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.
Poochie, I think we're talking about two different things.
I still say the worst thing a nurse could do would be to just say "ok" and walk away when a confused, elderly pt refuses meds or a shower.
And where are you seeing lies??
Is it a lie that their daughters said they want them to have a shower?
Is it a lie that the cup of pills I'm handing them are medications the doctor said they need to take?
For better or worse, most of my old residents still have an amount of blind reverence for doctors. Of course I invoke the name of the doctor to get them to take their meds. Again, where's the lie?
Most of us (caregivers) do not go into this field for the paycheck.
I feel like its hard to understand when you aren't a caregiver, so I thought this explanation may help you understand why we would fib to a patient to do for them that which is only going to help them.
I took care of my Mom for 8 years so don't patronize me.
Here is the Nursing Home Resident's Bill of Rights. Some of you who work on the industry need to brush up on it.
The right to freedom from abuse, mistreatment, and neglect;
The right to freedom from physical restraints;
The right to privacy;
The right to accommodation of medical, physical, psychological, and social needs;
The right to participate in resident and family groups;
The right to be treated with dignity;
The right to exercise self-determination;
The right to communicate freely;
The right to participate in the review of one's care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility; and
The right to voice grievances without discrimination or reprisal.
I took care of my Mom for 8 years so don't patronize me.
Here is the Nursing Home Resident's Bill of Rights. Some of you who work on the industry need to brush up on it.
The right to freedom from abuse, mistreatment, and neglect;
The right to freedom from physical restraints;
The right to privacy;
The right to accommodation of medical, physical, psychological, and social needs;
The right to participate in resident and family groups;
The right to be treated with dignity;
The right to exercise self-determination;
The right to communicate freely;
The right to participate in the review of one's care plan, and to be fully informed in advance about any changes in care, treatment, or change of status in the facility; and
The right to voice grievances without discrimination or reprisal.
Woah. I know the rights by heart, first of all. I don't violate any of those rights. I guess I should have said Professional caregiver. Up to 13 patients at one time, and sometimes you have to gently coerce 11 of those 13. I was not trying to patronize anyone, but you seem to want to attack those of us who give our lives to caring for others because you don't agree with the way we get it done.
I just had surgery because of what I do for a living and how hard it is on my body. I wouldn't continue to do it if I didn't love it and if I didn't love the people I care for.
Where I work, we call the residents "members". They are a member of the facility and indeed participate in the planning of their care.
Our alert and oriented members sign a contract upon admission. This contract sites all the rights you mentioned, but it also lists expectations that the facilty has for its members. There are mutual expectations between members and staff. Their contract states that a level of personal hygiene WILL be maintained. It states that the members WILL follow a basic medical care of plan laid out by the physician and they WILL follow a basic nursing plan of care laid out by a registered nurse. Can they refuse to follow this care plan? of course. But, IF they choose to violate this contract by not bathing or refusing ordered medications they stand to lose privileges, such as smoking privileges, activities and trips.
This is the very definition of treating our members like adults. Adults are expected to follow the rules or face the consequences, no?
Now, our confused/demented residents are another story. We work hard to ensure their hygiene and medical needs are met. Sometimes this requires gentle coercion. Telling them their children said to take their meds. Telling them they need to shower because they're going to the garden club tomorrow. Telling them these are the medications the doctor said they need to take. Gently persuading confused Alzheimer's residents to accept care is a kindness.
I doubt very much anyone would want their confused, elderly mother to stink to high heaven with a huge bowel obstruction building inside her just because she always refuses showers and laxatives.
92 year old Mary-Sue refuses bowel care when asked because she thinks she had a BM this afternoon. She also thinks its 1979 and I'm her nephew...... so if I hand her some colace and tell her it's just her "supper pills" it's not the crime of the century. It is supper time and they are her ordered pills......
I STILL don't want to be lied to or have someone misrepresent! Oh and showers aren't a recent invention. Our house is over 150 years old and one bathroom still has the original fixtures. The tub is what was called boat-style which is legless and the glass and steel shower is a phone booth-sized compartment attached to the front of the tub. To take a bath, you can collapse and fold back the shower against the wall. I suspect it was designed by Rube Goldberg!
I just tried to take a picture of the tub and shower, but that bathroom faces north and since it's pouring out, it didn't show up well. We have a commercial-sized hot water tank and it drains it to fill the tub slightly more than halfway.
No, I've never worked in a nursing home. I did work in our state mental hospital for two decades. Some assignments included forensics, addictions of varying types, etc. In a couple of the buildings, based on age and diagnosis, I might as well have been in a nursing home!!
Ok, Well many didn't have showers because they couldn't afford them then. (Shower was officially invented in 1810 I stand corrected :-p)
My grandparents had a metal bath tub they filled up with water from the stove..... :-).... I don't think its a bad thing to coorifice someone into something that isn't going to harm them if and only if they are not capable of making the decision themselves. Im talking about changing their mind about it, not making them do it despite saying no.
I understand what you are saying, that patients should have a choice, and I agree, but if they don't know why they are refusing something and they don't comprehend the benefits to them I see no problem with talking them into it.
P,S. Your house sound super cool!! I wish I could see it!
Many of the transfers we see into our ER from nursing homes are atrocious. Pts with old soiled briefs, teeth with green slime, skin breakdown, deconditioning etc. The excuse for these elders living in this condition "she refused."
The work load in nursing homes is huge, and I'm sure it makes a day just a little easier to leave Milly lying in bed unwashed and unchanged without mouthcare, and the fact she told you to get the heck out is something you can chart as a reason, but who benefits?
I do not condone lying to patients, and in most cases I agree the patient's right to refuse needs to be honoured, but from his post I'm pretty sure Brandon isn't among the nurses sending in deconditioned, filthy, neglected patients and for that I thank him and the others who care enough to try a little harder.
Many of the transfers we see into our ER from nursing homes are atrocious. Pts with old soiled briefs, teeth with green slime, skin breakdown, deconditioning etc. The excuse for these elders living in this condition "she refused."
The work load in nursing homes is huge, and I'm sure it makes a day just a little easier to leave Milly lying in bed unwashed and unchanged without mouthcare, and the fact she told you to get the heck out is something you can chart as a reason, but who benefits?
I do not condone lying to patients, and in most cases I agree the patient's right to refuse needs to be honoured, but from his post I'm pretty sure Brandon isn't among the nurses sending in deconditioned, filthy, neglected patients and for that I thank him and the others who care enough to try a little harder.
I seriously hate when I hear stuff like this. There has to be a line. In my LTC facility the patients are not able to refuse things like brief changes unless they are A&O in which case they get a psych consult. Rarely do we have to actually force someone into letting us change their brief, but it does happen. Makes me feel so horrible but what can you do? They can't very well lie in BM all afternoon, that in and of itself is abuse. So sad. I just went back PRN I also work in a hospital and they are two completely different worlds for sure.
Your ignorance about LTC combined with your extreme personal bias makes it difficult to take any of your hyperbolic comments seriously.
The bottom line is this: if you are violating the residents right by lying and deceiving to deliver care you'd better hope that you don't get caught. And just because your demented residents act like children because of their disease doesn't mean you have the right to treat them as such.
And yes, falls are not 100% preventable but maybe if my Mom's nurses and aides had spent more time trying to prevent them instead of worrying about her not taking a bath and eating chocolates things might have turned out differently. She also had untreated cellulitus-the doctors and nurses at the facility had her wearing compression stockings because she had swollen legs. No one could understand why her legs were swollen. They also caused her problems with walking and the nurses knew this but did nothing to help her even though they admitted to CMS that she needed someone to help her walk. When she broke her hip the ER doc took one look at her leg and said she had cellulitis and gave her an antibiotic-it was cleared up before she left. She also had a raging UTI that the nursing home failed to diagnose.
So go on about bowel movements, failing to take showers and the other petty things you all are complaining about that your residents don't do. None of them is going to kill them.
And to Brandon-there is a difference between telling a lie to get someone to take medicine and not telling someone their husband died 10 years ago. You've seemed to have forgotten that your residents have RIGHTS which means the right to refuse medication and showers. That applies to the demented that you, by your own words, seem to use a lot of lies to make your job easier.
It's scary to thing that LTC and SNF hire people who coerce and bully residents into doing what they want them to. It's even scarier that people actually condone this behavior.
If I'm honest, I guess many of my strong feelings come from the stroke I had almost a decade ago as the result of a congenital anurysm that ruptured when I was home alone.
I do indeed realize that patients suffering from dementia must be treated using a different set of rules. I know that from my nursing at the state hospital, that different rules apply. Sometimesm the psych patients had to be gently persuaded too. I discovered that rewards worked sometimes.
I remember when my Grandmother was living with us when I was in high school. She had fairly advanced Parkinson's and it definitely affected her cognition. I had much better luck sometimes than my mom did and I'm not totally sure why. Grandma tended to treat my mom as though she were about six and just generally knew how to push all of her buttons, as any mother can.
I think, unfortunately, that sometimes when a caretaker reminds a patient of a child or other close relative, they tend to dig in their heels and just say "NO!" as though they were toddlers.
I had to deal with another type of dementia when my mom died of breast ca that eventually migrated to her brain, liver, and bones.
We moved from several states away so I could take care of her. She went downhill very fast and it was a shock even though I thought
I was prepared. I wasn't! She swung back and forth emotionally and I'd never know whether when I walked through the door, she'd
look up, grin at me, and say, "Hiya, Babe!" as she always had or look at me coldly and ask something like, "What are you doing here?"
or "What have you come to steal this time?" All this change when just mere weeks before, she had been practicing law fulltime. She did NOT relinquish her dignity, her personhood, or her power easily.Nor should she have. Thank *** she had all necessary paperwork already done. I had POA and medical POA.
I tried very hard to make decisions that I thought she (and my dad) would have approved of. Many days, she fought every single thing I tried to accomplish. I think there is good bit if carryover in facilities. What to do remains the eternal problem.
Ohhhh Sharpei how devastating!! My Nana died the same way as your mom except for her it started in her brain. Thats' how I got into this field.....and thats where I learned the powers of persuasion to start with. I would offer her cookies if we could stop trying to stick the knife in the toaster while it was on. So sad. Eventually I just unplugged it and let her wait and wait for the toast to come up.
I think its perfectly normal to feel the way you do. I would never want to take someones choice away if there were any way to avoid it, and I imagine that I will someday fear that my choices will be taken away from me.
I work with stroke survivors every day and I am so sorry that you get treated like you aren't still you. I wish that people understood that stroke survivors are, many times, just as much the people they were the day they had the stroke. I can't even imagine how frustrating it must be to deal with that.
So sad. I just went back PRN I also work in a hospital and they are two completely different worlds for sure.
BrandonLPN, LPN
3,358 Posts
Poochie, I think we're talking about two different things.
I still say the worst thing a nurse could do would be to just say "ok" and walk away when a confused, elderly pt refuses meds or a shower.
And where are you seeing lies??
Is it a lie that their daughters said they want them to have a shower?
Is it a lie that the cup of pills I'm handing them are medications the doctor said they need to take?
For better or worse, most of my old residents still have an amount of blind reverence for doctors. Of course I invoke the name of the doctor to get them to take their meds. Again, where's the lie?