1. Choosing Respect in Caregiving Exercices for Beginners
Fiji National University – CEU 304 – Week 9 Communications with the Elderly:
Choosing Respect in Caregiving
Exercices for Beginners

2. Choosing Respect in Caregiving

3. We offer them our sincerest apologies.
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.

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;
. How to limit the caregiver’s temptation to build relations
based on authority and the potential for manipulation;
. How to maintain the caregiver’s integrity and to limit
the possibility of mistreatment;
. How to receive the patient’s family. .

5. Objectives
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.
Getting the student to realize that warm and empathetic relations can be established through minor gestures.
Margot Phaneuf, inf., Ph.D.

6. 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.

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. 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.

9. 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.

10. 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.
Margot Phaneuf, inf., Ph.D.

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?
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

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

13. Better response to follow
Well don ’t come complain
to us that you’re constipated!
I don’t want to take a laxative.
It hurts my stomach and I’m
embarrassed to repeatedly ask
to go to the bathroom.
Retaliation, mocking and intimidation are considered acts of psychological abuse.
OIIQ, Le Journal, Chronique déonto.
Better response to follow

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

15. Better response to follow
You’ll 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 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
Margot Phaneuf, inf., Ph.D.

16. Better response to follow
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. I saw a great
movie yesterday.
We have to
hoist him.
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) L’exploitation des personnes âgées).

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

19. Code of Ethics of Nurses, OIIQ
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).

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

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

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

24. Best response for slide 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.
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.

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

26. I like having baths - often.
As soon as one of us
is available,
we’ll give you a bath.
I like having baths - often.
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,

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.
Best response for slide 16
Same comment for slide 15

28. We should address the patient, get him to talk and avoid
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. Best response for slide 18
I’m hungry, Marge!
You’re bringing him back late,
but there’s surely a way to
find him something to eat.
Best response for slide 18
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.
Margot Phaneuf, inf., Ph.D.

31. Alleviating pain is an essential need which raises certain problems:
Responding to the patient’s 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 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.
Margot Phaneuf, inf., Ph.D.

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

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

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

35. This answer illustrates that the nurse
I’ll call the doctor.
He might be able to prescribe something.
I’ll 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

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

37. 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.

38. Ernest it is time you went to bed like everyone else!
We’ve 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?

39. Can you change my diaper?
Again?
You’ll 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 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).
Suite
Margot Phaneuf, inf., Ph.D.

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

41. You stupid, stop going through
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. This response blames the individual and is punitive.
You didn’t want to eat
earlier. Too bad! Now you’ll
just have to wait until
dinner.
Lise, I’m hungry.
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.
You got chocolate
all over the place.
Retaliation, mocking and intimidation are
considered acts of psychological abuse.
OIIQ, Le Journal, Chronique déonto
novembre/décembre 2001, vol. 9, no 2 .

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. Responses for slides 38 to 44
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.
Margot Phaneuf, inf., Ph.D.

46. Abuse is more common than we may think.
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.

47. 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, Silence on frappe. Collectif, p. 18).

48. Other forms of abuse Other forms of abuse:
Denying the elderly person’s 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.

49. OIIQ. (2000) L’exploitation des personnes âgées.
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. The nurse is in a position of authority, but that
Whether you like it or not, it’s time to take a bath. I’ll show you who’s the boss here.
I don’t want to get up
and take a bath.
The nurse is in a position of authority, but that
never justifies abusing it or developing relationships of power.

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

52. Rudeness, threats and blackmail -
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.
Margot Phaneuf, inf., Ph.D.

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

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

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

56. Infantilization and use of threat contrary to ethical guidelines.
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. Denying the sexuality of elderly persons
Why do they want
to separate us?
Denying the sexuality of elderly persons
is abusive.
Margot Phaneuf, inf., Ph.D.

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

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

60. All forms of violence are prohibited when administering care
I don’t undestand why
they insult me,
why I’m 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) L’exploitation des personnes âgées.
Margot Phaneuf, inf., Ph.D.

61. 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 déonto, nov./ déc. 2001, vol. 9, no 2.

62. Responses in slides 49 to 60
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.
Margot Phaneuf, inf., Ph.D.

63. Defensive or aggressive behaviour does
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.

64. Excuse or reality...? 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?
Margot Phaneuf, inf., Ph.D.

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

67. Defensive, impolite and aggressive behaviour which
She’s mean and impossible. She is agitated and assaults
us.
My sister is filthy and
smells bad. Why is that
the case?
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.
Margot Phaneuf, inf., Ph.D.

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

69. I don’t 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 hôpitaux du Québec (2004) Utilisation exceptionnelle des mesures de contrôle : contention et isolement, 2004, p. 21).

70. 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 déonto, nov./ déc. 2001, vol. 9, no 2.

71. Responses for slides 64 to 69
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.
Margot Phaneuf, inf., Ph.D.

72. 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 caregiver’s attitude often involuntarily provokes violence and agitation among patients.

73. Dealing with difficult behaviour
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.
Constraints are not the only solution to overcome difficult behaviour.
Constraints should be used only under extraordinary circumstances.

74. Rules for engaging with a patient whose behaviour is difficult
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.

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

76. Code of Ethics of Nurses Which ethical principles
Were you aware that
Mr. Lemire had a young
mistress?
What a Casanova!
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.

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

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

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

81. 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 nurse’s duty to exercise leadership and to protect those under her responsibility.
Margot Phaneuf, inf., Ph.D.

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. Leadership is important in a team to put things into
Listen up girls! We’re here to
answer the patient’s needs.
Raising him
is extremely important.
I’m really fed up!
Mr. L. want us to raise him. It’s
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 patient’s needs are met.

84. Next The team must avoid spreading stereotypes. They’re contagious.
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.
Next
The team must avoid spreading stereotypes. They’re contagious.

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

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
Margot Phaneuf, inf., Ph.D.

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. Never! Constraint is to 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!

89. again complaining that we’re neglecting her dad.
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. Avoid value judgements and stereotypes!
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.

91. The Nurse’s or Care givers 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.
The nurse must exercise leadership
to guarantee the patient’s quality of life.
The nurse provides warnings and
guidelines when necessary.
Margot Phaneuf, inf., Ph.D.

92. 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.

93. guys spoil the patients and then we’re stuck with more work!
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. You just want the families to like you. You’re wrong! We just want
to offer the best care
possible to the patients.
Margot Phaneuf, inf., Ph.D.

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

96. all touchy-feely. We don’t have your resources!
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.
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).
Margot Phaneuf, inf., Ph.D.

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

99. Teams sometimes gang up on families.
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.

100. You are mistaken. We never forget to raise them
You are mistaken. We never forget to raise them. It’s a standard operating procedure.
My wife is frightened when you forget to raise her bedrails.
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. We don’t want to criticize you guys, but he’s always sleeping
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.
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.
Margot Phaneuf, inf., Ph.D.

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

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

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

106. She must also provide the necessary explanations.
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. 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 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.
Margot Phaneuf, inf., Ph.D.

108. 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.

109. Responses for slides 100 to 105
Ethical principles
Disregarding the dignity of a person and/or his
family or significant others.
Disregarding the person’s integrity.
NOTE
It is an extremely serious offense to tolerate
abuse against others.

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

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;
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

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;
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)

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.
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Pancrazi, Marie-Pierre et Patrick Metais (2004) Éthique et démence. Paris, Masson.
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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). Ethics Elements - Serious Thoughts in a Cartoon (3 parts). Infiressources, Professional Crossroad, section Day-to-day Ethics :
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 :
Rigaux, Natalie (1998). Le pari du sens. Une nouvelle éthique de la relation avec les patients âgés déments. Le Plessis-Robinson, Institut Synthélabo.
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