What would you do???

That is tough. She doesn't have a nurse or aide who know her well enough to tell you what works with her? Some people who have dementia have a better time of day that they are cooperative. Maybe try talking in a softer voice. Flat out saying refused isn't going to cut it with some family members. Maybe they can come in and say what has worked for them. That is tough. ((Big Hugs)) I hope it gets figured out soon for the Resident and your sake.

What happens if you give the toothbrush to Mary?

I'd stop. I don't care about legal ramifications or POA outrage.

I don't care if the pt is confused or not. If an intervention requires me to restrain the pt/res It's going to have involve something life threatening.

Teeth brushing doesn't rise to my threshold of necessary treatments.

I'm a nurse. I know the importance of oral hygiene. I also know the psychological pain caused by being forcibly restrained and having unwanted whatever done to your body. Saying the person is confused just doesn't cut it. When shown the toothbrush she knew exactly what it was and that she didn't want it.

I'd chart refusal ad nauseam. Speak to the family, and make them watch.

If they continued to demand it be done, I'd very politely insist THEY try it.

I'd stop. I don't care about legal ramifications or POA outrage. I don't care if the pt is confused or not. If an intervention requires me to restrain the pt/res It's going to have involve something life threatening. Teeth brushing doesn't rise to my threshold of necessary treatments. I'm a nurse. I know the importance of oral hygiene. I also know the psychological pain caused by being forcibly restrained and having unwanted whatever done to your body. Saying the person is confused just doesn't cut it. When shown the toothbrush she knew exactly what it was and that she didn't want it. I'd chart refusal ad nauseam. Speak to the family and make them watch. If they continued to demand it be done, I'd very politely insist THEY try it.[/quote']

How do you know she knows what a toothbrush is??? She's confused, we can't read her mind.

And it may become life threatening if it ruins her teeth and she can't eat or she gets so germy that she gets pneumonia or she has infected sores in her mouth that we don't know about bc no one bothers to look in there anymore.

How do you know she knows what a toothbrush is??? She's confused, we can't read her mind.

And it may become life threatening if it ruins her teeth and she can't eat or she gets so germy that she gets pneumonia or she has infected sores in her mouth that we don't know about bc no one bothers to look in there anymore.

It doesn't matter if she remembers what a tbrush is. It doesn't matter if she doesn't know it's for her own good. According to the OP, the resistance to the activity began as soon as she saw the tbrush. She might not have remembered what the object was for, but she didn't want it in her mouth. Maybe she connected the restraint and the pain with having her teeth brushed. Who knows?

As far as I'm concerned, in this situation, with this resident, with the described activity, she has the right to refuse. Germy teeth and all:yes:

How do you know she knows what a toothbrush is??? She's confused, we can't read her mind.

And it may become life threatening if it ruins her teeth and she can't eat or she gets so germy that she gets pneumonia or she has infected sores in her mouth that we don't know about bc no one bothers to look in there anymore.

Wow I think you are taking this way out of the relm of what the OP was looking for when posting this. She is not asking if we think oral hygene is important or not. What she is asking is if you find yourself in this situation where you are seeing this aide pushing herself onto a dear old lady by force and asking YOU to help her are YOU going to participate in this, or are you going to be this ladies advicate and saying I will not be a part of this? As previous posters have stated there are other ways and options we can do to try to see that this important care is given. BUT there are also limits to what I am willing to do.

I would have the FAMILY come in and brush her teeth twice a day

Maybe poor Mary has an abscessed tooth that needs to be looked at, or caries that hurts when you brush her teeth. I'd smack you if you came at me with a toothbrush when my mouth already hurts too.

I would tell the aide that the resident has a right to refuse regardless of what her family wants. Wait until later, calm her down and sweet talk her a bit, THEN ask again to brush her teeth. Also tell the nurse what happened.

Does she talk? Does she answer questions? Ask her what's up.

You said she's not non-decisional. That means she has the right to refuse care, no matter what it is, unless there's a court order or establishment of her inability to make decisions for herself.

Restraining her is battery, as is forced tooth-brushing.

If I were you I would tell your hall partner Jessica to stop trying to brush Mary's teeth at the moment, because this is aggravating the resident, also for backup and for documenting purposes call the nurse or whoever is in charge for the shift in and let them see this and explain that Jessica was trying to do the task the family had requested. Let it be known that you did not lay hands on Mary either because if I would think that if you didn't mention that, it could come back later in a report against you, but I don't really know for sure. I personally have a lot of patients where I work that if they outright refuse the care I try to give them and its known on their chart they have dementia, then I go to my nurse and tell them they refused at this time, and I chart it, but also ask the nurse to see if she approach this patient and try to see if they will let me do their care. On the subject of the family request for this care to be done, how many times do they actually come in and see her? I am not trying to be nosy but where I work we get a lot of family requests and which most are followed through, but in some cases if they are never there and I know I have to try and do all the care needed on my patient and when they refuse it time and time after again, then I can't go against what my patient wants, my patient obviously still knows what is going on apparently, at least that is what I think in my head. So when family does come in and see the patient I do explain to them what has been going on and if the patient has refused what they have requested, and if they have an issue then they need to talk to the nurse or nurse manager, because I am doing what the patient wants. So my personal feeling on family requests is kinda mixed depending on the situation and the person. Hope that helps in any way!

Dementia patients take someone with a special touch. Redirect...re approach and then redirect some more is the key....always ask your charge nurse for help. She actually should come down and try to brush the patients teeth herself just so she can see the behavior and chart accordingly. Brushing her teeth against her will first is illegal but second if can cause her to become so angry that she falls or hurts herself....just not worth the risk. The nurse needs to speak with the family. Many families of dementia patients are just not educated on behaviors that a patient with dementia can exhibit. I cant tell you how many times Ive heard..."my mother would never behave that way".........sometimes they have to be shown......good luck to you