Failure to Maintain Resident Dignity During Fluid Restriction Enforcement
Penalty
Summary
A deficiency occurred when a registered nurse (RN) physically struggled with a resident to take away a cup of water, resulting in the resident feeling disrespected and sustaining a scratch on the arm. The resident, who had a diagnosis of schizoaffective disorder but was able to communicate clearly and had no history of behavioral symptoms directed toward others, reported that the RN grabbed his arm and scratched him while attempting to enforce a fluid restriction. The resident expressed feeling treated like a child and experienced emotional distress as a result of the incident. Multiple staff interviews confirmed that the RN attempted to take the cup of water from the resident, leading to a physical struggle. A certified nursing assistant (CNA) and another RN witnessed the event, with one staff member intervening to stop the struggle and clean up spilled water. The progress notes documented the resident's report of being scratched by the nurse during the incident, with visible evidence of a scab and red mark on the resident's forearm. The RN involved acknowledged attempting to take the cup from the resident and stated that she had received crisis prevention training. The facility's crisis prevention instructor clarified that staff are not permitted to physically handle residents unless there is a danger to self or others. The director of nursing (DON) stated that the expectation is for staff to communicate calmly with residents, explain risks, and avoid physical altercations.