Monday, April 20, 2009

Saving them from themselves

The lines we walk in this industry are so fine as to be invisible.

If a resident wants to do something, but it's going to hurt them, how do we decide what's right? If it's not illegal or immoral, but it could result in injury, hospitalization, or death, do we have the right to stop them?

Smoking is a big one. If having a cigarette can result in respiratory arrest, can we forbid them from having one? Isn't it their right to smoke if they want to? Do we have the right to limit them or forbid them from smoking?

If the resident refuses a shower, but desperately needs one, do we have the right to force them in there and hose them off? If we don't, and they suffer from skin breakdown, is it then our fault because we respected their wishes?

How do we know whether what we're doing is abuse or just saving them from themselves?


Dr. Eleanor Barbera said...

K. Tree, another thought-provoking post.

I've spent a lot of time puzzling over this issue, especially since, as a nursing home psychologist, I'm sometimes asked to determine whether or not residents have the capacity to make decisions for themselves. The request for a capacity evaluation is often preceded by the resident wanting to engage in a behavior that could be deleterious to their health or well-being. I tend to come from the perspective that residents who understand what they're doing should be allowed to make bad decisions for themselves. Most of us in the community make bad decisions for ourselves at one time or another. But I understand the nursing home's perspective of wanting to avoid a potential lawsuit which could result from allowing residents to harm themselves, even if the residents did it knowingly against medical advice.

This is a very important issue which deserves further discussion. Thanks for bringing it up.

Eleanor Feldman Barbera, PhD

Patti said...

I say, if they want it, let them have it. For the most part.

It gets gray when the resident has some form of dementia. Or, has a family that likes to control their every movement in life.

Why do we force the 93yr old lady OOB because "she has to eat!"-- even though she never was an early riser or a breakfast eater all her life?

Why do we "bring" residents to activities they want nothing to do with-- is it to make ourselves feel better? Sometimes I think so.

Bathing? There are other options...bed baths, quick wash ups and the like that will keep skin clean enough to prevent breakdowns.

Respecting their wishes should be mean we're neglecting our duties. It's not about US. It is about THEM. We can pick and choose our battles, and keep the peace.