained through attempting to maintain a dialogue with a non-nurse who apparently has an axe to grind against nurses and nursing homes in general and clearly appears to be stuck in a complicated grieving process.We all GET that-it's pretty clear.And attacking nurses on a message board is not a particularly healthy outlet,IMHO. ...

.I'll continue to encourage my demented residents to accept the care they need to maintain their dignity and wellbeing by almost any means,I'll sing,I'll dance,I'll make an orifice out of myself.I'll feed then Hersehy Kisses and peppermint patties all day long.I'll also offer support to their loved ones.And when they act like complete orifices I have a DON who will hand them brochures of other LTC's in the area and offer them assistance with alternate placement.....

Over and out......

Specializes in Pediatrics, Emergency, Trauma.
I've had residents on ONE to ONE fall! In one particualr case the staff was sitting right in front of him,he jumped up and practically shoved her backwards and dived OVER her.It happens.

Many of us in dementia care have persued certification and are educated in that area and also in dealing with family members as they go through their stages of grieving. We GET IT.

I also get that there is nothing to be gained through attempting to maintain a dialogue with a non-nurse who apparently has an axe to grind against nurses and nursing homes in general and clearly appears to be stuck in a complicated grieving process.We all GET that-it's pretty clear.And attacking nurses on a message board is not a particularly healthy outlet,IMHO. ...

.I'll continue to encourage my demented residents to accept the care they need to maintain their dignity and wellbeing by almost any means,I'll sing,I'll dance,I'll make an orifice out of myself.I'll feed then Hersehy Kisses and peppermint patties all day long.I'll also offer support to their loved ones.And when they act like complete orifices I have a DON who will hand them brochures of other LTC's in the area and offer them assistance with alternate placement.....

Over and out......

^Well SAID!!! :yes:

SleeepyRN

1,076 Posts

I've had residents on ONE to ONE fall! In one particualr case the staff was sitting right in front of him,he jumped up and practically shoved her backwards and dived OVER her.It happens.

Many of us in dementia care have persued certification and are educated in that area and also in dealing with family members as they go through their stages of grieving. We GET IT.

I also get that there is nothing to be gained through attempting to maintain a dialogue with a non-nurse who apparently has an axe to grind against nurses and nursing homes in general and clearly appears to be stuck in a complicated grieving process.We all GET that-it's pretty clear.And attacking nurses on a message board is not a particularly healthy outlet,IMHO. ...

.I'll continue to encourage my demented residents to accept the care they need to maintain their dignity and wellbeing by almost any means,I'll sing,I'll dance,I'll make an orifice out of myself.I'll feed then Hersehy Kisses and peppermint patties all day long.I'll also offer support to their loved ones.And when they act like complete orifices I have a DON who will hand them brochures of other LTC's in the area and offer them assistance with alternate placement.....

Over and out......

Well put.

Much better so than my post. I started to get angry as this is actually a very personal topic to me and my husband. I couldn't form the words, but you put into writing what I was thinking "There's nothing to be attained by attempting to maintain a dialogue with a non-nurse...."

CrazyGoonRN

426 Posts

I still agree with BrandonLPN.

I am just to practical. If your patient is lying in bed, stinky, dirty, getting rashes, but refusing to get into the shower, and hasn't pooped in a week. Do you just let them lie there?

It would be wonderful if every LTC facility had a psychiatrist/social worker, 1:1 nurse to go into the deep psychological reasons the patient didn't want to get clean.....however since LTCs don't have this luxury the patient needs to be cleaned and needs to poop!

I am sorry old people get confused, scared, angry, forgetful, etc. But they do, and they lose their ability to make safe, rational, decisions about their care.

I don't want to die lying in a stinky dirty bed all constipated! I want Brandon!

I totally agree with you! Also, allowing someone to become impacted because they continuously refuse a laxative is not the same thing as allowing someone to eat sweets all day. I want Brandon to give me my laxative so that I don't get all the bad effects from being impacted and I don't care what he tells me it is if it gets me to take it. I think that most people commenting are forgetting that most LTC residents have some level of dementia and cannot always be treated like they are AAO x 3. The nurse knows who has dementia and who doesn't there for each resident gets individualized treatment.

Alnitak7

560 Posts

Specializes in retired from healthcare.

They give them milk shakes and watch them become obese. In reality, they should only offer milk shakes if they ask for them and they should try using bananas and blueberries and other real food in them instead of ice cream. Accepting a milk shake can be a type of obsessive compulsive behavior sometimes that a good nurse should learn how to recognize and work around. They should offer things to replace bad habits. These people do not want to be fat and they should be offered a pathway out of bad health, not into bad health.

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