Inside one nursing home I have been adamently told, "You should not force her to do anything..." about an ill patient who said she wanted to stand up but was too weak.
In the same facility on other patients and other shifts, I have heard the phrase, "You have to....."and I have heard a charge nurse say, "Nope, nope nope, she HAS to come downstairs," in response to me saying, "She needs to finsish her breathing treatment."
In school, I was taught, "You can use powers of persuasion but you can't force them," ie, "They are all afrain you might fall out of bed..."
Some nurses still insist, "She has a right to refuse," and end off the conversation. They won't lilsten to any discussion about this.
I agree with you. At the same time, as a CNA, I can understand why she said that. The majority of our residents can be 98 years old but unless they are actively dying, there's a lot of pressure to keep them from deteriorating, even though the changes are normal and inevitable. If someone loses weight, can't walk as far as they used to, can't wash themselves up, is more frequently incontinent, etc. it's like, OMG, the end of the WORLD! Now sometimes there's a reason for it and with some investigation and work, we can help the person bounce back. But most of the time it's just the progression of their dementia. But we get shamed for it... told that we must be lazy, not doing something right, whatever.
no one has the right or authority to "shame you".
the elderly feeling anorexic, is a common phenomena and thankfully you recognize this and respect it.
it irritates me when i've heard a zillion tactic used in trying to get some of these folks to eat.
i knew of one aide who used to put sugar on green beans, potatoes, etc.
my logic is, you give them their dessert first and foremost.
for one, the pt most always enjoys and appreciates it;
and two, wouldn't it make more sense to give them the most fattening thing, first?
they also like it when you mix their ensure and ice cream together.
sweet, creamy, cool is usually a big hit.
besides- i'll be darned if i'm going to worry if a 95 yo gets their veggies.
bottom line: i am not their mother and can't imagine a bigger insult, than to treat these folks as if they're children.
There is a balance to be struck in which we may try to persuade and problem solve to encourage people to do what we think is good for their health. But we are their nurses not their keepers. Old people are not children. The closer I get to that age group the more I get annoyed by nurses who insist on treating the elderly like children. I work in acute care, so some of the imperatives are a bit different, but I also don't like to hear a sharp, intelligent, self sufficient older person described as "cute" or addressed by demeaning pet names like "dear" or "honey".
One thing I learned from my teachers is that each patient is different from the last so some of mine had the mind of a baby and some of them like being called "honey" and being touched on the head. In one case, I sent a visitor to the D.o.N.s office because she expressed some irritation with my behavior toward a resident who I knew very well. I could not legally discuss the patient with her but our D.o.N got around it somehow because I overheard her laughing with the visitor and explaining that I was not abusing this patient.
Is there anything less healthy than stripping someone of his/her autonomy?
Most times you can tell someone the consequences of their refusal but you can't force them. When people hear me explaining consequences they sometimes confuse this with force.
OK, this is kinda off-topic but I want to throw it in the mix anyway. My mother was 71 years old and in the hospital. Her foley catheter kept leaking. (Probably needed a new one or more sterile water in the balloon; she was also on Lasix so really needed the cath.) I walked into her ICU room and saw the catheter was gone; she also had a horrible rash all over her bottom, extending up her back. The nurses claimed my mother had "refused" the foley catheter. My mother told me that was not true, that what she said was "I might as well not have it, if it is going to keep leaking all the time." The nurse took this simple comment as a refusal, took it out and put a diaper on my alert, oriented mother. (No, didn't offer a bedpan, either.)
Yes, all patients/residents ultimately have the right to refuse. But that doesn't mean that we don't do our best to convince them to tale ordered meds/treatments anyways.
If mrs smith says she doesn't want a shower this week, we don't just say "okay" and walk away. A good nurse knows the tricks of the trade to gently persuade. "Your daughter called and said she wants you to have a shower today" or "the activities girl is coming in tomorrow to do your flowers so you need to be nice and clean."
In LTC "they refuse" is often just a convenient excuse for aides to skip baths or leave someone in bed.
It's the same with medications. As a 3rd shift LPN, I'm responsible for bowel care protocol. I have residents who flat out will refuse milk of mag or suppositories no matter how many days they are without a BM. The key here is they would refuse..... if they know what they're getting. I'll hand a resident a cup of MOM and when they say "what's this?" I'll say "oh, just some medicine the doctor ordered." Technically they never refused and thecnically I didn't lie.
We can't not even try to administer care as ordered.
As a 3rd shift LPN, I'm responsible for bowel care protocol. I have residents who flat out will refuse milk of mag or suppositories no matter how many days they are without a BM. The key here is they would refuse..... if they know what they're getting. I'll hand a resident a cup of MOM and when they say "what's this?" I'll say "oh, just some medicine the doctor ordered." Technically they never refused and thecnically I didn't lie.
We can't not even try to administer care as ordered.
That's unethical Brandon- how would you feel if a nurse snuck laxatives into your meds, you asked what you were being given, and they didn't tell you. I'd be willing to bet that you wouldn't trust that nurse anymore- or any nurse for that matter. It's one thing if the patient can't understand the consequences of going for x amount of time without having a bowel movement, but if they're asking what you're giving them; what they're putting into their bodies? A lie of omission is still a lie.
Yes, all patients/residents ultimately have the right to refuse. But that doesn't mean that we don't do our best to convince them to tale ordered meds/treatments anyways.
If mrs smith says she doesn't want a shower this week, we don't just say "okay" and walk away. A good nurse knows the tricks of the trade to gently persuade. "Your daughter called and said she wants you to have a shower today" or "the activities girl is coming in tomorrow to do your flowers so you need to be nice and clean."
In LTC "they refuse" is often just a convenient excuse for aides to skip baths or leave someone in bed.
It's the same with medications. As a 3rd shift LPN, I'm responsible for bowel care protocol. I have residents who flat out will refuse milk of mag or suppositories no matter how many days they are without a BM. The key here is they would refuse..... if they know what they're getting. I'll hand a resident a cup of MOM and when they say "what's this?" I'll say "oh, just some medicine the doctor ordered." Technically they never refused and thecnically I didn't lie.
We can't not even try to administer care as ordered.
One of the major tenets of ethical care is truthfulness. And no, half-truths and evasions do not count. This sort of nurse's self-deception and rationalization to maintain power is thoughtless and unprofessional, and if deliberate, shameful.
Provision 5 of the ANA Code of Ethics for Nurses: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. ... Section 5.4:Integrity is an aspect of holistic character and is primarily a self concern of the individual nurse ... Threats to integrity may include a request to deceive the patient, to withhold information, or to falsify records* ... Threats to integrity also may include an expectation that a nurse will act in a way that is inconsistent with the values or ethics of the profession ...
* in my opinion, charting this behavior as if it were congruent with patient wishes is falsifying documentation
Okay so I am volunteering at nursing home, and I am shock at what the nurses/staff allow patients to do. They allow them to take "smoking breaks" as well as feed them unhealthy foods (icecream, lollipops, and cake). I thought a nursing home was supposed to be about keeping the patients' healthy, not feeding them poisonous food and allowing them to smoke the rest of their lives away.[/quote']
PCT here, but as an LTC worker i can tell you, they have the right to refuse to be healthy. Mostly because they are, you know, people.
Also, check diabetic treatment protocols and treatment outcomes when we (yeah I am one) are allowed to eat the things we would like. They are actually better than the outcomes if you "restrict" our diets (moderation is key). If I'm 90 in a LTC I swear if you try and take a cupcake from my diabetic hand I will kick your butt with my walker. That's not even a joke.
Lastly, if someone wants to smoke, that's their right, be they 20 or 97.
Okay, so I am volunteering at nursing home, and I am shock at what the nurses/staff allow patients to do. They allow them to take "smoking breaks" as well as feed them unhealthy foods (icecream, lollipops, and cake). I thought a nursing home was supposed to be about keeping the patients' healthy, not feeding them poisonous food and allowing them to smoke the rest of their lives away.
No offense but it's not a question of what the nurses allow. Residents still retain their rights to make their own decisions whether you or anyone else approve of their choices. And after seeing how depressing a nursing home can be while my Mom was there I say let them have THEIR little pleasures in life. If smoking and sweets make them happy who is anyone to say they can't or shouldn't have them? It's not a prison where inmates lose their rights and are told what to do.
And if nursing homes are supposed to be about keeping residents healthy why did the one that my Mom was at fail to put any fall precautions in her careplan since she was noted to be a high fall risk? And why, after she fell once and broke her hip, did she fall again a month later and break her femur? Is that keeping someone healthy? And Mom is not just an isolated case-in the same month there were at least 5 falls resulting in broken bones that were documented on the Medicare site. And that was just the random residents the sampled during their inspection. So much for the theory they are supposed to be keeping them healthy.
I've seen firsthand NURSES and CNA's treating residents like children. That didn't fly with me when they did it to my Mom and they were reported to the DON. One was removed from the unit as soon as I complained and others were fired for various reasons. My Mom was a so-called "hermit" as the OP calls them-she was happiest in her room watching old movies on her TV. She had no problem telling those who persisted in her socializing to go to Hades.
Most, if not all SNF are understaffed. Residents do not get the timely care they deserve and from what I saw are left out on the hallways in wheelchairs. Mom was in a locked unit but when that person become wheelchair bound they were moved into the main unit. There they were put on the floor in their wheelchair for the whole day and left to fend for themselves. I'm glad my Mom passed away before they could do this to her.
One of the major tenets of ethical care is truthfulness. And no, half-truths and evasions do not count. This sort of nurse's self-deception and rationalization to maintain power is thoughtless and unprofessional, and if deliberate, shameful.
Provision 5 of the ANA Code of Ethics for Nurses: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth. ... Section 5.4:Integrity is an aspect of holistic character and is primarily a self concern of the individual nurse ... Threats to integrity may include a request to deceive the patient, to withhold information, or to falsify records* ... Threats to integrity also may include an expectation that a nurse will act in a way that is inconsistent with the values or ethics of the profession ...
* in my opinion, charting this behavior as if it were congruent with patient wishes is falsifying documentation
Thanks for posting this. Lying to the residents is the same as treating them as children IMO. If Mom doesn't want to take a shower that's her RIGHT. I think a lot of nurses and CNA's in their quest to control the residents forget they still have rights. It makes their lives and jobs easier if they have a bunch of residents who are under control and don't make waves with them. Like I said in my other post, this daughter never let anyone treat her mother that way. It's too bad that a lot of the residents at these places have no family to advocate for them because they can't be bothered. That is why a lot of nurses and CNAs get away with bullying the residents.
leslie :-D
11,191 Posts
no one has the right or authority to "shame you".
the elderly feeling anorexic, is a common phenomena and thankfully you recognize this and respect it.
it irritates me when i've heard a zillion tactic used in trying to get some of these folks to eat.
i knew of one aide who used to put sugar on green beans, potatoes, etc.
my logic is, you give them their dessert first and foremost.
for one, the pt most always enjoys and appreciates it;
and two, wouldn't it make more sense to give them the most fattening thing, first?
they also like it when you mix their ensure and ice cream together.
sweet, creamy, cool is usually a big hit.
besides- i'll be darned if i'm going to worry if a 95 yo gets their veggies.
bottom line: i am not their mother and can't imagine a bigger insult, than to treat these folks as if they're children.
thanks fuzzy.
you obviously see the big and real picture.
leslie