CT hospital workers on strike, doing what is so typical of people who don’t know any better.

STAMFORD — After three days on the picket line, Gloria Miller said she is returning to her cashier job at Stamford Hospital’s cafeteria disappointed.

“I’m happy to go back to work, but I’m not happy we didn’t get a contract,” Miller said yesterday as she took a break from picketing and waving her yellow flag.

After 26 years at the hospital and an hourly wage of $14, Miller said she doesn’t earn enough to cover the proposed health insurance costs for her four children under the hospital’s plan.

I worked in a hospital dietary dept. for a while and if I made $14.00 sitting around on a cash register I’de be quite happy. There is NO skill to this job. AT ALL. Who pays this? Patients. You. Me. Our government. We all subsidize these pay rates, and it’s not right. It would be one thing if this were a nursing position, but COME ON…cash register?
Give me a break!

Miller said she would have to shell out $100 a week to cover her family. She doesn’t pay any health insurance premiums.

“I wouldn’t be able to make it living in Stamford,” she said.

Join the rest of the working people of America. Healthcare costs are going UP, UP and UP. And the unions that represent healthcare workers add to this increase.

The three-day strike at Stamford Hospital over job retention and health-care coverage — which began Wednesday — ended without incident or a settlement yesterday.

Workers garnered support from Mayor Dannel Malloy and clergy members, who rallied with the workers and drew complaints from patients and residents about the noisy strikers.

Oh now this is sweet. Just what patients want. To see those who claim to care for them, outside making a ruckus and noise and being generally, immature.

Not all of the striking workers will be welcomed back today.

Of the 171 dietary workers and nursing service employees who were striking, all but 76 certified nursing assistants were able to return to work today because of a five-day temporary staffing contract commitment, hospital officials said.

Dietary workers have little in common with nursing. While the central purpose of everyone’s job is to take care of patients, each department has separate and very different workloads. I would HATE to think of going on a strike because a kitchen workers wasn’t happy with their wage. I would walk across the picket line in a heartbeat.

Read the rest of this bulloney of an article. I get too ticked off when I read this stuff and think, THESE people represent ALL OF US. Not me.

This is BAD. Really BAD.

An Escondido nursing home yesterday received the state’s most serious citation and a $100,000 fine after a resident receiving oxygen was left alone while smoking a cigarette. He caught fire and burned to death.

It is the fourth state accusation in three years against the 98-bed facility, now named Palomar Heights Care Center.

A state health official said the man’s death Jan. 11 is the second attributed to mismanagement by a California nursing home in at least a year.

“Even though the resident was advised he shouldn’t be smoking while his oxygen was turned on, he wasn’t wearing a flame-retardant apron as required and the attendant left him alone,” said Anna Ramirez of the state Division of Licensing and Certification’s coastal region, which includes San Diego County.

Palomar Heights administrator Sharon Constable said the 66-year-old man’s death “was deemed accidental,” but declined further comment.

In state documents, the nursing home promised to reassess any resident at risk for injury while smoking and to prohibit people from smoking while receiving oxygen.

Ramirez called the incident “significant and critical.” The resident was visible through a surveillance camera, Ramirez and state documents said, but the nurse who was supposed to be watching him was instead filling out charts.

“She wasn’t aware that the resident had caught on fire until she heard someone call a code red,” Ramirez said.

The man burned for six minutes just before 10 p.m., with injuries to his face, torso, arms and legs. He was spotted by a laundry worker, who said she “saw flames coming from outside the main door … and saw (the resident) seated in his wheelchair burning from the neck down,” according to the state documents.

The resident was pronounced dead at Palomar Medical Center, which has no relationship to Palomar Heights.

The patient had been diagnosed with chronic obstructive pulmonary disease and had problems breathing as a result of his “around the clock” smoking habit, Ramirez said, which was all the more reason the staff should have made sure that if he were allowed to smoke he would be directly observed.

“You don’t light matches and have an open flame around oxygen. Everyone knows that, especially in a health facility where oxygen is very likely to be used,” Ramirez said. “This facility and the attendants were well aware he was being noncompliant, all the more reason to make sure he would be directly observed.”

In addition, the state said the nursing home was cited twice in 2004 with lesser violations carrying fines of $1,000 and $900. In one case, Dec. 31, the facility failed to follow doctor’s orders and as a result, a resident was found to be without pulse, blood pressure or respiration.

The other incident occurred July 7, 2004, when a certified nursing assistant placed a pillowcase over a resident’s head. State regulators said the facility failed to ensure that the resident was free from physical abuse, and didn’t report the abuse for two months.

The facility was called SunBridge Care & Rehabilitation prior to Dec. 10, 2004. In January of 2004, a sting operation by the state attorney general resulted in the arrest of 12 SunBridge employees, who were accused of elder abuse of a resident.

A Florida nursing home has been banned from excepting new admissions.

TALLAHASSEE — Saying a Port Charlotte nursing home failed to take steps to stop sexual abuse and other problems, state regulators have issued an emergency order to prevent the Peace River Nursing and Rehabilitation Center from accepting new residents.

The incident has also led the federal government to halt any Medicare or Medicaid payments to the Charlotte County nursing home.

The new patient moratorium is the first the state has imposed on a nursing home in more than a year. The last moratoriums were issued in 2004, when the state issued three bans for nursing homes that had problems.

The problems at Peace River occurred in a secured unit housing some of the facility’s most vulnerable residents — those suffering from Alzheimer’s disease and other forms of dementia.

The state Agency for Health Care Administration initially discovered the problems during a survey of the 104-bed home in late January. The home has about 70 residents.

During the inspection, the state regulators “discovered several serious instances of resident abuse,” including sexual abuse, according to ACHA’s emergency order.

Residents in the Alzheimer’s unit had been subjected to sexual abuse by other residents. One male resident had been seen in bed with a female resident. And the male resident had put his hand down the blouses of several residents as well as a staff member.

After the survey, Peace River officials voluntarily agreed not to take any new patients and promised to put an extensive plan in place to prevent abuse and to make sure it was properly reported if it occurred again.

But when state inspectors returned on Feb. 12, they determined the nursing home had “utterly failed to adhere to the remedial measures.”

The emergency order to prevent new residents from entering the facility was issued on Feb. 15.

Among other issues, the inspectors observed a male resident wandering in and out of rooms occupied by female residents. They also discovered the male resident who had been involved in the previous sexual abuse incidents was not being closely monitored as the facility had promised.

The inspectors found a number of other deficiencies, including the failure to properly train staff to prevent abuse and the failure to conduct psychological testing on residents who had been subjected to abuse.

Read the rest of this article—>

Hospice nursing is different from all other specialties. I agree, it takes a special person to do this work. I have seen them in action- hospice doctors, nurses, aides…they are compassionate and think outside the box. It’s refreshing in spite of the caseload.

Hospice is not like the rest of the medical profession. There are some similarities to be sure, but the men and women who provide hospice care are endowed with a special temperament.

Their successes and failures are judged differently than other health care professionals because hospice patients share one thing in common: They are going to die — soon.

There are steps that can be taken to ease pain or bring a smile to someone’s face in the last stages of life. But the moments of joy are interspersed with those of profound sadness. Modern medicine can do nothing to cure hospice patients, nor can anything be done to delay the inevitable.

Death is something all hospice workers know well and they are not immune to the pain and suffering their patients and their families go through.

“The hardest part is when a young person with a family dies,” said home health aide Carol Feltz. “When I think about how they are leaving behind a spouse and young kids, those are the times I cry.”

Nurse Angela Cieslewicz said she has seen dozens of people die in her four-plus years working at Ministry Home Care.

“Sure, all of my patients are going to die, and that could be pretty depressing,” she said. “But for me, it all depends on how you look at it. I can help my patients have the best quality of life for as long as they have life left. I like to look at it that way.”

Hospice care is not for everyone. Volunteer coordinator Lynda Pilot said the nurses who work in hospice are unlike most.

“They like a great deal of autonomy and work best in a setting where they are on their own,” she said. “It is a different kind of work and it requires a special kind of person.”

Hospice workers are drawn to the profession for many reasons, and some of them are personal.

“I tell the people here that I will be working one day and the next day someone will be giving me a bath,” Feltz said. “My mother-in-law had hospice care and after I saw how wonderful they treated her up until the end I knew I wanted to do something like that; I wanted to give back.”

This is a work that follows you home at the end of the day. Leaving it behind is not an option, so you have to learn to live with it.

“I am a hospice nurse, I don’t have two lives. This is not something I can shut off,” Cieslewicz said. “I have three kids and they know I take care of people who are dying. And when my pager goes off they know it’s not a good thing.”

Patients who receive hospice care at Ministry must first decide where they want to die. Care can be provided in assisted living homes, nursing homes or at home.

A team of nurses, home health aides, doctors, therapists and volunteers offer a holistic approach to care for the patient and the family.

It is with the families that Cieslewicz finds the most joy and purpose to her work.

“There are a lot of tears, especially at the end,” she said. “Families realize that they have been fighting over the silliest things for the last 25 years and now it just didn’t matter.

“When I see one person’s eyes light up I don’t need a thank you. When I give someone comfort, when I ease someone’s pain or when I give a family member the courage they need to care for a loved one, that is the thanks I need.”

Ministry accepts patients based on referrals from doctors, families or patients. The typical patient has a life expectancy of six months or less.

Hospice work teaches you to not fear death, but to revere it instead. A hospice also serves as a place to find energy for life.

“Everyone always thinks death is so sad, and it is,” Feltz said. “But after working in hospice for a while I have learned that it is not as sad as I always thought it was. There is something to learn about life from death and hospice teaches you that.”

In many states it’s already set up - nursing homes are not supposed to know when an inspection will occur. BUT, the fact that most surverys happen every 12 months, nursing home administrators KNOW when the time is going to be. Once a year or every 15 months an inspection happens. I say, make this more often and truly unannounced. I’ve seen what happens when an inpending inspection is due: Extra staff are scheduled, the building gets painted and cleaned…it should be this way all the time.

FRANKFORT - Betty Higgins was impressed with the number of staffers rushing around inside a Western Kentucky nursing home, caring for patients, sweeping floors, cleaning rooms.

“It was like a hive of bees on steroids,” said Higgins, whose elderly mother was a resident. “They were getting ready for a state inspection.”

Higgins said she thinks nursing homes would provide that level of service every day if administrators didn’t know when state inspectors were going to show up. That’s why the Lexington woman was pleased to hear about legislation pending in the General Assembly that would punish state employees who tip nursing homes to impending inspections.

A Senate bill would require that any state employee who informs a nursing home of an impending inspection be fired. That bill passed on a 36-1 vote yesterday, and now moves on to the House.

A similar bill already pending in the House would make it a crime to inform nursing homes of impending inspections.

State Rep. Kathy Stein of Lexington, sponsor of the House version, said the legislation is important because nursing homes house some of the state’s most vulnerable citizens. Stein likened unannounced inspections to pop quizzes in a classroom. If no one at nursing homes knows when they’re coming, they will stay better prepared.

Bernie Vonderheide, spokesman for Kentuckians for Nursing Home Reform, said he prefers the House version, which would require tipsters to be charged with misdemeanors and if convicted ordered to jail for up to a year.

“When my mother was in a nursing home, I was naive and I was unaware about inspections, and I would notice all of a sudden that there was more staff on the floors,” Vonderheide said. “I would ask, ‘What’s going on?’ and they would say, ‘We’re going to be inspected by the state tomorrow.’ ”

State Sen. Tom Buford urged legislators to vote for his bill yesterday.

“It is very similar to a fire marshal calling up a theater and saying, ‘Get the chains off those exit doors because we’re about to do an inspection,’ and when it’s over they might put the chains back on,” Buford said. “Thus, in a nursing home, it could result in conditions not being satisfactory in the future, but only being satisfactory for the inspection, at that moment.”

State Rep. David Floyd, R-Bardstown, a nursing home owner, said he was unaware that notifying nursing homes in advance of inspections was a widespread problem. He said no one had ever notified him.

Of the two proposals, Floyd said he thinks Buford’s is more reasonable. He questioned whether a state worker should be sent to jail for the offense.

“It seems extreme to me,” Floyd said.

Now this is using modern technology in a positive manner for nursing home residents. Isn’t this a good idea??

Crimson Ridge Gardens in Greece is the only adult living center in Rochester to use web cams. It’s a quick dial up and easy connects.

“What is your name?”

Frank Doherty and Olive Moore start warming up to new friends in Buffalo just to get the hang of it all.

“Kind of scary actually not sure where to look, what to say,” said Frank Doherty.

Peregrine Health Management Company plans to install computers and web cams in all five of its adult living centers in upstate New York.

“You don’t get to see your family as much as you’d like to. To get on the web cam and call them that would be wonderful,” said Olive Moore.

The new technology is fun and it allows residents to talk to family every day, but staff members say it shouldn’t be a substitute for regular visits in person.

But for Frank Doherty it’s a vital way to communicate. Frank Doherty has one brother in Greece, but his other relatives live in Florida and his home country Scotland.

“The last time I was home was about 20 years ago,” said Doherty.

But recent news of elderly abuse detected by web cameras at the Jennifer Matthew nursing home made the idea of using web cams even more important.

“Jennifer Matthew was a terrible tragedy, and we don’t want that to happen here,” said Sharon Weinel, Executive Director at Crimson Ridge Gardens.

But President of Peregrine Health Management says the new equipment isn’t meant to monitor patients, but to connect families.

“A disembodied voice on telephone can sometimes be confusing, actually see the person, see son, see sister, becomes more comforting,” said President of Peregrine Health Management Stephen Bowman

For residents like Moore and Doherty they’re more than excited about the idea.

“Hahahah. . .I talked to a lot of people. It’s fun talking to them and it’s nice to have something like that.”

The service is free for families. The center has already received 50 free web cams from a California based company called Logitech. Those cameras will be given to residents’ family members.

Some recent articles about Alzheimer’s Disease.

Alzheimer’s progresses quicker in highly educated: study
Alzheimer’s disease, a leading cause of dementia in the elderly, appears later in highly educated people — but once it does, it advances more quickly, scientists said on Thursday.

“We find that after the onset of manifestations of Alzheimer’s disease patients with higher education decline faster,” Dr Nikolaos Scarmeas, of Columbia University Medical Center in New York, said in an interview.

He and his team followed the progression of the illness in 312 people who ranged from being illiterate to highly educated. The patients were given brain function tests and monitored for five years.

Cognitive decline occurred in all the patients. But the researchers noted that each additional year of education was related to an additional 0.3 percent deterioration, particularly in memory and speed of thought processes.

The researchers looked at other factors, such as changes in the brain, high blood pressure, depression and age, that could have an impact on the disease.

“We couldn’t find any other explanation for it,” said Scarmeas, who reported the finding in the Journal of Neurology, Neurosurgery and Psychiatry.

***********************************************************

Testosterone ups quality of life in men with AD
A testosterone patch can improve the quality of life for men with Alzheimer’s disease (AD), but it seems to have little effect on cognition, according to the results of a study.

Previous reports have suggested that testosterone levels are lower in men with Alzheimer’s than in their counterparts without the neurologic disorder. Testosterone use has been shown to improve cognition in older men without Alzheimer’s disease and, in animal models, treatment with the male hormone has been linked to reduced formation of beta-amyloid, the protein that forms the plaques that clog the brains of Alzheimer’s patients.

***********************************************************

This is written by Tammie, a CNA who frequents the message board. I asked her for permission to post it here.

What a Nursing Home is really like: By Tammie CNA

A nursing home is a world that used to exist on the outside. It’s the one we often crave in our own world. The people who live there smile at you, know your name, greet you with good mornings. They live in a basic world without computers, cell phones and other gadgets we are used to today. It contains teachers, farmers, doctors, writers, housewives, cooks, well diggers, coal miners, world war vets, and others. They have great grandchildren and great great ones too. They are yesterday behind a set of walls built just for them. Each day, they give a gift of trust to you. How you take that gift is your decision.

They each want you to give them dignity. They will show you their most personal moments and you must maintain a professional and personal touch that makes them feel safe in your care. You will see them using the bathroom and you will see them naked. You will touch parts of their body during daily care that have never been touched by anyone other than themselves and the one they married. And, while doing this you must not snicker, make comments, or show them any negative reactions displayed your face or body posture. Not only does their body need your help, but their tender hearts do as well. When a negative remark is said about their body in any way, they feel as though you have hurt them. You damage any sense of control they have left in the world they now know.

For example, once able to cook for an entire family several times a day, Hazel now needs you to spoon feed her as she lies in the bed alone. Her legs are straight, thin and flat because they are now stuck this way permanantly because of muscle contracture. Her arms do not move above the elbow joint and her fingers are permanantly crossed within each other like her small legs. She has no bladder or bowel control and depends on you to clean her. She weighs eighty to ninety pounds in total. She wears adult diapers and baby powder on her skin. At meal times, you must remind her to open her mouth so you can get the spoon inside.

But, Hazel can hear every word you say to her and she can speak too. You often hear her singing as you walk past her bedroom. She is soft spoken and often says, thank you, please and good morning dear. When you are dressing her, she helps as much as she can by moving her arm this way or that way for you and by lifting her head so the pink gown goes on easily. When you are rolling her to the side to wipe a bowel movement off her skin, she says thank you each time. She likes chocolate and hates peanut butter. If you make a mistake, she is patient with you. She quietly sits in a swing 4 feet above the ground as you transfer her from the bed to a chair in a mechanical lift.

Now, Hazel is a special lady and each person is different. Like many others, she is helpless in your hands. Literally, your hands are her hands now. Your feet are now her feet. And, she is grateful for the use of them. She never yells when you take too much time or don’t give her enough time at all. She politely smiles and forgives you if you accidently scrape her skin with your fingernails while dressing her. And when you walk in the room, she lights up. Hazel trusts you.

Nursing homes are worlds seperate and opposite from the outside. The residents automatically trust instead of judge. They don’t know how to type an email or use a cell phone to keep in touch. Instead, if they are able, they learn your name and remember what you like and what makes you smile during the day. They see the same rooms and the same people day after day, yet every single day is different. They often face difficult times within these walls and your face is the one they look to for comfort.

Every now and then a resident comes along that is not so pleasant but, is combative and violent. These residents require special care and even more patience than the other ones. They can give you a challenge that is unique. And, they too are in your trust.

If you work in a nursing home, you can make the difference between a smile and a tear. You can make an otherwise routine day a special one. Your words can encourage and lift them up or you can disappoint and destroy a spirit. The trust you are given can be held softly in secret or can be broken loudly in an instant. You can share in an accomplishment and offer patience or you can hinder recovery and damage happiness in the future. There are people like Hazel out there right now living their life each day in a nursing home. You are given the gift of trust every single day. How you choose to handle that trust up to you.

If you are looking for an easy job, a place where you can be lazy or even a place where you can be dominating to others a nursing home is not for you. Abuse and neglect are not a joke and it is always revealed eventually. Being a CNA in a nursing home requires special people with compassion who are protectors of the helpless.

A nursing home requires those who are worthy of trust.

What’s in the news recently:::

Oregon nursing home could lose it’s license:

The state of Oregon is threatening to close an east Portland nursing home if the facility doesn’t get its act together. Citing three bad inspection reports in the last two years as well as several complaints that were found to be valid, the state on Jan. 18 informed St. Jude Specialty Care on Southeast 136th Avenue that it’s prepared to strip the home of its license. Such notices are very unusual and “a very big step for us to take, quite frankly,” said Elaine Young, nursing program director for the state Department of Human Services.

Brockton MA nursing home probed:

BROCKTON —The state Department of Public Health and local police are investigating allegations that a worker at a local nursing home abused a patient earlier this month. The DPH launched an investigation into St. Joseph Manor, a Brockton nursing home, after getting a complaint about the facility Feb. 4. Brockton police were called Wednesday to investigate the allegations. Anne Teri, chief executive officer at St. Joseph Manor, confirmed the state was investigating the Thatcher Street nursing home but declined to detail the allegations. “I can’t really comment about the investigation,” she said. “We take any allegations seriously.”

FL nursing home shut down after it failed FIRE safety drill:

PALM HARBOR - Dozens of elderly people are being forced from their homes, but state officials say it’s ultimately not a bad thing. Officials with the state Attorney General’s Office shut down the Long Shadow Inn, an adult living facility in Palm Harbor, because managers there failed a surprise emergency drill Thursday. During the drill, officials said, some residents were left unattended, several were trapped in wheelchairs on the second floor of the building, and at least four residents were never even evacuated.

Man found dead three days after leaving facility:

Searchers found the body of a missing Indiana man in a creek Monday, three days after he wandered from a nearby Rockville health care facility, authorities said. Robert E. Didelot, 62, was discovered just west of Lee Alan Bryant Health Care Facilities Inc., where he lived, said Parke County Sheriff Charles Bollinger. The facility, which includes a nursing home and residential facility, is about 2 1/2 miles east of Rockville. “It appears [he] was trying to cross a log jam and fell off into the water,” near Sanatorium Bridge, Bollinger said. Didelot was up to his neck in water, the sheriff said. An autopsy is scheduled today in Terre Haute Regional Hospital.

British Nurse under investigation:

A nurse alleged to have carried out “unprofessional” practical jokes in hospital put a patient’s glass eye in a cup of Coca-Cola, a disciplinary panel heard today. The accusations came at the start of an inquiry into 12 allegations of misconduct against Christine Mitchelson, including allegations of assault, racism and tasteless practical jokes. The 53-year-old nurse, from Newcastle upon Tyne, has denied all the charges, which are being examined by the conduct and competence committee of the Nursing and Midwifery Council (NMC) in London. She is not attending the hearing, citing ill health. The allegations cover the period between late 2001 and early 2004, when Ms Mitchelson was working at the Royal Victoria Infirmary in Newcastle. Her colleagues - including staff she was supervising - brought the complaints against her.

Legal Issues for CNA’s

Legal Standards
These are guidelines to lawful behavior. When laws are not obeyed you can be prosecuted and found liable (responsible) for injury and damages. Legal guilt can result in fines and imprisonment, as well as loss of certification/license to work as a CNA.

Laws are passed by local, state and federal governments. All citizens are expected to obey these laws…when you disobey a law you are liable for fines and/or imprisonment. CNA’s can avoid this by:
• Knowing and staying within their state’s scope of practice rules.
• Do only those tasks and skills you have been taught; if you’re asked to do tasks you have not been trained to do ask for guidance (and if necessary seek the advice of your supervisor).
• Carry out your tasks and procedures carefully and only as you were taught.
• Keep up to date with your skills and education and in-service requirements.
• In questionable situations, seek the advice of your supervisor.
• Make sure you fully understand your assignment and what is expected of you
• Know your facility policies and procedures and follow them.
• Do no harm to your patients.
• Respect the personal property of your patients

Legal Definitions and Examples
As a CNA the legal issues you might encounter and witness would be negligence, theft, defamation, false imprisonment, assault, battery and abuse. You need to understand what these are.

Negligence:
The failure to provide a degree of care that others would consider reasonable under the circumstances; when injury results to your patient. Negligence is often caused by rushing around to get your work done and by not thinking FIRST.
• YOU give a patient a bath…and don’t check the water temp first. The patient is burned.
• YOU place a tray of food in front of a patient and don’t check the menu; the tray belonged to another patient. The patient who got the tray eats the wrong consistency food and chokes.
• YOU transfer a patient by yourself even though the care plans states two staff should be present for the transfer. You drop the patient.

Theft
One would think this is pretty simple. It should be but often isn’t. Taking ANYTHING that doesn’t belong to you is considered theft. It doesn’t matter how cheap or expensive the item is. When you see another person take something that isn’t their’s, and you fail to report this, you are guilty of aiding and abetting the crime. Keep your standards high. We need all the honest people we can get in this work- don’t be scared or indifferent to report theft you witness. I’ve seen aides take wash clothes, briefs, deodorants, soaps ect from their facility (for their own personal use at home). I’ve also seen aides steal jewelry and clothing from patients. It’s NEVER acceptable to do this. EVER.

Defamation
This means making statements about another person, either verbally (slander) or in writing (libel)
when the character of that person is injured. Examples would be you telling a co-worker wrongful and inaccurate information about patients. I’ve seen this happen: We had an admission coming and the chart was available to all of us. The patient had Crohn’s Disease. One of the aides I worked with at that time went around and told everyone this patient had C-Diff. Not a good thing to do. Unless you know something to be actual fact, (and even then make sure you hear it from a reliable source), keep your mouth SHUT. And never put anything like this in writing.

False Imprisonment
This is an area many nursing staff have trouble understanding. It’s not just about restraints. It’s about a mindset. It is defined as restraining a person’s movements or actions without the proper authorization. Patients have rights and we must respect these rights. In the hospital setting, a patient CAN leave the hospital without a doctor’s permission. They can also leave a nursing home/assisted living home. Under very few circumstances can we interfere with this right. If you do, it’s called false imprisonment.

Physical Restraints
Using them requires a doctor’s order. Threatening to use them is considered false imprisonment.

Physical restraints are defined as any manual or physical device, material, or equipment attached to or near to the patients body, that:
• A patient cannot easily remove
• Restricts movement of ANY and ALL body parts
• Restricts the patient from accessing their own body or parts of their body
Examples of physical restraints:
• Wrist, Arm, Leg and Ankle restraints
• Vests
• Jackets
• Hand Mitts
• Geri chairs, recliners
• Seatbelts, safety belts
• Bed rails and the pads sometimes used on them
• In some populations the use of certain clothing would be considered a restraint: For example, donning a one piece undershirt on a child to prevent him from having access to his body. Or, a long sleeved shirt to prevent access to an IV site.

Also, many practices are considered a restraint. When a patient doesn’t have the physical strength to remove a device it is a restraint.
• When a patient doesn’t have the strength to sit up from a low rise sofa, for example, this practice is considered a restraint.
• Tucking in blankets and sheets so tightly the resident cannot move is considered a restraint. Using Velcro and tape to secure sheets is also a restraint.
• A lap tray being used with a wheelchair is a restraint if the patient cannot remove it.
• Using recliners and Geri chairs, tilted back, is a restraint.
• Moving chairs and beds so close to a wall that it prevents a patient from rising is a restraint.
• Placing a patient up into a table so close they cannot move their chair is a restraint.

In short, any action or device (designed for the sole purpose or something put together by you) that prevents the free movement of body parts is a physical restraint.
Some patients require splints and other appliances to maintain alignment and posture. These are restraints as well, but are often referred to as enablers because they assist the patient with ADL’s.
The patient may not be able to remove the splints, but it’s not an overt restraint. An MD order is always in place for these items.

Many medications are considered restraints. This is called chemical restraining and it is a very different thing than physical restraints. Nurses and doctors must understand the ramifications of using meds to induce sleep, states of relaxation, pain control that could be considered restraining activity.

Assault and Battery
There is some confusion about the meanings of these terms. Assault means purposely attempting to touch the body of another person without their permission, and threatening to do so. Battery is when you actually doing this. These terms are not all about hitting and hurting patients like so many of us have been taught.
Every task we perform is done so with the patient’s informed consent. This means the patient needs to know what it is we want to do, why, the benefits of the task-and they have to agree to it.
Informed consent can be withdrawn at any time and we must honor this. More and more patients are taking their healthcare into their own hands these days, and many will question the value of treatments. In spite of our best efforts to explain the need for treatments, the patient always retain the right to refuse. If you continue with the treatment you are guilty of battery. And threatening to get the nurse or others to assist you with said treatments is battery as well. You must report to the nurse any and all refusals of care by your patients, but do so quietly and not within hearing distance of the patient. Let the nurse handle the situation from this point forward.

To avoid being charged with battery:

• Tell the patient what you plan to do
• Make sure the patient understands what you’re saying
• Asking the patient if they have any questions or concerns
• Allowing the patient some time to think about this
• If the patient refuses, don’t push the issue. Quietly report the refusal to the nurse and document facts only.
• NEVER carry out the refused treatment

In our work we will come across a lot of coercion- which is forcing a patient to do something against their will. Unfortunately, it’s a problem within nursing in general. We always think we know what is best. This happens more with patients who are confused, mentally incapacitated or those with dementia. Almost always, these patients are not their own legal guardian, their family is. This makes it difficult for us to do our job at times because the patient is still refusing the care but we have to do it anyway- because the family has consented on behalf of the patient. It’s ALWAYS best to try to get the patient to cooperate with us vs. a full struggle. It really helps to wait and come back later when a confused patient refuses care. They tell us to always assume the patient would want our care if they were not confused so we have to think of things differently. It’s a hard spot to be in.

Abuse
Abuse: Doing harm to a patient. Abusing a patient is ethically wrong as well as legally wrong. Ethical standards require us to do no harm and legal standards enforce this through laws. There are severe penalties if you’re found guilty.

Abuse is defined as the act (or failure to act) that is non accidental and causes or could cause harm or death to a patient. It’s not just about hitting here. It’s also about mental abuse, verbal abuse and other more subtle forms. Abuse comes in many shapes:
• Physical
• Verbal
• Emotional
• Sexual
• Involuntary seclusion

Physical Abuse:
• Handling the patient roughly
• Hitting, slapping, punching, kicking, pinching a patient
• Performing the wrong treatment on the patient

Verbal Abuse:
• Swearing when you’re dealing with the patient
• Raising your voice, yelling
• Calling the patient unpleasant names
• Teasing the patient
• Embarrassing the patient at anytime
• Using gestures
• Making threats
• Use of inappropriate words/terms to describe a patient’s race or nationality

Sexual Abuse:
Using physical means and verbal threats to force patients to perform sexual acts.
In most states sexual abuse is ANY behavior that is seductive, sexually demeaning, harassing. As with Sexual Harassment policies, this harassment need only be considered as such by the patient without regard to your intentions. Be careful. THINK before your interactions with patients (and everyone else for that matter). Be considerate of your patient’s values and morals.

Emotional/Psychological Abuse:
THIS can be the worst kind of abuse because it’s typically ongoing and subtle.
• Causing a patient to be afraid of you (through threats, actions, attitude, and body language)
• Threatening the patient
• Threatening to withhold treatment
• Threatening to tell others about the patient’s condition
• Making fun of the patient
• Belittling the patient (and this would include all those cute little nicknames we tend to have)
• Calling the attention of others to the patient’s behavior.

Involuntary Seclusion
I see this happen a lot in nursing homes. A resident is being noisy and disruptive so we remove them to another area. This is another one of those hard spots to be in- trying to balance the needs of the larger group of residents without violating the rights of one. A good care plan, communication with everyone, documentation and other interventions should really be in place to prevent the resident from having outbursts in the first place. The nurse should always be the one who directs you to remove a resident. Don’t ever make this decision on your own.

Other forms of involuntary seclusion:
• Closing the door to the patient’s room when they want it kept open
• Placing a patient in a wheelchair away from others
• Leaving a patient without a means to communicate- removing the call bell for example

Abuse by Others
There are times when we will witness another CNA or nurse do harm to a patient, as described above in all the various forms. Often the CNA/nurse will not realize they are doing these things. It doesn’t matter whether she knows better or not. The abuse MUST be reported. As soon as it occurs, not at the end of the shift, the next day or next week. All healthcare workers are required by law to report actual or suspected abuse. When you don’t report, you’re just as guilty.

Sometimes it is a member of the patient’s family who abuses them. This is difficult to see happen, to suspect is happening. Again if you suspect this you are required to report it to the nurse. I’ve seen nursing home residents go out on a day trip with a family member and return to the facility with bruises and cuts; or with complaints of hunger and thirst. These things caused me to suspect some sort of abuse or neglect and I reported the findings to the nurses. I made sure they came down and looked at the bruises and cuts firsthand as well.

Neglect
Neglect is failing to provide the services, care and treatments necessary to avoid physical harm, mental anguish or mental illness. Neglect can be intentional or unintentional. Neglect is against the law no matter what. CNA’s are not expected to decide if neglect has occurred- that is the nurses job. However, you must report signs of neglect. Some examples of neglect we might see on the job:

• Routine hygiene and care not being provided. Patients not being repositioned, bathed, toileted, ROM exercises not being performed according to the care plan.
• Patients not being given enough time to eat
• Patients not being offered water and snacks

Invasion of Privacy
This is an area where every CNA should put themselves in the patients’ shoes. Would you like it if someone went around talking about your medical condition to anyone? How would you feel if you were in a hospital room and the nurse came in, started to do a treatment without closing the privacy curtain? You wouldn’t like these things at all. Most people don’t. Every patient has a right to expect their medical information will be kept confidential and that only those who NEED to know will have access to this information.

~This material can be used freely for educational purposes.