Was it verbal abuse? Y/N or maybe?

[RivkaLev]

Hello, first time poster here.

I've been at my current job for over a week now. I'm eve shift at an LTC. While administering HS insulin to a resident, she frowned and asked, "Why are you guys always poking me?" I explained that I'm giving a long acting insulin to keep her sugars down. She asked why it was so important as to keep poking her with needles. I told her that, if left untreated, it can lead to poor health and effect eyesight. She nodded her head - I bid her goodnight and left.

I'm wondering if this could be considered verbal abuse.

The next day, this resident approached me and said "I'm going to tell my son you said I'll lose my eyesight." I asked what she meant - she responded, "That's right, I'm gonna tell him," and walked away.

I told my DON what transpired - she asked me to write a statement of what happened - and I did. So far, I've heard nothing from her son - nor that she told anything to anyone but myself.

I've been an LPN for just over a year. Looking back, it was poor judgement to have shared possible disease process consequences to a resident with (supposedly) mild dementia. This resident is fairly independent, and has been described by the faculty as "cantankerous." I'm feeling horrid because I don't remember the exact verbiage I used describing retinopathy. All I know is that I meant to reassure her that she was getting treatment to keep her healthy. Not 'if you don't take insulin - you're going to be blind.' I also know that intent doesn't always matter as much as the effect of words. I'm feeling guilty, and I can't quite place why.

Can it be considered verbal abuse if you describe the consequences of an untreated disease process?

[idkmybffjill]

I actually saw a presentation on this subject today, coincidentally. In the presentation, there was a scenario where one of the elderly dementia patients kept trying to escape and wander the streets. Out of frustration, the CNA shouted, "If you wander the streets, you'll get hit by a car!" Somehow, this still counted as verbal/mental abuse, even though it was a possibility and was said in an attempt to get the resident to understand the seriousness of the situation because her safety was at a great risk.

The resident in OP's situation *could* have been implying some type of abuse. OP's situation is similar to the one above in the sense that the caretaker noted the negative consequences that would result from partaking in or denying an action. I think, however, you could say that it was taken out of context because part of your job is to inform the resident of the consequences that would result from refusing a prescribed treatment, and the resident also has the right to know why he or she is receiving a particular treatment. You literally answered her question that asked that, in a (presumably) professional and non-offensive manner.

I see that as a different scenario, honestly. In that situation, the CNA is yelling at a patient in frustration over their displaying a symptom of their disease. Dementia patients aren't wandering as a conscious choice, understanding exactly what they are doing. So telling them they're going to get run over or yelling at them isn't going to change their behavior because their behavior is born out of confusion and disorientation, not some sort of ignorance of the danger. Yelling is only going to agitate and upset them more.

That's different than telling someone who is cognitively aware the common consequences of not taking a certain medication as the doctor has prescribed.

[opalbee]

I see that as a different scenario, honestly. In that situation, the CNA is yelling at a patient in frustration over their displaying a symptom of their disease. Dementia patients aren't wandering as a conscious choice, understanding exactly what they are doing. So telling them they're going to get run over or yelling at them isn't going to change their behavior because their behavior is born out of confusion and disorientation, not some sort of ignorance of the danger. Yelling is only going to agitate and upset them more.

That's different than telling someone who is cognitively aware the common consequences of not taking a certain medication as the doctor has prescribed.

I believe you're right, I suppose I just found it odd that it should count as "abuse" when the action wasn't done out of ill-intent. Every other example I was given for "verbal abuse" were things like "If you don't eat your food now, I won't give it to you at all" and "If you keep being mean, your family will never come and see you". The difference between these and the scenario I learned about today is that the nursing assistant in that scenario wasn't threatening the patient with punishment; she was exasperated at the fact that the resident could very well be injured while wandering the streets. Residents who suffer from dementia can be agitated by things that aren't abuse, either. They can be agitated from people who are trying to help them calmly, as well, even if the caretakers are trying to approach the situation "by the book". I don't think yelling "you'll get hit by a car" is necessarily effective, but I still find it odd that it would be considered something as serious as "verbal abuse."

And the OP's resident does seem to have some type of mild cognitive problems:

Looking back, it was poor judgement to have shared possible disease process consequences to a resident with (supposedly) mild dementia.

[wondern, ASN]

It was actually teaching ...Cheers!

[OpinionatedCNA, CNA]

Good lord No! You just have to watch what you say around those types of residents. It is unlikely that anything will ever come of this silly type of stuff although it will give you a headache.

I was working with a (lpn) nurse taking care of a resident who was somewhat confused like this and is known for being very short tempered. For some reason he was trying to explain to her that he was an lpn not an rn, and she started screaming "Why is he giving me medication if he's not a REAL nurse!" And then every time he had to give her medicine the rest of the shift she would just antagonize him "You said you're not a real nurse!"

Don't let these residents drive you crazy. When you're giving them care just keep it simple stupid and leave.

[NurseSpeedy, ADN, LPN, RN]

I only worked LTC for a short while. I learned the least amount of information with those that are confused is the best, otherwise, good luck getting them to take their meds and you are the demon that told them they have a,b,c and d and now they need these 20 pills to keep them alive. I had family members that wanted me to tell them they were vitamins. One lady would refuse unless that's what they were called. She needed her afib/BP meds. She had a B12 pill. I guess it wasn't a total lie. For those without the vitamin included I would try, "these are what's going to keep you healthy and happy" with a smile and pleading look. They would usually take it after they got used to seeing me around.

I don't think you did anything wrong. It's just with dementia, sometimes less info gets us more compliance. Pharmacy told the regional director that we were to tell each patient in memory care what the med was, what it did, and what it was for. The director was training me so she tried to do it by the book. The first five patients took one hour. Complete meltdown disaster. She finally shook her head, sighed, threw her hands in the air and said, "pharmacy is nuts. These people haven't understood their meds for years. Just pass meds". It was a lot more traumatizing for the resident to relearn they had afib, high BP, cancer, and a slew of other problems each time they got their meds like it was a new diagnosis. That I felt would be cruel.

[Been there,done that, ASN, RN]

That was medication teaching.. to a cantankerous old fart. You did fine.

[TriciaJ, RN]

I once took care of a sweet little lady on a surgical floor who told me her family was trying to sell her into prostitution. Then she told her family the same thing about us. This is the kind of stuff people with dementia come up with.

Untreated diabetes leading to blindness? It's called health teaching. Although I suppose the technique might have to be tweaked a bit for that population. I loved NurseSpeedy's anecdote about trying to provide information to everyone about each med. I laughed out loud and think that job should have been dropped into Pharmacy's lap if they're so concerned about it.

Please pour another glass of wine and quit sweating this.

[rnleee]

No, it's not. But you're right as well, it would have been better if you just kept things simple and not dwell much on the "scientific" disease process.

[NurseSpeedy, ADN, LPN, RN]

I once took care of a sweet little lady on a surgical floor who told me her family was trying to sell her into prostitution. Then she told her family the same thing about us. This is the kind of stuff people with dementia come up with.

Untreated diabetes leading to blindness? It's called health teaching. Although I suppose the technique might have to be tweaked a bit for that population. I loved NurseSpeedy's anecdote about trying to provide information to everyone about each med. I laughed out loud and think that job should have been dropped into Pharmacy's lap if they're so concerned about it.

Please pour another glass of wine and quit sweating this.

A resident accused me of trying to sell her roomate into prostitution. She actually accused me of being the pimp. This was the same facility that pharmacy was insisting on medication teaching. I was caught completely off guard. I was handing the roomate her "supplements" and I got whacked in the backside with a cane! It was then I learned to always have a clear pathway to the door in sight, regardless of how harmless the situation may initially seem. I was cornered between the roomates bed, nightstand, and the cane packing little old lady. There was no talking about the situation down. I eventually found a way around her (on crutches to top it off!). She followed me out to the main room, saw a male resident who was about 6'5" but rail thin screamed "there he is!" And charged him, knocking him on the floor. It took three of us to pry her off of him. Thankfully he seemed more stunned than anything and no noticeable injuries. That was an interesting incident report and follow up phone calls.

But yeah, these were the people that pharmacy was insisting on med teaching. The ironic part was, they were there, for about two hours, observing a typical med pass before the counseling session. This is one of those situations where you want to take "the book" that pharmacy wanted us to follow line by line and beat them over the head with it. It's kind of like ‘reality re-orientation' for this population. You only go so far with it. We would never try to tell them their mom isn't coming to visit because, well, the resident is 102...the math just doesn't work out....no. I'm not doing that one. Just like I'm not going to say anything about the ‘baby' she wants me watch while she goes to the bathroom just being a doll. Reality re-orientation would devastate this poor lady. I'm certainly not going to re-educate her about the long list of meds she's taking for 10 plus chronic conditions she wasn't still aware she had. That's just wrong. There should be a separate course on handling this as ‘by the book' just shouldn't apply in some situations.

I think the OP did just fine. The patient had only mild dementia, if I remember correctly. She also had the where with all to threaten to tell her son the next day. Honestly, she sounds more like a slightly confused possibly chronically noncompliant diabetic who didn't like getting shots, especially when tired.

[MinneNurse, BSN, RN]

I agree with the others, I think you are being wayyyyy too hard on yourself. The patient asked why you were administering the medication/"poking" her with needles and you responded appropriately as to why the medication is being administered and potential side effects of not receiving the medication.

Sounds like you are new at your job so you are probably still getting comfortable but yourself some slack. This won't be the last time a patient gets upset and misunderstands/twists your words. You handled this situation appropriately, have faith and confidence in yourself.

[nursej22, MSN, RN]

Im my experience the demented and kiddos hear the last thing you say.

So I try to say this is to keep you healthy, or in your case, your eyes and kidneys healthy, or protect your eyes.

[psu_213, BSN, RN]

it was poor judgement to have shared possible disease process consequences

Only the the folks that count Press Ganey replies think that's true. This is part of med teaching, and it should be a part of any good nurse's med pass.