Resident Dignity Compromised by Improper Wheelchair Handling
Penalty
Summary
A deficiency occurred when a nurse aide (NA) pulled a resident's geriatric wheelchair backwards down the hall from the nurses' station to the dining room, a distance of approximately 50 yards. The resident, who had a history of cerebral infarction resulting in limited range of motion on one side and was dependent on staff for wheelchair locomotion, was cognitively intact and reported feeling undignified and as if she was being treated like a 'crazy person.' The resident expressed that she did not want to go to the dining room and specifically disliked being pulled backwards, noting that this NA was the only staff member who moved her in this manner. The NA stated that she pulled the wheelchair backwards because the wheels were misaligned, making it difficult to push the chair forward as trained. However, she had not reported the issue to maintenance, and there were no work orders on file to repair the wheelchair. Facility leadership, including the Nurse Consultant and Administrator, were unaware of the wheelchair's condition and confirmed that staff were expected to push, not pull, wheelchairs. The act of pulling the wheelchair backwards was acknowledged by facility leadership as undignified treatment.