Communicating with the Elderly: Choosing respect in Caregiving

Communicating with the Elderly: Choosing respect in Caregiving

Communicating with the Elderly: Choosing Respect in Caregiving Exercises for Beginners Margot Phaneuf, inf., Ph.D. 1 Choosing Respect in Caregiving Margot Phaneuf, inf., Ph.D. 2

WARNING The case studies in this presentation illustrate situations that are unacceptable and the dialogues are unfortunately all too real. These cases unfortunately diminish the accomplishments of exemplary caregivers. We offer them our sincerest apologies. Margot Phaneuf, inf., Ph.D. 3 Ethics: a bastion against abuse Providing care to the elderly raises serious ethical

questions, namely: . How to always maintain the elderly persons dignity; . How to always respect his autonomy, even if he is in a state of confusion; . How to limit the caregivers temptation to build relations based on authority and the potential for manipulation; . How to maintain the caregivers integrity and to limit the possibility of mistreatment; . How to receive the patients family. Margot Phaneuf, inf., Ph.D. 4 Objectives Generating the students reflection

on critical situations with the elderly patient. Raising awareness that despite the best intentions, some of the patients significant needs may be left unanswered. Getting the student to realize that warm and empathetic relations can be Margot Phaneuf,minor inf., Ph.D. gestures . established through 5 Objectives

Getting students to understand that ethical principles apply to everyday caregiving activities. Generating awareness that abusive behaviour exists and is more common than we think. Getting students to understand that abusive behaviour is often subtle or hidden. Margot Phaneuf, inf., Ph.D. 6 Satisfying the needs and expectations of the elderly

One of the foundations of quality caregiving is to satisfy the needs of the patient. Downsizing and repetitive standard operating procedures often impede this objective. Organizational routine often becomes an end instead of a means. This often results in caregivers providing inadequate responses, which demonstrate a lack of ethics, simple manners and quality of care. Margot Phaneuf, inf., Ph.D. 7 Needs, expectations and preferences vary Every person experiences different needs. Some

hate washing themselves while others enjoy baths. Some like getting up and walking while others need stimulation to engage in activities. Quality care takes these differences into account. It is what we refer to as personalized care. This is based on proper organization and, more simply, on politeness, respect and good manners. Margot Phaneuf, inf., Ph.D. 8 Task organization and personalized care Establishing good relations with the patient usually depends upon minor, everyday details and

answering simple requests to meet his needs or those of his loved ones. Sometimes, this can mean: Breaking the routine Demonstrating goodwill Being creative Margot Phaneuf, inf., Ph.D. 9 Responding to the patients physical needs The following situations illustrate inadequate responses in which the patients needs are not met.

How would you respond if you were in the caregivers position? More practical responses will be made available later on. Margot Phaneuf, inf., Ph.D. 10 Could you let me sleep a little? I havent slept all night.

So you think youre the only one here! Do you think youre at a hotel? Which articles of the code of ethics have been ignored in this case and those that follow? Which ethical principles are ignored? Dysfunctional and arrogant response Better response to follow

11 Thats not possible! Could you wake me up earlier so that I can take my bath? I like getting up early. Youll just have to wait your turn. Dysfunctional and authoritative response. Better response to follow Margot Phaneuf, inf., Ph.D.

12 Well dont come complaining to us that youre constipated! I dont want to take a laxative. It hurts my stomach and Im embarrassed to repeatedly ask to go to the bathroom. Retaliation, mocking and intimidation are considered acts of psychological abuse. OIIQ, Le Journal, Chronique donto novembre/dcembre 2001, Vol. 9 No 2.

Better response to follow Could you put on a second gown? The opening in the back gives me the chills. Thats odd! Why dont you just pull up your blanket? Youve got hands This is a case of mocking. The patients need is unmet.

Better response to follow Youll have to wait a week. The attendant is on holiday. I wish someone would give me a bath. I used to wash myself every day. I like feeling clean. The patients values always supersede those of the nurse. The quality of the therapeutic relation relies on the ability to establish a respectful, reliable and trustworthy environment in which the primary focus is the patient.

OIIQ, Le Journal, mars/avril 2001, Volume 8, Numro 4. Chronique donto. Les obstacles la relation thrapeutique Better response to follow Margot Phaneuf, inf., Ph.D. 15 I wet my bed. Could you change my pants and sheets? Well have to hoist you and you know that using that machine is complicated

It is the nurses fundamental duty to guarantee the safety and well-being of the patient. It is our duty to provide him with the care required by his condition while respecting his physical and psychological integrity. OIIQ, Chronique donto, Le Journal, novembre/dcembre 2001, vol 9 no 2. Better response to follow We have to hoist him. I saw a great movie yesterday.

I was with Paul. It was a terrific evening. 2- Staff indifference is noticed. For example, it consists of talking about unrelated subjects with other staff members while the elderly person is being moved like an object and is not even acknowledged by them. (OIIQ. (2000) Lexploitation des personnes ges). 17 Im bringing back Mr. Dubois Im hungry, Marge! Cant you see that its too late

for supper? Now hell have to wait until tomorrow. Unanswered need and threat. Margot Phaneuf, inf., Ph.D. 18 Responses to slides 11 to 18 Code of Ethics of Nurses, OIIQ Division I 6 Availability and Diligence 25. In the practice of his or her profession, a nurse shall display due diligence and availability.

Division II 3- Prohibited behaviour 37. A nurse shall not use verbal, physical or psychological abuse against the client. (threats and pressure are a type of abuse). 19 Ethical principles for slides 11 to 18 We should never forget the ethical principles which guide caregiving. The following principles were neglected in the previous cases: . Respecting the persons dignity regardless of his physical or psychological state. Courtesy is mandatory. . Respecting the persons freedom, autonomy, values and decisions (if

he is competent). We must obtain his consent before proceeding with a medical act and he has the right to refuse care. . Respecting the persons integrity, inviolability (respecting essential needs, avoiding all forms of violence, preventing risks to his health and well-being). 20 Responses which are not time-consuming and which require little effort exist and go a long way. The following are a few examples of appropriate responses for the preceding cases. It is often easy to respond and meet the persons needs and expectations.

However, hiding behind standard procedures and regulations can be convenient. This shadows the fear of getting involved and of being overwhelmed by the patients demands. Margot Phaneuf, inf., Ph.D. 21 Best response for slide 11 Please rest! Ill start with someone else.

I havent slept all night! Logical and comprehensive response 22 Could you wake me up earlier so that I can take my bath? I like getting up early. Ill switch your turn with someone who likes to stay in bed.

Best response for slide 12 Respecting the patient is also respecting his values andMargot autonomy whenever possible . Phaneuf, inf., Ph.D. 23 I dont want to take a laxative. It hurts my stomach and Im

embarrassed to repeatedly ask to go to the bathroom. Best response for slide 13 Well try to find a better balance. Division II- 3. Prohibited behaviour. 37. A nurse shall not use verbal, physical or psychological abuse against the client. Imposing a treatment is abusive. 24

Im cold wearing this gown. Best response for slide 14 Ill get your sweater. Youll be more comfortable. Code of Ethics of Nurses; Division I 6, section 25. In the practice of his or her profession, a nurse shall display due diligence and availability. Margot Phaneuf, inf., Ph.D. 25 I like having baths - often.

As soon as one of us is available, well give you a bath. That would be nice. Best response for slide 15 Whenever possible, put aside what you are doing and pay attention to the client and his family. If you are unable to do so, inform the client and his family. By reacting promptly, you are in fact demonstrating that you are listening to their concerns. This will help maintain their confidence. (OIIQ, Le journal, mai juin, 2005. http://www.oiiq.org/uploads/periodiques/Journal/vol2no5/ss04.htm) 26

I wet my bed. Could you change my pants and sheets? Ill ask for help and well be able to change your pants and sheets without moving you too much. Best response for slide 16 Same comment for slide 15 27 Were here to lift you.

How are you feeling today? Youll feel better getting up. Best response for slide 17 We should address the patient, get him to talk and avoid engaging in personal conversations in his presence. 28 Im hungry, Marge! Youre bringing him back late, but theres surely a way to

find him something to eat. Best response for slide 18 Margot Phaneuf, inf., Ph.D. 29 Alleviating pain is a primordial element to consider. Neglecting to carry out this responsibility appropriately is a serious breach of ethics.

Margot Phaneuf, inf., Ph.D. 30 Alleviating pain Alleviating pain is an essential need which raises certain problems: Responding to the patients complaint requires attentive listening; Evaluating pain is difficult among the elderly, who are often confused; Determining the relevance of offering a prescribed analgesic can contradict our fear of creating addiction. Nurses should avoid judging another persons threshold for pain based upon

their personal limits; Administering a medication to provide optimal relief. Nurses should not wait too long and should follow the correct intervals between doses. Margot Phaneuf, inf., Ph.D. 31 Im still suffering. Could you give me something? Again? Youre taking way too much medication.

Dismissive attitude which demonstrates lack of empathy. Margot Phaneuf, inf., Ph.D. Next Im still suffering! I understand you Ms. White. The pain has got to stop. Ill talk to the doctor. Well find a solution.

Best response for slide 32 33 My back is killing me! I dont have anything prescribed for you. You just have to talk to your phsyician! I really cant do anything. I dont have a magic lamp! This dysfunctional response

blames and casts guilt upon the patient and illustrates a lack of empathetic understanding. Next Ill call the doctor. He might be able to prescribe something. Ill massage your back to alleviate your pain before bedtime. Now my back is really killing me! This answer illustrates that the nurse

has listened and responded to the patient. Best response for slide 34 35 Inappropriate behaviour resulting in mistreatment: using rudeness and infantilization. Avoid at all cost! Margot Phaneuf, inf., Ph.D. 36 Mistreatment or abuse

It is not our job to judge fellow caregivers as if they were slaves to an assembly line; however, we should be aware of the potential for abuse and denounce it in all of its forms. Abuse is unfortunately present among families and healthcare institutions. There is plenty of abuse, even hidden. Abuse occurs when a caregiver or an institution commits, tolerates or provokes an act that a healthcare professional would not commit against his own family member or a loved one." Source: Yves Gineste, 2004, Silence on frappe. Collectif, p. 17. 37

Ernest it is time you went to bed like everyone else! Weve got more to do than just putting you to bed. Which articles of the Code of Ethics of Nursing are breached in the following situations? Which ethical principles are disregarded?

38 Can you change my diaper? Again? Youll just have to wait. Rudeness, threat and failing to respond to a need 2- "It should be noted that incontinence pants are widely used. The Association des CLSC et des CHSLD du Qubec reported that it is imposed upon 66% of residents whereas it is known that 13% of these residents can manage their own hygiene if only adequate supervision were provided, and that 15% of these residents would be continent if they were provided more frequent assistance to go to the bathroom."(OIIQ. (2000) Lexploitation des personnes ges).

Margot Phaneuf, inf., Ph.D. Suite Albert, you unplugged your collector pouch again. Could you be more careful? 40 Inappropriate and infantilizing manner of addressing patient. Bernadette! You stupid, stop going through the drawers! This isnt your room, you know.

Using insults is a prohibited behaviour, considered an acts of psychological abuse. OIIQ, Le Journal, Chronique dontonovembre/dcembre 2001, vol. 9, no 2. 41 Lise, Im hungry. You didnt want to eat earlier. Too bad! Now youll just have to wait until dinner. The nurse lacks empathy, is impersonal and fails

to consider the other persons needs and expectations. This response blames the individual and is punitive. I just changed your sheets. I hope its the last time today that you leave me with a surprise. You got chocolate all over the place.

Retaliation, mocking and intimidation are considered acts of psychological abuse. OIIQ, Le Journal, Chronique donto novembre/dcembre 2001, vol. 9, no 2 . Reflection I dont understand why people enter my room without knocking, why they are impolite with me, why they bark orders, why Im constantly being blamed, and why Im being treated as if I were a nobody.

2- The OIIQ will not tolerate any situation involving lack of respect observed during a formal inspection or which is reported by interveners in residential and long-term care centres (CHSLD). OIIQ. (2000) Lexploitation des personnes ges. 44 Responses for slides 38 to 44 Code of Ethics of Nursing, OIIQ. Section II3. Prohibited behaviour. 37. A nurse shall not use verbal, physical or psychological abuse against the client. Retaliation, mocking, intimidation or indifference are considered acts of psychological abuse. OIIQ, Le Journal, Chronique donto novembre / dcembre 2001, vol. 9, no 2.

Ethical principles: - Respecting the persons dignity, freedom and autonomy. Margot Phaneuf, inf., Ph.D. 45 Mistreatment: Violence Abuse is more common than we may think. Families often avoid filing a complaint because they fear

reprisals against their loved one. Complaints are not always well accepted or taken seriously when families undertake this process. Margot Phaneuf, inf., Ph.D. 46 Types of violence Abuse exists in many forms, including: Physical abuse, which can be identified through bruising; Psychological abuse (pressure, threats, insults, raising tone of voice);

Passive neglect, which is omitting to help an elderly person walk or to take care of his hygiene and nutritional needs; Active negligence by depriving a person of his freedom, unnecessarily using physical constraints, hurrying care and disregarding standards; Therapeutic violence through relentlessness or denial of treatment (i.e. neuroleptic abuse, casual administering of laxatives, omitting medications). (Yves Gineste, 2004, 47 Silence on frappe. Collectif, p. 18). Other forms of abuse Other forms of abuse: Denying the elderly persons sexuality;

Sexual abuse or indecent assault; Robbing or extorting assets or money; Living in a situation in which the individual loses the desire to live. Abuse is often subtle and hidden. Excuses are often found to justify it. 48 If you want me to comb your hair and look good, be kind to me! There is such a thing as tipping. Financial requests or exploitation are abusive

gestures that contravene with ethical standards. "The OIIQ denounces the exploitation of elderly persons who are among the most vulnerable in our society." OIIQ. (2000) Lexploitation des personnes 49 ges. I dont want to get up and take a bath. Whether you like it or not, its time to take a bath. Ill show you whos

the boss here. The nurse is in a position of authority, but that never justifies abusing it or developing relationships of power. 50 I need to urinate. Pee in your pants! I dont have time and we didnt put you a diaper for nothing. Rudeness, profound lack of respect and

failure to meet a need. 51 Albert, if I catch you smoking again, youll be the last one looked after in the morning. Rudeness, threats and blackmail all contrary to ethical standards. Margot Phaneuf, inf., Ph.D. 52 Albert, you pig! Leave Ms. Aphrodite alone!

Rudeness, insult and value judgement. Margot Phaneuf, inf., Ph.D. 53 Im soiled. Could you change my pants? Soiled again, eh! Always stuck with your shit! Totally unacceptable insult.

54 Arthur, you baby! Stop playing with the IV pole. Infantilizing and disrespectful behaviour. Margot Phaneuf, inf., Ph.D. 55 Albert, if you keep on wandering and poking around, Ill have to

restrain you. Infantilization and use of threat contrary to ethical guidelines. 1- "depriving a person of his freedom and well-being through the inappropriate use of contentions. According to the Association des CLSC et des CHSLD du Qubec (1999 : 4), nearly 3 out of every 10 persons in residential and long-term care centres experience physical restraints." 56 OIIQ. (2000) Lexploitation des personnes ges. Why do they want to separate us? Denying the sexuality of elderly persons is abusive.

Margot Phaneuf, inf., Ph.D. 57 Undressing a person without permission and care is showing lack of respect. I dont want to undress in front of others. I dont like it when a member of the opposite gender washes me. 1. "Even when the person is confused, showing lack of respect deeply affects their families who regretfully put up with these situations. In many centres, elderly persons are unable to choose an intervener of the same gender for

their intimate needs." (OIIQ. (2000) Lexploitation des personnes ges.) 58 Paul, I saw Lise hitting Mr. D. His arm is covered with bruises. Pretend you didnt see anything. Weve got to protect our own. Youre right! Shes a coworker. 3- "[Abuse] is often known, but some employees remain silent, fearing retaliations or being marginalized, etc. In some environments, violence is the

norm. Being attentive, compassionate or polite towards residents is not accepted." OIIQ. (2000) Lexploitation des personnes ges). 59 All forms of violence are prohibited when administering care I dont undestand why they insult me, why Im left in my excrements, and why they treat me brutally. 3- "When examining elderly abuse, we must discuss physical and verbal violence, which unfortunately is common in certain environments. OIIQ. (2000) Lexploitation des personnes ges.

Margot Phaneuf, inf., Ph.D. 60 Responses for slides 49 to 60 Code of Ethics of Nurses, OIIQ. Section 2- Integrity 10 A nurse shall fulfill her or his professional duties with integrity. Division II- 3. Prohibited behaviour 37. A nurse shall not use verbal, physical or psychological abuse against the patient. It is understood that inappropriate behaviour means any form of verbal, physical or psychological abuse. Hitting, pushing or using force without reason against a client are examples of physical abuse. Finally, retaliation, mocking,

intimidation and cultural indifference are considered psychological abuse. OIIQ, Le Journal, Chronique donto, nov./ dc. 2001, vol. 9, no 2. 61 Responses in slides 49 to 60 There is a serious disregard of the following ethical principles: - Respecting the persons dignity and right to autonomy; - Respecting the persons integrity and inviolability; - Respecting the persons intimacy.

Margot Phaneuf, inf., Ph.D. 62 Questions and criticism raised by families It is true that it is difficult to receive questions and criticism from families; however, not all are without foundation. Staff must be willing to listen. Defensive or aggressive behaviour does not solve the problem. Margot Phaneuf, inf., Ph.D. 63

My mother is anxious. Why doesnt she get her Ativan when she needs it? She gets it, but cant remember. Excuse or reality...? Which articles of the Code of Ethics of Nurses are being breached in this example and those that follow? Which ethical

principles are disregarded? Margot Phaneuf, inf., Ph.D. 64 My fathers face is bruised. He claims the night-time attendant struck him. No, he hit himself against the bed stand. 3- "What do we mean by physical and verbal abuse? Abuse includes slapping,

threatening, intimidating, touching or, abruptly moving, etc. There is talk of people who escaped and fell on the ground, of bruising and inexplicable injuries. These terms describe the everyday reality of some elderly persons in loss of autonomy." (OIIQ. (2000) Lexploitation des personnes ges). 65 Every time I come here, my wife is sleeping. Well, she screams all the time whenever she doesnt. I wonder whether shes taking too much medication.

1. "Is it not tempting when staff is limited to resort to medicinal restraints that are capable, in the form of a little pill, of calming individuals but which fail to meet their needs?" (OIIQ. (2000) Lexploitation des personnes ges). 66 My sister is filthy and smells bad. Why is that the case? Shes mean and impossible. She is agitated and assaults us. She defecates just to annoy us.

Defensive, impolite and aggressive behaviour which fails to solve the problem. Repeated incontinence is not necessarily voluntary. It is the result of brain injuries or Margot Phaneuf, Ph.D. 67 problems with theinf.,sphincter. My wife says you hit her. She assaulted me

first! Theres no excuse for assaulting a patient. Violence is violence. 68 I dont understand why my father is always tied to his bed. He wanders continuously. Medical substances, constraints and abusive isolations should only be used as control measures when there is an imminent threat to safety. Association des hpitaux du Qubec (2004) Utilisation exceptionnelle des mesures de contrle : contention et isolement,

2004, p. 21). 69 Responses for slides 64 to 69 Code of Ethics of Nurses, OIIQ. Section 2- Integrity 10 A nurse shall fulfill her or his professional duties with integrity. Division II- 3. Prohibited behaviour 37. A nurse shall not use verbal, physical or psychological abuse against the patient. It is understood that inappropriate behaviour means any form of verbal, physical or psychological abuse. Hitting, pushing or using force without reason against a client are examples of physical abuse. Finally, retaliation, mocking, intimidation and cultural indifference are considered

psychological abuse. OIIQ, Le Journal, Chronique donto, nov./ dc. 2001, vol. 9, no 2. 70 Responses for slides 64 to 69 There is a serious disregard of the following ethical principles: - Respecting the persons dignity and right to autonomy; - Respecting the persons integrity and inviolability; - Respecting the persons intimacy. Margot Phaneuf, inf., Ph.D.

71 Dealing with difficult behaviour Caring for patients who express difficult behaviour requires not only patience, but an adapted approach. Employees must never respond to difficult behaviour with violence. The caregivers attitude often involuntarily provokes violence and agitation among patients. 72 Dealing with difficult behaviour

A soft and respectful approach with a delicate touch generally provide better results. Responding to the persons essential physical needs and need for recognition as a human being is a key to success. Constraints are not the only solution to overcome difficult behaviour. Constraints should be used only under extraordinary circumstances. 73 Rules for engaging with a patient whose behaviour is difficult One of the nurses fundamental duties is to guarantee the safety and well-being of the client. This is not always easy in

the existing context, but it nonetheless remains: to provide the care required by the client and his condition while respecting his rights and physical and psychological integrity. It is the nurses duty to withdraw or to ask for assistance when she feels she is about to commit an unforgivable act. OIIQ, Le Journal, novembre/dcembre 2001, vol. 9, no 2. Chronique donto, Comportements inadquats envers la clientle : quand les motions dpassent la raison. 74 Confidentiality involves the patient, his background, his record and his family.

Margot Phaneuf, inf., Ph.D. 75 Were you aware that Mr. Lemire had a young mistress? Which articles of the Code of Ethics of Nurses are being breached in this example and thosethat follow? Which ethical principles

are disregarded? Margot Phaneuf, inf., Ph.D. What a Casanova! 76 I read Victors record. Did you know he has a sexually transmitted disease? I sure didnt!

77 Guess what girls! Mr. Bells son has just been arrested for robbery. 2- "The OIIQ will not tolerate any situation involving lack of respect observed during a formal inspection Invasion of privacy and exposing another person to ridicule can occur in caregiving or residential care." ( OIIQ. (2000) Lexploitation des personnes ges). 78 Responses for slides 76 to 78 OIIQ, Code of Ethics of Nurses Section II Provisions to protect the secrecy of confidential

information 31- A nurse shall abide by the rules set forth in the Professional Code in regard to the obligations to preserve the secrecy of confidential information that becomes known to her or him in the practice of her or his profession and the cases where she or he may be released from the obligation of secrecy. 36- A nurse shall refrain from holding or participating in indiscreet conversations concerning a client and the services rendered to such client. Ethical principles: - Respecting the persons dignity - Respecting the persons social and psychological integrity . Margot Phaneuf, inf., Ph.D.

79 Leadership in nursing against rudeness and violence Margot Phaneuf, inf., Ph.D. 80 Leadership in nursing Employees sometimes engage in inappropriate behaviour. Teams often have grudges against patients or do not accept the families criticism.

Through her training, it is the nurses duty to exercise leadership and to protect those under her responsibility. Margot Phaneuf, inf., Ph.D. 81 You shouldnt speak so impolitely to the patients. Its inappropriate. Nobody complains! When confronting inappropriate behaviour, leadership and the intervention of coworkers

are important and often prove to be positive. 82 Listen up girls! Were here to answer the patients needs. Raising him is extremely important. Im really fed up! Mr. L. want us to raise him. Its the second time today. We have other things to do. Leadership is important in a team to put things into

perspective and to ensure that the patients needs are met. 83 Did you see Ms. V. putting her gown on all by herself? So why is she asking us to dress her? She wont catch me falling for that one again. Next The team must avoid spreading stereotypes.

Theyre contagious. 84 Dont you think that she suffers more on certain days? Were there to help her. Youre right! We didnt think about it. Considering the various aspects of a situation can make a difference.

85 I got crap all over my hands. Ms. C. crapped in her wheelchair. It was disgusting. Some do it intentionally. Its called grey power. I felt like kicking her ass. Next Margot Phaneuf, inf., Ph.D.

86 Be careful with what you say! Dont forget that were here to help the patients. Avoid using comments that could encourage others to slide down the path to insults and violence. Any nurse can influence comments by exercising leadership. 87 Mr. E. always bothers us during our break.

Could we tie him to a chair? Never! Constraint is to be used only under extraordinary circumstances! 88 Marys family is once again complaining that were neglecting her dad. Theyre always

complaining. They have nothing else to do. Dont take it that way! Were here to improve the patients quality of life. 89 Its not what you think. He probably needed to urinate and forgot to do up his zipper. Hamelin is wandering with his pants open. Old pervert!

Just remind him to zip up. Avoid value judgements and stereotypes! Margot Phaneuf, inf., Ph.D. 90 The Nurses Role Our philosophy in this department is one of helping relations in which we provide warm, empathetic care which corresponds to the clients needs. Our focus is on care that is adapted, humane

and respectful. The nurse must exercise leadership to guarantee the patients quality of life. The nurse provides warnings and guidelines when necessary. Margot Phaneuf, inf., Ph.D. 91 Teamwork Teams often compete because of different visions of the provision of services. The nurse must disseminate her knowledge and caregiving philosophy so that team members agree to

provide quality care. Margot Phaneuf, inf., Ph.D. 92 Youre in team A. You guys spoil the patients and then were stuck with more work! Dont you think that were here to answer the patients needs?

Which ethical principles are being breached in this example and those that follow? You just want the families to like you. Youre wrong! We just want to offer the best care possible to the patients. Margot Phaneuf, inf., Ph.D.

94 They dont understand our point of view. They dont respect us. They think theyre better than us. Margot Phaneuf, inf., Ph.D. 95 You guys in the day team are numerous and all touchy-feely. We dont have your resources!

Then we get blamed for lacking compassion. Margot Phaneuf, inf., Ph.D. 96 Responses for slides 93 to 96 The ethical principles which apply to patients also apply to coworkers. They are: - Respecting the dignity of other staff - members; - Respecting their integrity; - Respecting their right to be unique and to - have their own opinions (alterity).

Margot Phaneuf, inf., Ph.D. 97 Teamwork Once again, the nurse must demonstrate leadership to help other teams function in harmony. Margot Phaneuf, inf., Ph.D. 98

Family Requests Teams sometimes gang up on families. Their impression is that families lack confidence in caregivers. Their reactions to the requests of patients and families do not always demonstrate professional maturity. Margot Phaneuf, inf., Ph.D. 99 My wife is frightened when you forget to raise her bedrails.

Respecting a person and his significant others is a prerequisite for a partnership in caregiving. You are mistaken. We never forget to raise them. Its a standard operating procedure. Which articles of the Code of Ethics of Nurses are being breached in this example and

those that follow? Which ethical principles are disregarded? 100 We dont want to criticize you guys, but hes always sleeping. Is he getting too much medication? Its not our fault if he sleeps a lot.

Margot Phaneuf, inf., Ph.D. 101 My wife hates sleeping in the dark. She feels shut in. Shes afraid of everything. Thats not our fault. Margot Phaneuf, inf., Ph.D. 102 Well change him during

our run, as always! Hes soiled every time we see him. Margot Phaneuf, inf., Ph.D. 103 My father tells me you put him to bed at 5 or 6 p.m. Thats ridiculous. You surely understand that we must follow procedures.

Margot Phaneuf, inf., Ph.D. 104 My father says that nobody answers him in the night when he calls for assistance. Families cannot begin to grasp our workload. Its easy to criticize when youre not in our position.

Margot Phaneuf, inf., Ph.D. 105 It is vital that the nurse establish a relationship based on trust with the families and that she understand their concerns and accept their questions and comments. She must also provide the necessary explanations. Family members must be free to express their criticism.

A nurse shall provide her or his client with all the explanations necessary for the clients comprehension of his care and services being provided to him by the nurse. OIIQ, Div. III, 1-40. 106 Responses for slides 100 to 105 OIIQ, Code of Ethics of Nurses, Division II, 1- Relationship of trust 29- A nurse shall act respectfully toward the client and the clients spouse, family and significant others. In relationship to section 29

Recognize whenever necessary that a problem has occured and have a frank discussion about the events and the measures that you will implement. Offer apologies if warranted. Some situations require sincere apologies which illustrate sensitivity to the experiences of others. OIIQ, Le Journal, Chroniques de donto Mai/ juin, vol. 2 no 5 - Le respect dans la relation entre linfirmire et le client. Margot Phaneuf, inf., Ph.D. 107 Responses for slides 100 to 105

OIIQ, Code of Ethics of Nurses, Division II, Relationship of trust 3- section 37. A nurse shall not use physical, verbal or psychological abuse against the client. Division III Quality of care and services 3- section 45. A nurse shall not be negligent when administering medication. In particular, when administering medication, a nurse shall have sufficient knowledge of the medication and abide by the principles and methods applicable to its administration. 3- section 48. A nurse shall not harass, intimidate or threaten a person with whom she or he interacts in the practice of the profession.

108 Responses for slides 100 to 105 Ethical principles Disregarding the dignity of a person and/or his family or significant others. Disregarding the persons integrity. NOTE It is an extremely serious offense to tolerate abuse against others. 109 Those who take care of us

are our only recourse. When they understand and help us, they are our guardian angels. Margot Phaneuf, inf., Ph.D. 110 As part of our conclusion, here is a statement regarding the rights of dependent elderly persons which our organization of care and our conscience should allow us to respect.

Margot Phaneuf, inf., Ph.D. 111 In recognition of the rights of elderly persons, we propose: That any person to whom we provide care has the right : 1- To be received in a physical environment that is adapted to his age, abilities and needs; 2- To be managed by competent staff and to receive quality care; 3- To enjoy a certain quality of life: adequate nutrition, and adapted physical, social and recreational activities; 4- To be treated respectfully as a person, as a physical being and find respect of his suffering.

5- To have his values, religious beliefs and freedom of conscience respected; 6- To develop relationships with whom he or she chooses and to maintain family and social relationships; 7- To his or her intimacy (physical integrity and confidentiality); 8- To live in a safe environment, free of violence, mocking, non-essential constraints and other safety hazards; Next we propose: That any person to whom we provide care has the right: 9- To live in an environment that recognizes him as a human being and which treats him or her with respect and dignity; 10- To be treated by personnel with whom he or she can develop a relationship built on trust, thereby creating a genuine partnership in caregiving;

11- To live free from exploitation, retaliation and being addressed impolitely; 12- To have his or her assets secured and, if capable, to manage his or her own affairs; 13- To receive preventative care to offset degeneration and dependency; 14- To be provided with all the information needed about the care being administered to make a clear and informed decision; 15- To have his or her autonomy and decision-making ability respected according to his cognitive abilities and to be consulted so that he or she can accept or decline care; 16- To receive warm and empathetic end-of-life care without therapeutic relentlessness; 17- To have his or her family and significant others welcomed courteously and respectfully; 18- To feel protected by the right of oversight of his or her family and that this right be respected by staff members. ( Margot Phaneuf) 113

BIBLIOGRAPHY Gineste, Yves (2004). Collectif : Silence on frappe. De la maltraitance la bientraitance. Milly-la-Fort, Animagine, Sarl.

Gineste, Yves et Jrome Pellissier (2004). Humanitude. Comprendre la vieillesse, prendre soin des hommes vieux. Paris, Bibliophane, Daniel Radford. Khosravi, Mitra (2003). La communication lors de la maladie dAlzheimer. Paris, Doin. Mrette, Marguerite (2004). Pour la libert dtre. Montral, Les ditions Logiques. OIIQ. Code de dontologie des infirmires et infirmiers. Montral, OIIQ. OIIQ (2000). Lexploitation des personnes ges. Montral, OIIQ. Pancrazi, Marie-Pierre et Patrick Metais (2004) thique et dmence. Paris, Masson. Phaneuf, Margot (1998). Le vieillissement perturb. Montral, Chenelire/McGraw-Hill. Phaneuf, Margot (2007). Le vieillissement perturb. La maladie dAlzheimer, Montral, Chenelire ducation. Phaneuf, Margot (2002). Communication, entretien, relation daide et validation. Montral, Chenelire/McGraw-Hill. Phaneuf, Margot (2006). Ethics Elements - Serious Thoughts in a Cartoon (3 3 parts). Infiressources, Professional Crossroad, section Day-to-day Ethics : http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics1engl__04march06_revised.pps http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics2engl__4March06_revised.pps http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics3engl__5March06_revised.pps

Plamondon, Louis, Sylvie Lauzon et Marc Bourdeau, (2003) Abus et ngligences chez les personnes ges tel que perus par les intervenants dans les services domicile. Rseau Vieillir en libert : http://www.fep.umontreal.ca/violence/dossiers/index.html Forst , Luc, Louis Plamondon, Sylvie Lauzon, Charles-Henri Rapin et Marc Bourdeau (2006 ) Vieillir sans violence. www.pinel.qc.ca/Download.aspx?nav_id=1499&lang_id=F Rapport mondial sur la violence et la sant : http://www.who.int/violence_injury_prevention/violence/world_report/en/chap5fr.pdf#search=%22infantilisation%20pe rsonnes%20%C3%A2g%C3%A9es%22 Rigaux, Natalie (1998). Le pari du sens. Une nouvelle thique de la relation avec les patients gs dments. Le PlessisRobinson, Institut Synthlabo.

Selms, Jacques et Christian Derouesn (2004). La maladie dAlzheimer au jour le jour. Montrouge, France, ditions John Libbey, Eurotext. 114

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