Wouldn't this be considered some kind of abuse?

Long Term Care Columnist / Guide · Jul 1, 2005

It's inappropriate, to say the least.

Surely there must be some way to distract this resident from wandering while you're on rounds. Part of the problem is that you're understaffed (which is unfortunately too often the case in LTC), and you should have a minimum of one nurse and two CNAs, or two nurses and one CNA. If you had a third staff member, that person could deal with the wanderer while the other two are on rounds.

But I'm going to assume that this is not an option, and I'd suggest that you find something for this resident to do while you're busy elsewhere in the building. Could she be stationed in some centrally located area and given some linens to fold, or some other simple project to do? Does she still have enough of her faculties to enable her to follow simple instructions and frequent reminders, so that could she go along with you but stay outside the room while you do your care?

I know how annoying it can be to chase a wanderer around all night while you're trying to get your work done, but you can't stop her, and she certainly doesn't need to be in other residents' rooms while you're doing personal care. Enlist the help of your DON and the resident care manager to get the help you need; perhaps they don't know how severe the wandering problem is, and they need to reassess her for change of condition. (It's possible, believe me.......I was an RCM for a couple of years, and if my night-shift staff didn't report such changes I might not have ever been aware of them.)

Good luck to you. This is a very common issue in LTC, and with a little patience and creativity it can be dealt with effectively.

pricklypear · Jul 1, 2005

I think for it to be "abuse" the exposure would have to be intentionally abusive. Like taking a resident into a room with the intention of exposing other patients in front of her. It's pretty obvious that the other nurse didn't mean any harm to anybody, and was only trying to keep an eye on a wanderer while ensuring that everybody else got taken care of. It would have been far more dangerous to allow her to roam the halls and potentially get out of the building. I think for now, the suggestion that one of you sit with her while the other makes rounds is the best option.

markjrn · Jul 1, 2005

I think for it to be "abuse" the exposure would have to be intentionally abusive. Like taking a resident into a room with the intention of exposing other patients in front of her. It's pretty obvious that the other nurse didn't mean any harm to anybody, and was only trying to keep an eye on a wanderer while ensuring that everybody else got taken care of. It would have been far more dangerous to allow her to roam the halls and potentially get out of the building. I think for now, the suggestion that one of you sit with her while the other makes rounds is the best option.

I agree. I definitely wouldn't call it "abuse", I would call it trying to make the best of a bad situation.

I wonder how the other resident felt about it?

carolinapooh, BSN, RN · Jul 1, 2005

Let me take a second to say "hats off" to all of you LTC folks. Horror stories aside (because they are everywhere), you all provide wonderful care.

I couldn't do it. And I admire you for being able to. :balloons:

Bird2 · Jul 1, 2005

I work in a small LTC facility with only about 45 residents. Every once in awhile I have to fill in on some night shifts, we have an Alzheimer's resident (no alzheimer's unit) who when awake is constantly going out every door in the building and setting off alarms even in the middle of the night wearing nothing but her nightgown. One night last week when I was working a night she started to do this while we were doing our bedchecks, there are only 2 of us on at night. The other nurse I was working with said I guess we'll just have to take her room to room! We went into a room with 2 residents that each were incont. and had to be changed, I pulled the curtain between them and the other nurse along with the confused res. were on the other side while the nurse changed a resident, I commeted to her that I didn't agree with taking the res. room to room. :angryfire she just said well it's either that or keep chasing after her. Wouldn't this be some kind of sexual abuse, because she was exposing one resident to another while changing her pad???? I spoke to my DON about it who said well state would really frown upon that (DUH!!) and suggested that one of us sit with her and take turns while doing bedcheck. But I don't believe she said anything about it to the other nurse.[/QUOT
If that resident gets out of the building it is reportable to the State. Can your facility really meet that residents needs? Maybe they should look for placement in a locked dementia unit.

DG5 · Jul 2, 2005

If that resident gets out of the building it is reportable to the State. Can your facility really meet that residents needs? Maybe they should look for placement in a locked dementia unit.

Exactly what I thought too. This is management's issue. They shouldn't be leaving it totally up to you to have to deal with. This is not a safe place for this resident. Can this also be addressed on the day shift? What happens to her during the day - is she asleep in the day and awake at night? What wakens her at night? Is she on a proper toiletting schedule, is she soaking through at night? Or is she so agitated that she may need a referral by a geriatric psychiatrist?

DG5 · Jul 2, 2005

Seems like this isn't the right place for her, unless she is a new admission and still trying to adjust to the facility, and you are still trying to assess all her needs. What's happening on dayshift? Do they have her on a regular toiletting schedule? What is waking her up? Does she need some sedation to help her sleep better at night? What about a snack before she goes to bed? If she is so agitated maybe she needs a referral to a geriatric psychiatrist? I would address the safety issue with management and suggest a move to a secure environment if this is an ongoing issue.

DG5 · Jul 2, 2005

Sorry for the repeat post! I didn't think the first one had been posted!

casi, ASN, RN · Jul 2, 2005

Is she easily distracted from her wandering? Would it work to put her in a spot that's visable and give her something to do while you do your checks?

Does she sleep at all during the night? Does she sleep in the day or evenings if she doesn't sleep at night? She may need something to help her sleep at night.

It does sound though like she would be a perfect canidate for a locked unit.

CoffeeRTC, BSN, RN · Jul 5, 2005

Sounds like my facility...size and staff wise. No you can't transfer the resident. Not being able to meet their needs is not an excuse (or so I'm told) We need to find a way to meet their needs. Okay....How??

Only suggestion..how about taking them with you, but leaving her outside of the room? Maybe in a chair with an actvity? Like....watch these towels for me...or could they fold them?

We only have one nurse, and 2 cnas on nights too, so I hear your pain. I know this is bad.....some nights we have more than one wonderere up then what :rolleyes: :crying2:

sgent · Jul 6, 2005

Hmm... inventive ways to work around this.

1) Get the patient transfered -- its the only way to take care of her, and your other patients. Its like puting an ICU patient in the Med and expecting them to do well...

To that end, I would talk to the admin, ephasizing the liability risk. If she won't budge, I would probably do the following in order of nefariousness.

Talk to physician, talk to family, talk to board of health (anonymously on this one).

I don't like any of the options, but when does it become ok to go with the status quo?