When responding let me know if you are an RN/LPN/MA/CNA or other.

I am a CNA and one day I was asked by an RN to help assist her while she inserted a Cath in one  of our HOSPICE patients who had a very bad bladder infection and had not urinated in over 32 hours. She was the sweetest little lady and 92 years old and dementia had pretty much consumed her mind.  Well, it was just about the worst experience I have ever had as a CNA.  The RN was borderline abusive in my opinion. I want to know what others think. First of all, she did'nt really explain what we were trying to do. The little lady was so scared. She yelled and yelled. STOP!  DON'T TOUCH ME DOWN THERE!  RAPE! RAPE!  She of course clamped her legs together. She cried and screamed throughout the whole procedure.  The nurse did not stop, she was not gentle, she never talked to her ...always about her as if she was'nt there. (Which she was'nt (pardon the pun)). Anyway she did not have the proper needle to fill the little bulb-thing.  So she had me run out and ask the facility for one.  We were a hospice unit coming into that facility 4 times a week. Anyway when I got back she was holding her down by her shoulders saying, "Stop it. Stop it right now."   I have never assisted inserting a catheter before.  I do not think this was normal.  But I often wonder when I will become a nurse how will I handle this kind of situation.  I want to be better. What advice or experience can u share?  (This happened over a year ago and it still bothers me.  She died about 3 weeks later as she was terminal. But what a horrible experience after 92 years on this earth) Mel_nurse13

dmazment says ...

I'm an RN and several things I would have done differently are I would have talked to her, at length to explain what I was doing and why.  Regardless of whether or not she had dementia, you can allay fears and get co-operation when talking in a gentle tone, even raising your voice, keeping it gentle if the patient is hard of hearing.  I would have made very sure I had all of my supplies before even starting, rather than having you run out of the room.  I also would have checked to see if possibly there was some medication ordered prn for agitation and given this a half hour prior to trying to place the foley.  If there was not, I would have called the physician, after trying to place the foley, let her calm down and administer the medication and tried again later. After 32 hours of not urinating, another half hour to an hour wouldn't have made much difference, usually.  If neither of you were familiar with her and did not perform regular daily care, I would have found a staff member who knew her well and she trusted to also assist with the insertion.  I also would have asked you to talk calmly and nicely to her, reassuring her this was not a rape or assault.  Calm voices do wonders, if used from the beginning.  If none of these steps worked, I would have stopped, called the physician.

I totally agree. I am a CNA who has specialized in hospice for over 10 years and the main thing to remember is to reassure. Even if they are confused, a calm, reassuring voice works wonders. Pre-medication and making sure all equipment is there is very important.  I am sorry this was a bad experience for you and hope that in the future that it will go better.  Good luck!

I agree with dmazment. Talking to the patient calmly and explaining what she was going to be doing before she even started would have been great. Also to talk to the patient while you're doing it and telling her exactly what you're doing and when you will be touching them. Also a prn med like ativan would have been good to give before hand. Having a staff member present that the patient knew and trusted would have probably made it a little easier on the patient too. I know alot of older patients especiallly at 92 do not want to spread their legs no matter what. But there were steps the nurse could have taken to make it a little less tramatic for the patient.