Resident's Right to Refuse Care Not Honored, Resulting in Injury
Penalty
Summary
A deficiency occurred when a Certified Nursing Assistant (CNA), who was an agency staff member, failed to respect a resident's right to self-determination by transferring the resident out of bed for a shower despite the resident's explicit refusal. The resident, who had diagnoses including high blood pressure, arthritis, weakness, and chronic pain, was assessed as having moderate cognitive impairment but was able to make their needs known and communicate effectively. The resident verbally communicated to the CNA that they did not want to get out of bed, but the CNA proceeded with the transfer after being told by a nurse that the resident would be fine once up. During the transfer, the resident resisted, and the CNA used a bear hug technique to move the resident from the bed to the wheelchair. As a result of the transfer, the resident sustained a significant skin tear, approximately ten centimeters long, to the left lower leg, which required hospital treatment and sutures. The incident was witnessed by other staff who noted the CNA appeared verbally agitated, and the resident later described the transfer as rough and feeling like a tussle. The resident expressed being upset about being made to get up and reported pain and ongoing discomfort from the injury. The care plan and medical records confirmed the resident's ability to make choices and the expectation that staff would respect those choices, including the right to refuse care. The facility's investigation into the incident focused primarily on the mechanics of the transfer rather than the violation of the resident's rights. Interviews with staff revealed inconsistent understanding and application of resident rights, with some staff indicating they would follow a nurse's directive even if it contradicted a resident's expressed wishes. The facility's policies and resident handbook emphasized the importance of resident choice and self-determination, but these were not followed in this instance, leading to the resident's rights being disregarded during the event.