Sunday, March 20, 2011

How pushy is too pushy?

One of the really fun things we get to do is convince people to do things they don't want to do. Sometimes this is just a matter of re-approaching them. Sometimes it involves a bribe. Sometimes you just have to do it and apologize later.

But at what point does "No" mean "Go away and don't bother coming back today"? I had to pass meds yesterday to a new resident. 40 minutes (and no, I am not exaggerating: 1800-1840) I got about 2/3 of it out of the cup but I'll bet she spit out more than half. At one point, she started coughing, meaning she could have aspirated if I had continued.

I told the charge nurse we need to do something because A.) I cannot spend 40 minutes with one resident and B.) She has the right to refuse, even though she's not completely in her right mind and C.) If she does aspirate, then I'm to blame, even though the family really wants her to take her meds.

We're constantly walking a fine line between abuse and neglect. I don't care what you say, it's true. 40 minutes cajoling and slipping little bites of medicine in a resident's mouth could be construed as abuse. Not giving her the medication could be construed as neglect. Same thing with a resident who doesn't want to be bathed even though she clearly needs it. If you force her to be bathed, even with a bed bath, it could be abuse. If you let her lay in her own filth, you are guilty of neglect.

My solution is to get the charge nurse involved. Not just tell her about it; make her come with you and see what is going on with her own eyes. Ultimately, she's your shield and if she sees what's going on, she should either offer suggestions or back you up when you just can't get the task accomplished.

(Yes, sometimes I use this blog to think things through and figure out the best course of action.)


Hold my hand: a social worker's blog said...

I think you did the right thing by getting the charge nurse involved. This type of issues may be discussed during the facility "behavior management" meetings. That way, everyone is aware of the situation, and it won't look like it's solely the CNA or CMT or Nurse's problem.

You made a good reference about the "fine line" between abuse and neglect. I know, it's a tricky one. However, when the resident is cognitively impaired, we are obligated to provide the care he/she needs.


K. Tree said...


Dr. El said...

K. Tree, you raise a very important issue that I see every day. Is it the right of the resident to refuse various aspects of care? Certainly. But the issue gets murkier if the resident is confused, or if the family wants the staff to provide something the resident doesn't want but they feel is in the resident's best interest. As you did, bringing up the issue with the team is essential, and document, document, document.

Eleanor Feldman Barbera, PhD