Presentation is loading. Please wait.

Presentation is loading. Please wait.

Margot Phaneuf, inf., Ph.D.1 Communicating with the Elderly: Choosing Respect in Caregiving Exercises for Beginners 2008, revised nov.2012 Margot Phaneuf,

Similar presentations


Presentation on theme: "Margot Phaneuf, inf., Ph.D.1 Communicating with the Elderly: Choosing Respect in Caregiving Exercises for Beginners 2008, revised nov.2012 Margot Phaneuf,"— Presentation transcript:

1 Margot Phaneuf, inf., Ph.D.1 Communicating with the Elderly: Choosing Respect in Caregiving Exercises for Beginners 2008, revised nov.2012 Margot Phaneuf, inf. PhD.

2 Margot Phaneuf, inf., Ph.D.2 Choosing Respect in Caregiving

3 3 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. WARNING

4 Margot Phaneuf, inf., Ph.D.4 Ethics: a bastion against abuse Providing care to the elderly raises serious ethical questions, namely:. How to always maintain the elderly person’s dignity;. How to always respect his autonomy, even if he is in a state of confusion; state of confusion;. How to limit the caregiver’s temptation to build relations based on authority and the potential for manipulation; based on authority and the potential for manipulation;. How to maintain the caregiver’s integrity and to limit the possibility of mistreatment; the possibility of mistreatment;. How to receive the patient’s family.

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

6 Margot Phaneuf, inf., Ph.D.6 Objectives Getting students to understand that ethical principles apply to everyday caregiving activities. 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. 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. Getting students to understand that abusive behaviour is often subtle or hidden.

7 Margot Phaneuf, inf., Ph.D.7 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.

8 Margot Phaneuf, inf., Ph.D.8 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. 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. 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. It is what we refer to as personalized care. This is based on proper organization and, more simply, on politeness, respect and good manners.

9 Margot Phaneuf, inf., Ph.D.9 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. 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 Task organization and personalized care

10 Margot Phaneuf, inf., Ph.D.10 Responding to the patient’s physical needs Responding to the patient’s physical needs  The following situations illustrate inadequate responses in which the patient’s needs are not met.  How would you respond if you were in the caregivers’ position?  More practical responses will be made available later on.

11 11 Could you let me sleep a little? I haven’t slept all night. So you think you’re the only one here! Do you think you’re at a hotel? Dysfunctional and arrogant response Which articles of the code of ethics have been ignored in this case and those that follow? Which ethical principles are ignored? Better response to follow

12 Margot Phaneuf, inf., Ph.D.12 Could you wake me up earlier so that I can take my bath? I like getting up early. That’s not possible! You’ll just have to wait your turn. Dysfunctional and authoritative response. Better response to follow

13 I don’t want to take a laxative. It hurts my stomach and I’m embarrassed to repeatedly ask to go to the bathroom. Well don’t come complaining to us that you’re constipated! Retaliation, mocking and intimidation are considered acts of psychological abuse. OIIQ, Le Journal, Chronique déonto novembre/décembre 2001, Vol. 9 No 2. Better response to follow

14 Could you put on a second gown? The opening in the back gives me the chills. That’s odd! Why don’t you just pull up your blanket? This is a case of mocking. The patient’s need is unmet. You’ve got hands… Better response to follow

15 Margot Phaneuf, inf., Ph.D.15 I wish someone would give me a bath. I used to wash myself every day. I like feeling clean. You’ll have to wait a week. The attendant is on holiday. The patient’s 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, Numéro 4. Chronique déonto. Les obstacles à la relation thérapeutique » Better response to follow

16 I wet my bed. Could you change my pants and sheets? We’ll have to hoist you and you know that using that machine is complicated… It is the nurse’s 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 déonto, Le Journal, novembre/décembre 2001, vol 9 no 2. Better response to follow

17 17 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) L’exploitation des personnes âgées). We have to hoist him. I was with Paul. It was a terrific evening. I saw a great movie yesterday.

18 Margot Phaneuf, inf., Ph.D.18 Can’t you see that it’s too late for supper? Now he’ll have to wait until tomorrow. I’m hungry, Marge! I’m bringing back Mr. Dubois Unanswered need and threat.

19 19 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. 37. A nurse shall not use verbal, physical or psychological abuse against the client. (threats and pressure are a type of abuse). Responses to slides 11 to 18

20 20 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 person’s dignity regardless of his physical or psychological state. Courtesy is mandatory.. Respecting the person’s 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 person’s integrity, inviolability (respecting essential needs, avoiding all forms of violence, preventing risks to his health and well-being).

21 Margot Phaneuf, inf., Ph.D.21 The following are a few examples of appropriate responses for the preceding cases. The following are a few examples of appropriate responses for the preceding cases. It is often easy to respond and meet the person’s needs and expectations. It is often easy to respond and meet the person’s 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. Responses which are not time-consuming and which require little effort exist and go a long way.

22 22 Please rest! I’ll start with someone else. Logical and comprehensive response I haven’t slept all night! Best response for slide 11

23 Margot Phaneuf, inf., Ph.D.23 Could you wake me up earlier so that I can take my bath? I like getting up early. I’ll switch your turn with someone who likes to stay in bed. Respecting the patient is also respecting his values and autonomy whenever possible. Best response for slide 12

24 24 I don’t want to take a laxative. It hurts my stomach and I’m embarrassed to repeatedly ask to go to the bathroom. We’ll 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. Best response for slide 13

25 Margot Phaneuf, inf., Ph.D.25 I’m cold wearing this gown. I’ll get your sweater. You’ll 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. Best response for slide 14

26 26 I like having baths - often. As soon as one of us is available, we’ll give you a bath. That would be nice. 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, Best response for slide 15

27 27 I wet my bed. Could you change my pants and sheets? I’ll ask for help and we’ll be able to change your pants and sheets without moving you too much. Same comment for slide 15 Best response for slide 16

28 28 We’re here to lift you. How are you feeling today? You’ll 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.

29 Margot Phaneuf, inf., Ph.D.29 You’re bringing him back late, but there’s surely a way to find him something to eat. I’m hungry, Marge! Best response for slide 18

30 Margot Phaneuf, inf., Ph.D.30   Alleviating pain is a primordial element to consider.  Neglecting to carry out this responsibility appropriately is a serious breach of ethics.

31 Margot Phaneuf, inf., Ph.D.31 Alleviating pain is an essential need which raises certain problems: Alleviating pain is an essential need which raises certain problems: Responding to the patient’s complaint requires attentive listening; Responding to the patient’s complaint requires attentive listening; Evaluating pain is difficult among the elderly, who are often confused; 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 person’s 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. Alleviating pain

32 Margot Phaneuf, inf., Ph.D. I’m still suffering. Could you give me something? Dismissive attitude which demonstrates lack of empathy. Again? You’re taking way too much medication. Next

33 33 I understand you Ms. White. The pain has got to stop. I’ll talk to the doctor. We’ll find a solution. I’m still suffering! Best response for slide 32

34 My back is killing me! I don’t have anything prescribed for you. You just have to talk to your phsyician! I really can’t do anything. This dysfunctional response blames and casts guilt upon the patient and illustrates a lack of empathetic understanding. I don’t have a magic lamp! Next

35 35 Now my back is really killing me! I’ll call the doctor. He might be able to prescribe something. I’ll massage your back to alleviate your pain before bedtime. This answer illustrates that the nurse has listened and responded to the patient. Best response for slide 34

36 Margot Phaneuf, inf., Ph.D.36 Inappropriate behaviour resulting in mistreatment: using rudeness and infantilization. Avoid at all cost!

37 37 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 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." « 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. Mistreatment or abuse

38 38 Ernest it is time you went to bed like everyone else! Which articles of the Code of Ethics of Nursing are breached in the following situations? Which ethical principles are disregarded? We’ve got more to do than just putting you to bed.

39 Margot Phaneuf, inf., Ph.D. Can you change my diaper? Again? You’ll just have to wait. Suite 2- "It should be noted that incontinence pants are widely used. The Association des CLSC et des CHSLD du Québec 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) L’exploitation des personnes âgées). Rudeness, threat and failing to respond to a need

40 40 Albert, you unplugged your collector pouch again. Could you be more careful? Inappropriate and infantilizing manner of addressing patient.

41 41 Bernadette! You stupid, stop going through the drawers! This isn’t your room, you know. Using insults is a prohibited behaviour, considered an acts of psychological abuse. OIIQ, Le Journal, Chronique déontonovembre/décembre 2001, vol. 9, no 2.

42 Lise, I’m hungry. You didn’t want to eat earlier. Too bad! Now you’ll just have to wait until dinner. The nurse lacks empathy, is impersonal and fails to consider the other person’s needs and expectations. This response blames the individual and is punitive.

43 I just changed your sheets. I hope it’s the last time today that you leave me with a surprise. Retaliation, mocking and intimidation are considered acts of psychological abuse. OIIQ, Le Journal, Chronique déonto novembre/décembre 2001, vol. 9, no 2. You got chocolate all over the place.

44 44 Reflection I don’t understand why people enter my room without knocking, why they are impolite with me, why they bark orders, why I’m constantly being blamed, and why I’m 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) L’exploitation des personnes âgées.

45 Margot Phaneuf, inf., Ph.D.45 Code of Ethics of Nursing, OIIQ. Section II- 3. 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 déonto novembre / décembre 2001, vol. 9, no 2. Ethical principles: - Respecting the person’s dignity, freedom and autonomy. Responses for slides 38 to 44

46 Margot Phaneuf, inf., Ph.D.46 Mistreatment: Violence A 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.

47 47 Abuse exists in many forms, including: PPPPhysical abuse, which can be identified through bruising; PPPPsychological abuse (pressure, threats, insults, raising tone of voice); PPPPassive neglect, which is omitting to help an elderly person walk or to take care of his hygiene and nutritional needs; AAAActive negligence by depriving a person of his freedom, unnecessarily using physical constraints, hurrying care and disregarding standards; TTTTherapeutic violence through relentlessness or denial of treatment (i.e. neuroleptic abuse, casual administering of laxatives, omitting medications). (Yves Gineste, 2004, Silence on frappe. Collectif, p. 18). Types of violence

48 48 Other forms of abuse: Other forms of abuse: Denying the elderly person’s sexuality; Sexual abuse or indecent assault; Sexual abuse or indecent assault; Robbing or extorting assets or money; Robbing or extorting assets or money; Living in a situation in which the Living in a situation in which the individual loses the desire to live. individual loses the desire to live. Other forms of abuse Abuse is often subtle and hidden. Excuses are often found to justify it.

49 49 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) L’exploitation des personnes âgées.

50 50 I don’t want to get up and take a bath. Whether you like it or not, it’s time to take a bath. I’ll show you who’s the boss here. The nurse is in a position of authority, but that never justifies abusing it or developing relationships of power.

51 51 I need to urinate. Pee in your pants! I don’t have time and we didn’t put you a diaper for nothing. Rudeness, profound lack of respect and failure to meet a need.

52 Margot Phaneuf, inf., Ph.D.52 Albert, if I catch you smoking again, you’ll be the last one looked after in the morning. Rudeness, threats and blackmail - all contrary to ethical standards.

53 Margot Phaneuf, inf., Ph.D.53 Albert, you pig! Leave Ms. Aphrodite alone! Rudeness, insult and value judgement.

54 54 I’m soiled. Could you change my pants? Soiled again, eh! Always stuck with your shit! Totally unacceptable insult.

55 Margot Phaneuf, inf., Ph.D.55 Arthur, you baby! Stop playing with the IV pole. Infantilizing and disrespectful behaviour.

56 56 Albert, if you keep on wandering and poking around, I’ll 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 Québec (1999 : 4), nearly 3 out of every 10 persons in residential and long-term care centres experience physical restraints." OIIQ. (2000) L’exploitation des personnes âgées.

57 Margot Phaneuf, inf., Ph.D.57 Why do they want to separate us? Denying the sexuality of elderly persons is abusive.

58 58 I don’t want to undress in front of others. I don’t like it when a member of the opposite gender washes me. Undressing a person without permission and care is showing lack of respect. 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) L’exploitation des personnes âgées.)

59 59 Pretend you didn’t see anything. We’ve got to protect our own. You’re right! She’s a coworker. Paul, I saw Lise hitting Mr. D. His arm is covered with bruises. 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) L’exploitation des personnes âgées).

60 Margot Phaneuf, inf., Ph.D.60 I don’t undestand why they insult me, why I’m left in my excrements, and why they treat me brutally. All forms of violence are prohibited when administering care 3- "When examining elderly abuse, we must discuss physical and verbal violence, which unfortunately is common in certain environments.’’ OIIQ. (2000) L’exploitation des personnes âgées.

61 61 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 déonto, nov./ déc. 2001, vol. 9, no 2. Responses for slides 49 to 60

62 Margot Phaneuf, inf., Ph.D.62 There is a serious disregard of the following ethical principles: - Respecting the person’s dignity and right to autonomy; especting the person’s integrity and inviolability; - Respecting the person’s intimacy. Responses in slides 49 to 60

63 Margot Phaneuf, inf., Ph.D.63 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.

64 Margot Phaneuf, inf., Ph.D.64 My mother is anxious. Why doesn’t she get her Ativan when she needs it? She gets it, but can’t 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?

65 65 My father’s 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) L’exploitation des personnes âgées).

66 66 Well, she screams all the time whenever she doesn’t. Every time I come here, my wife is sleeping. 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) L’exploitation des personnes âgées). I wonder whether she’s taking too much medication.

67 Margot Phaneuf, inf., Ph.D.67 My sister is filthy and smells bad. Why is that the case? She’s 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 problems with the sphincter.

68 68 My wife says you hit her. She assaulted me first! There’s no excuse for assaulting a patient. Violence is violence.

69 69 He wanders continuously. I don’t understand why my father is always tied to his bed. ‘‘Medical substances, constraints and abusive isolations should only be used as control measures when there is an imminent threat to safety.’’ Association des hôpitaux du Québec (2004) Utilisation exceptionnelle des mesures de contrôle : contention et isolement, 2004, p. 21).

70 70 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 déonto, nov./ déc. 2001, vol. 9, no 2. Responses for slides 64 to 69

71 Margot Phaneuf, inf., Ph.D.71 There is a serious disregard of the following ethical principles: -Respecting the person’s dignity and right to autonomy; -Respecting the person’s integrity and inviolability; - Respecting the person’s intimacy. Responses for slides 64 to 69

72 72 Caring for patients who express difficult behaviour requires not only patience, but an adapted approach. 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 caregiver’s attitude often involuntarily provokes violence and agitation among patients. Dealing with difficult behaviour

73 73 A soft and respectful approach with a delicate touch generally provide better results. A soft and respectful approach with a delicate touch generally provide better results. Responding to the person’s essential physical needs and need for recognition as a human being is a key to success. Responding to the person’s 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. Dealing with difficult behaviour

74 74 One of the nurse’s 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 nurse’s duty to withdraw or to ask for assistance when she feels she is about to commit an unforgivable act. OIIQ, Le Journal, novembre/décembre 2001, vol. 9, no 2. Chronique déonto, Comportements inadéquats envers la clientèle : quand les émotions dépassent la raison. Rules for engaging with a patient whose behaviour is difficult

75 Margot Phaneuf, inf., Ph.D.75 Confidentiality involves the patient, his background, his record and his family. Confidentiality involves the patient, his background, his record and his family.

76 Margot Phaneuf, inf., Ph.D.76 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? What a Casanova!

77 77 I read Victor’s record. Did you know he has a sexually transmitted disease? I sure didn’t!

78 78 Guess what girls! Mr. Bell’s 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) L’exploitation des personnes âgées).

79 Margot Phaneuf, inf., Ph.D.79 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 person’s dignity - Respecting the person’s social and psychological integrity.

80 Margot Phaneuf, inf., Ph.D.80 Leadership in nursing Leadership in nursing against rudeness and violence against rudeness and violence

81 Margot Phaneuf, inf., Ph.D.81 Employees sometimes engage in inappropriate behaviour. Employees sometimes engage in inappropriate behaviour. Teams often have grudges against patients or do not accept the families’ criticism. Teams often have grudges against patients or do not accept the families’ criticism. Through her training, it is the nurse’s duty to exercise leadership and to protect those under her responsibility. Through her training, it is the nurse’s duty to exercise leadership and to protect those under her responsibility. Leadership in nursing

82 82 You shouldn’t speak so impolitely to the patients. It’s inappropriate. Nobody complains! When confronting inappropriate behaviour, leadership and the intervention of coworkers are important and often prove to be positive.

83 83 Mr. L. want us to raise him. It’s the second time today. We have other things to do. I’m really fed up! Listen up girls! We’re here to answer the patient’s needs. Raising him is extremely important. Leadership is important in a team to put things into perspective and to ensure that the patient’s needs are met.

84 84 Did you see Ms. V. putting her gown on all by herself? So why is she asking us to dress her? She won’t catch me falling for that one again. The team must avoid spreading stereotypes. They’re contagious. Next

85 85 Don’t you think that she suffers more on certain days? You’re right! We didn’t think about it. We’re there to help her. Considering the various aspects of a situation can make a difference.

86 Margot Phaneuf, inf., Ph.D.86 I got crap all over my hands. Ms. C. crapped in her wheelchair. It was disgusting. Some do it intentionally. It’s called grey power. I felt like kicking her ass. Next

87 87 Be careful with what you say! Don’t forget that we’re 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.

88 88 Never! Constraint is to be used only under extraordinary circumstances! Could we tie him to a chair? Mr. E. always bothers us during our break.

89 89 Mary’s family is once again complaining that we’re neglecting her dad. They’re always complaining. They have nothing else to do. Don’t take it that way! We’re here to improve the patients’ quality of life.

90 Margot Phaneuf, inf., Ph.D.90 Hamelin is wandering with his pants open. Old pervert! Its not what you think. He probably needed to urinate and forgot to do up his zipper. Just remind him to zip up. Avoid value judgements and stereotypes!

91 Margot Phaneuf, inf., Ph.D.91 The nurse must exercise leadership to guarantee the patient’s quality of life. The nurse provides warnings and guidelines when necessary. The Nurse’s Role Our philosophy in this department is one of helping relations in which we provide warm, empathetic care which corresponds to the client’s needs. Our focus is on care that is adapted, humane and respectful.

92 Margot Phaneuf, inf., Ph.D.92 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. Teamwork

93 You’re in team A. You guys spoil the patients and then we’re stuck with more work! Don’t you think that we’re here to answer the patients’ needs? Which ethical principles are being breached in this example and those that follow?

94 Margot Phaneuf, inf., Ph.D.94 You just want the families to like you. You’re wrong! We just want to offer the best care possible to the patients.

95 Margot Phaneuf, inf., Ph.D.95 They think they’re better than us. They don’t understand our point of view. They don’t respect us.

96 Margot Phaneuf, inf., Ph.D.96 You guys in the day team are numerous and all touchy-feely. We don’t have your resources! Then we get blamed for lacking compassion.

97 Margot Phaneuf, inf., Ph.D.97 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).

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

99 Margot Phaneuf, inf., Ph.D.99 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. Family Requests

100 100 My wife is frightened when you forget to raise her bedrails. You are mistaken. We never forget to raise them. It’s 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? Respecting a person and his significant others is a prerequisite for a partnership in caregiving.

101 Margot Phaneuf, inf., Ph.D.101 We don’t want to criticize you guys, but he’s always sleeping. Is he getting too much medication? It’s not our fault if he sleeps a lot.

102 Margot Phaneuf, inf., Ph.D.102 My wife hates sleeping in the dark. She feels shut in. She’s afraid of everything. That’s not our fault.

103 Margot Phaneuf, inf., Ph.D.103 He’s soiled every time we see him. We’ll change him during our run, as always!

104 Margot Phaneuf, inf., Ph.D.104 My father tells me you put him to bed at 5 or 6 p.m. That’s ridiculous. You surely understand that we must follow procedures.

105 Margot Phaneuf, inf., Ph.D.105 My father says that nobody answers him in the night when he calls for assistance. Families cannot begin to grasp our workload. It’s easy to criticize when you’re not in our position.

106 106 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 client’s comprehension of his care and services being provided to him by the nurse. OIIQ, Div. III, 1-40.

107 Margot Phaneuf, inf., Ph.D.107  OIIQ, Code of Ethics of Nurses, Division II, 1- Relationship of trust 29- A nurse shall act respectfully toward the client and the client’s 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 déonto Mai/ juin, vol. 2 no 5 - Le respect dans la relation entre l’infirmière et le client. Responses for slides 100 to 105

108 108  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. Responses for slides 100 to 105

109 109 Ethical principles  D isregarding the dignity of a person and/or his family or significant others. isregarding the person’s integrity. NOTE  I t is an extremely serious offense to tolerate abuse against others. Responses for slides 100 to 105

110 Margot Phaneuf, inf., Ph.D.110 Those who take care of us are our only recourse. When they understand and help us, they are our guardian angels.

111 Margot Phaneuf, inf., Ph.D.111 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.

112 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; 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; 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

113 113 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; 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; 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; 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 his cognitive abilities and to be consulted so that he or she can accept or decline care; care; 16- To receive warm and empathetic end-of-life care without therapeutic relentlessness; relentlessness; 17- To have his or her family and significant others welcomed courteously and respectfully; 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) be respected by staff members. ( Margot Phaneuf)

114 114 BIBLIOGRAPHY  Gineste, Yves (2004). Collectif : Silence on frappe. De la maltraitance à la bientraitance. Milly-la-Forêt, Animagine, Sarl.  Gineste, Yves et Jérome Pellissier (2004). Humanitude. Comprendre la vieillesse, prendre soin des hommes vieux. Paris, Bibliophane, Daniel Radford.  Khosravi, Mitra (2003). La communication lors de la maladie d’Alzheimer. Paris, Doin.  Mérette, Marguerite (2004). Pour la liberté d’être. Montréal, Les Éditions Logiques.  OIIQ. Code de déontologie des infirmières et infirmiers. Montréal, OIIQ.  OIIQ (2000). L’exploitation des personnes âgées. Montréal, OIIQ.  Pancrazi, Marie-Pierre et Patrick Metais (2004) Éthique et démence. Paris, Masson.  Phaneuf, Margot (1998). Le vieillissement perturbé. Montréal, Chenelière/McGraw-Hill.  Phaneuf, Margot (2007). Le vieillissement perturbé. La maladie d’Alzheimer, Montréal, Chenelière Éducation.  Phaneuf, Margot (2002). Communication, entretien, relation d’aide et validation. Montréal, Chenelière/McGraw-Hill.  Phaneuf, Margot (2006). Élément d’éthique et déontologie 1re, 2 e et 3 e partie. Infiressources, Carrefour professionnel, section éthique :  Plamondon, Louis, Sylvie Lauzon et Marc Bourdeau, (2003) Abus et négligences chez les personnes âgées tel que perçus par les intervenants dans les services à domicile. Réseau Vieillir en liberté :  Forst, Luc, Louis Plamondon, Sylvie Lauzon, Charles-Henri Rapin et Marc Bourdeau (2006 ) Vieillir sans violence.   Rapport mondial sur la violence et la santé : ntilisation%20personnes%20%C3%A2g%C3%A9es%22 ntilisation%20personnes%20%C3%A2g%C3%A9es%22 ntilisation%20personnes%20%C3%A2g%C3%A9es%22  Rigaux, Natalie (1998). Le pari du sens. Une nouvelle éthique de la relation avec les patients âgés déments. Le Plessis-Robinson, Institut Synthélabo.  Selmès, Jacques et Christian Derouesné (2004). La maladie d’Alzheimer au jour le jour. Montrouge, France, Éditions John Libbey, Eurotext.


Download ppt "Margot Phaneuf, inf., Ph.D.1 Communicating with the Elderly: Choosing Respect in Caregiving Exercises for Beginners 2008, revised nov.2012 Margot Phaneuf,"

Similar presentations


Ads by Google