Weighted blanket "to prevent contractures"?!?!?

Sour Lemon · Jul 28, 2018

Ok, so... Apparently a hospice nurse who sees a resident at a nursing home I work at told the wife that a weighted blanket would help prevent the man from getting contractures. Mind you, he's had a CVA and is up in a wheelchair and can propel himself around, albeit he is limited with that.
At our facility, restraints are prohibited/against policy. We are a nursing home. So his wife called the state and they agreed... the blanket is a restraint. The state called and spoke with our administrator and they agreed that we needed a meeting with the family and our medical director and we were to discuss this.
The blanket, in the mean time, was removed from the room and kept at the nurse's station. Meanwhile, the wife ignored the state, and us... and had a random doctor call us to give us an order to use the blanket "prn." No can do. The hospice nurse who told the wife to get the blanket (on what basis?!?!? and show me the studies on this blanket miracle!!!!!) got an order to use the blanket. It's still against our policy! So then the wife threatened to call the police and the news station unless we gave the blanket to the resident.
People are so out out of hand these days, I swear. If they don't want to follow our regulations and policies, why don't they take them home? God love these residents... but sometimes the families make you wonder why in the heck you chose this profession. If you want to disregard our policies, leave. I'm sorry.
What say you?????

I don't see anything about what the patient wants, but maybe he's not able to communicate his wants? Does the wife actually believe the blanket is helping, or do you suspect some other motivation?

ShimmaShimma0304 · Jul 28, 2018

I don't think he is able to communicate his needs and wants, no. She believes it's going to help prevent contractures because that's what the hospice nurse told her. I'm concerned about the blanket causing pressure areas on his toes or heels. She said that she "checks him every day" so she's not worried about that. The point is that state agreed with us- it's a restraint. It's intention is for it to be so heavy that it limits his movement. That's a restraint.

ShimmaShimma0304 · Jul 28, 2018

Why not simple range of motion??? She's obsessed with the blanket now. It feels very "control issue" motivated now... I'm not sure what is driving her so hard about it.

elkpark · Jul 28, 2018

I agree that this needs to be dealt with at a higher level than individual staff nurses. The meeting between family and the facility administrator and medical director sounds like the best way to move forward to me.

ShimmaShimma0304 · Jul 28, 2018

I agree. When she threw a huge tantrum late last night and said she wanted the blanket or she was calling the police or the news, the administrator just said to go ahead and let her have the blanket. The nurse documented everything in detail. We checked on the resident this morning and he had the weighted blanket on and his leg was drawn up (how he wants it!) and the blanket is preventing absolutely nothing as we suspected it would NOT. It's the most ridiculous suggestion I've ever heard to prevent contractures. The man moves his legs fine. The wife even came up to the facility right before midnight to make sure the staff didn't take it off of him.

MunoRN, RN · Jul 28, 2018

I don't think he is able to communicate his needs and wants, no. She believes it's going to help prevent contractures because that's what the hospice nurse told her. I'm concerned about the blanket causing pressure areas on his toes or heels. She said that she "checks him every day" so she's not worried about that. The point is that state agreed with us- it's a restraint. It's intention is for it to be so heavy that it limits his movement. That's a restraint.

Weighted blankets are legitimately used for certain indications, soothing autistic children for instance, you're correct there is no reason to believe it will prevent contractures, but It's not a restraint because it doesn't prevent movement, as you pointed out:

I agree. When she threw a huge tantrum late last night and said she wanted the blanket or she was calling the police or the news, the administrator just said to go ahead and let her have the blanket. The nurse documented everything in detail. We checked on the resident this morning and he had the weighted blanket on and his leg was drawn up (how he wants it!) and the blanket is preventing absolutely nothing as we suspected it would NOT. It's the most ridiculous suggestion I've ever heard to prevent contractures. The man moves his legs fine. The wife even came up to the facility right before midnight to make sure the staff didn't take it off of him.

JKL33 · Jul 29, 2018

This whole deal with these people is because WE have again chosen to swing from one extreme to the other.

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The blanket may not be preventing any contractures, but we also know for a fact that it is not doing much at all to restrict the movement of (restrain) this patient. So then this issue has become one that is creating distrust and animosity for absolutely no reason whatsoever. I'm glad they were allowed to have the blanket; it would matter not one bit to me as a nurse whether it was preventing contractures or not at this point. It clearly represents another aspect of this couple's life right now...it's part of this woman's grieving process, quite frankly. It must be so sad to prepare for saying good-bye to your life partner...

ShimmaShimma0304 · Jul 29, 2018

I'll bring that point up to my supervisors. Thank you for that perspective. Maybe the main point of education could be to not have it over his feet and toes so as not to cause foot drop or pressure injuries on the tips of his toes.

Thanks again.

ShimmaShimma0304 · Jul 29, 2018

To be honest, long-term care facilities are SCRUTINIZED (thanks to poor history, funding, help/staff that are not paid much and therefore the pickings for who we can hire are slim) by the state and federal governments. We were 1) looking out for the resident who doesn't really pipe up and communicate too much and 2) worried about pressure injuries caused by a ridiculous suggestion by someone who isn't our staff and 3) I didn't add how demanding this woman already is ... Yes, it's super-difficult to be saying goodbye to a loved one (most of us have lost someone in our lives) and most of us went into nursing because we love and want to help others but this woman is rude to the staff and mean, frankly. She doesn't care about attempts made to educate her... and when she called the state to ask if they deemed it a restraint because the point she was trying to use it for was to RESTRICT his movement by weighing his legs and feet down by 16 additional pounds- she didn't CARE. She's not trying to prevent pain or choking in this man... she's trying to prevent contractures which he is- by NO means- at imminent risk for. Excuse me for being fired up but there's more to the situation than us "being mean" and taking a simple blanket away. We have not blown it out of proportion. We are scrutinized and we have policies and regulations for a reason and she has dismissed all of them. Tying a sheet around someone is considered an attempt to restraint them- not very effective but still viewed as a restraint. I know she's grieving but being outright mean to the staff, yelling at them and dismissing our policies isn't constructive either. If she doesn't want to adhere to our policies, they have home hospice and she can put 3 weighted blankets on him there. Range of motion exercises would have been a GREAT suggestion from the hospice nurse rather than this other "idea." We don't think it's right or necessary to have added literal pressure on his feet and heels when he can still freely move. She WANTS to restrict movement and RESTRAIN him which is why she doubled the blanket on that one leg. I wouldn't be surprised if she has another 1 or 2 on order.

ShimmaShimma0304 · Jul 29, 2018

This whole deal with these people is because WE have again chosen to swing from one extreme to the other.
Not sure what you meant by that comment. One extreme to the other... We attempted to educate about the risks and gave her the blanket when she became irate when no administrative staff were there to handle it. We are trying to care for him. HE is our primary concern as a resident in our facility. The hospice nurse needs to undo the damage she did by talking to his wife about this blanket. He's not an autistic child nor is he suffering from insomnia. Geez.

Wuzzie · Jul 29, 2018

Marie, JKL is not in the habit of chastising people. I think she was speaking more generally. Once the state got involved then it became a pissing match. The wife wanting what she wants and the facility trying to abide by the rules, arbitrary ones at that, are now at odds and emotions are running high. The hospice nurse never should have suggested the blanket without first verifying that it is allowable and appropriate (which I don't believe it is). Had the medical team been involved at the beginning then none of this would have happened. Also, correct me if I'm wrong but I believe there is a formula to determine the appropriate weight of the blanket relative to body weight so as not to impede movement or cause injury. This information would have been helpful in determining whether it is a restraint although any state is going to err on the conservative side in these kind of decisions. Now an enormous and likely irreparable mess has been made. A care conference is needed immediately if your facility is to continue to care for this man. Otherwise issues like these are going to continue to come up and ultimately his care will be compromised.