The right to refuse has so many interpretations

[Alnitak7]

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.

[SleeepyRN]

Do it's better to lie and bully a patient into complying with your wishes? I hope no one catches on to what you are doing because you'll be out of a job if they do. Residents have rights-who cares how you feel about their behavior.

My Mom had one nurse that was bossy like this and she was yanked from the unit the minute I complained. No long after she was gone from the NH altogether.

You sound proud of the fact that you played a big part in some nurses getting fired. They have their own families, many with children to take care of. You kind of sound like the nightmare family member many of us nurses dread having to deal with. If you are familiar with any of Brandon's posts, you would know that he's compassionate towards his residents and is only trying to do what is best for his resident's health. I in no way believe it has to do with the nurse wanting power over someone. I don't want control. I care about my resident's health and do what I can to care for them. I think you should first have spoken with the nurse and told her that you did not want her to be treated that way. Many family members/POAs DO want us to do whatever it takes to get their loved ones to eat or take their medication if they are too confused. So to go straight to the DON is overreacting IMO. You mentioned places being understaffed. So your solution is to fire experienced nurses and hire new ones who will take a long time to train? I'm not just talking about hiring a new grad. Even if you were to hire an experienced nurse to replace a perfectly good nurse a family member complained about, it takes time for that nurse to learn all the policies and procedures of that facility. So in the meantime, the residents aren't getting the best care. That makes zero sense.

[SleeepyRN]

I had a hospice patient living in an ALF. Pt was bedbound on scheduled morphine. Facility policy was repostion Q2 hr, Pt consistently refused in spite of education. I directed LNAs to stop repositioning attempts (some had been repositioning against Pt's wishes). Administrative Director insisted nursing MUST reposition because it is policy. I had quite the discussion with her. She just wouldn't budge. I refused to assault the Pt.[/quote']

I had 2 residents in a SNF who were hospice. Both were in pain, even with round the clock pain meds. They were to be turned q 2 hours. I felt so bad for them. These poor people were woken up every 2 hours for the rest of their lives. One, it obviously disrupted their sleep a great deal, and 2, it was PAINFUL each time they had to be turned. I cried one time turning one of the residents because she had tears of pain in her eyes as the CNA and I turned her. But we were forced to do it by the administrators.

[SleeepyRN]

"If the resident is a&o x 3, I would briefly and respectfully educate them on the importance of their nutrition and then leave them alone and document."

I sometime feel uncomfortable telling a 98 year old that something is good for them...

Im thinking more along the lines of someone who is in for therapy, and educating them on how important nutrition is on wound healing. Mid 70's and beyond, I'm happy if they drink their ensure.

[SleeepyRN]

I know and it makes me angry. Angry because they use lies and deception to get a resident to do what they want them to do so it makes their job easier. Or trying to dictate that one shouldn't smoke or that they shouldn't eat sweets because they feel the residents are making horrible choices. You're a nurse and these are not your underage children who you CAN dictate to, lie and deceive.

I also want to mention the shower thing. Alzheimers or other dementia residents don't take showers because they are afraid of the water. When I asked my Mom she told me she was afraid of drowning. So to bully one into taking a shower is abuse IMO.

What makes it even worse is they get away with it because the facility is understaffed and there is no family member to advocate for them because they don't give a damn about Mom or Dad.

ETA:My Mom isn't dead because she ate the boxes of candy that we gave her, because she smoked for most of her life, because she refused to take a shower or didn't have a bowel movement. She died because of negligence because fall precautions were not put into place for an at high risk resident. Maybe if people had stopped spending so much time worrying about her showering or eating the candy she loved so much and more time making sure she didn't fall she'd still be here.

Why do you keep saying that it is to make our jobs easier? It would be easier to accept no the first time around and document pt. refused. Doing what we can to get a person to take their meds and eat comes from a place of compassion in my heart, not control, power, or to make anything easier. When I have a resident who is refusing care, I collaborate with family and my fellow nurses and CNAs. I just finished orientation at my newest job, and there is a resident who will not take any meds unless you tell him "this is your MS medication." So everyone training me told me to just say that to him even though his other meds besides his "MS meds" are in the cup. The last time I gave him his meds, before I could even say it, his daughter (his POA) said it to him first. I can't stand it when another resident or family member sees how I care for a resident and judges, because they don't know the story. It is not their right to know.

[SleeepyRN]

You still don't get it and I guess you never will. It's not about the "caring" nurse, it's about the resident who has rights.

I'm getting a little sick of the "caring" nurse routine. If my Mother had more "caring" nurses she's still be here. But they were too busy harping on the boxes of candies that she loved and not taking a shower. Instead she fell through the cracks. Preventing injuries to residents is a lot more important to me that whether Mom or Dad spends her days eating candy or not taking a bath. Those things are not going to kill her. Preventable falls, on the other hand will.

Poor hygiene causes skin breakdown which then yields even more problems. You don't think skin breakdown can kill? Wow. Please educate yourself more on the matter. And to say that your mom died because of a candy issue with nurses is just incredulous. There are sooo many factors that go into why a person in a SNF or LTC falls. And more often than not, I'm sure it's due to unsafe nurse and CNA ratios. We cannot be with every resident at once. Even residents with the best fall precautions can and do fall. But of course its the nurses fault and we don't care. Yep, I went into nursing because I just LOVE the abuse I get from patients, families and administrators. I went into nursing so I could work holidays and not get to spend time with my family. I went into nursing so I could abuse my body and go home every night in pain. Exhausted so that even on my days off, I'm just laying in bed trying to recuperate. It couldn't possibly be because I genuinely love to help people. People act like nurses and doctors are immune to health problems. We are people too. We have health issues, have been hospitalized. We have also been the family member to a patient or resident.

If I don't do what I can to get my residents to take their meds or to eat, the DON, the doctors, the administrators.... will blame ME. Damned if you do, damned if you don't.

[CrunchRN, ADN, RN]

Brandon and Sleepyrn are so right. It is a delicate balance. Especially with confused elderly.

Sometimes the actions they take are the kindest and least upsetting to the resident while ensuring they accept adequate care instead of just being allowed to be neglected with easy acceptance of refusal.

I am a HUGE advocate for telling it like it is and allowing the person to make their own decision. However, that requires a little tweaking in the not totally quite with it elderly.

[RNperdiem, RN]

Sometimes a nurse can't win. If you respect a residents wishes to go unwashed and underfed, the resident's children will not thank you for respecting Mama's rights when they see her sorry condition.

If you try to coax Mama to eat or get washed, you will be accused of being bossy and treating Mama like a child.

Not all families are like this; some of them understand dementia better than others.

[XYZ***123]

Anyone has the right to refuse any form of treatment. when we force someone to do something they do not want and we put our hands on them we run the risk of being charged with assault and or battery. The only time we as medical professionals have the right to force someone to do something is when their behavior puts themselves or others or property at risk for injury or damage. Pertaining to psych pts as well. We cannot make them take their meds. if they get out of hand then we have the right.

Jamie

[Poochiewoochie]

Not all families are like this; some of them understand dementia better than others.

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.

[chrisrn24]

Poochiewoochie, not all dementia patients are afraid of water. Maybe some are but certainly not all. Because each person is an individual we have to tailor care plans for that person.

Also, despite every good intention many high risk fallers do continue to fall. Short of tying them to the bed (which most LTC facilities to my understanding do not use restraints) there may not be much we can do, other than make their environment safe so when they do fall, they're not so critically injured.

The right to refuse in LTC is a toughie. I do everything I can think of. Leave the room and come back a minute later, have other staff try to help, etc. especially with dementia patients. Therapeutic lying is also a good technique. If they're yelling and fighting I usually will give up then. Some things can wait a while or aren't a huge deal to refuse.

[leslie :-D]

Not all falls are preventable. Even with fall precautions.

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, then all is right in the world.

i wish healing and peace for all who are grieving a loss of a loved one.

leslie

[Poochiewoochie]

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.