Where to cross the line with patient rights?

FolksBtrippin, BSN, RN · Nov 17, 2015

It is never okay to violate someone's rights. Sometimes a person's rights are in conflict with each other as in the case when a person has the right to receive care during dementia and also the right to refuse care.

You solve this dilemma by doing everything you can to elicit the resident's consent.

If you can't get consent as a CNA then get the nurse.

Never ever use force.

hookyarnandblanket · Nov 17, 2015

Sometimes, it's all about how you approach the resident. Often, asking isn't going to work but phrasing it in a friendly, direct statement works better.

For example: asking, "Mr. Smith, would you like to take a bath now?" isn't going to work if the resident has a history of refusing. Saying, "Mr. Smith, today is your bath day. You can take it now or you can take it at 10 a.m." may get you farther. It doesn't work on everyone, but it works for the majority.

And always, ALWAYS, document refusals. Paper trails are the only way to get things done.

elkpark · Nov 17, 2015

Document, document, document -- and make sure the entire treatment team is aware of the issue(s) and working toward a reasonable solution to the conflict (basic health needs vs. client rights)

Karou · Nov 17, 2015

If the patient is alert and able to make their own decisions and refuses care, then you need to make the nurse aware so that they can document it. It's something that needs to be addressed in the residents personalized care plan. Sometimes there may have to be a meeting about it with the patient, family members, social worker, staff and physician involved.

It's especially a problem if they are refusing basic hygiene care or safety interventions. It needs to be documented and addressed.

BBboy · Nov 20, 2015

If patient/resident refuses care always document no matter what. Try to let fellow coworkers or nurses know about the issue as they may be able to resolve it or work with that person slightly better.

Missingyou, CNA · Nov 20, 2015

You have to take in consideration the level of function and ability to make informed decisions. If a resident always refuses a bath/shower by saying no or by screaming in the shower, the nurse will often instruct me to give a bed bath.

If it's something like changing their brief....again the level of ability to make informed decisions. The result is usually to re approach later. If they still refuse and they are pretty much of sound mind, we let them be. We have never had anyone refuse during an entire shift.

If they had a bm then they must be changed. If they refuse by fighting and saying no, we wait a few minutes or try another CNA. If that doesn't work and the resident (who is generally late stage dementia) continues to fight etc, then we go in with the nurse and quickly do what needs to be done. We do it without restraining them in any way but have another CNA help by blocking and/or distracting. Again, we rarely have to go to this extreme and re-approaching later almost always works.

Most of our late stage dementia residents refuse and fight with us when we give showers or change briefs...we also know them well enough that we know what helps to distract them (holding a doll or singing etc). Bathing is done in their own beds with warm soaking blankets with no rinse soap. I have yet to have a resident fight me during a bed bath like this.

VicChic20 · Nov 23, 2015

A resident has the right to refuse care if they are alett, oriented and able to be with it. You should never use force on a resident. All you can do is tell the nurse and document that they refused. If they are demented , they can't really speak up for their needs,do usually have 2 aides in the room for incontinence care and showers. You can't really leave them soiled if they aren't with it.