Resident Physically Restrained and Injured During Care by Nurse
Penalty
Summary
A cognitively impaired resident with severe vascular dementia, psychotic disturbance, anxiety, delusional disorder, depression, and chronic pain was subjected to physical restraint by a nurse during incontinence care. The resident, who had a history of combative behaviors such as hitting, scratching, and rejecting care, required two-person assistance for personal care. During an episode of care, a nurse entered the room while two nurse aides were assisting the resident and proceeded to hold the resident's arms down, crossing them over her body to restrict movement. The nurse used a technique previously employed in an emergency department setting, despite not being familiar with the facility's policies and procedures regarding restraints in LTC settings. The nurse's actions were witnessed by two nurse aides, who reported that the nurse also cursed and spit at the resident, further escalating the resident's agitation. The nurse placed a pillow over the resident's face, though it was not held down, and the aides removed it. The resident screamed during the restraint and subsequently developed bruising and scratches on her hands, wrists, and forearm, as well as pain that required as-needed pain medication. The nurse aides recognized the actions as abusive and reported the incident, though one aide delayed reporting due to being in shock. Medical assessments following the incident documented new bruising, scratches, and complaints of pain in the resident's hands and wrists. The resident expressed fear and stated that her hand was broken and hurt. X-rays were performed, revealing no fractures, but the resident continued to experience pain and anxiety, requiring additional medication. Staff interviews confirmed that the nurse's actions constituted physical restraint and were not in accordance with the resident's care plan, which emphasized non-restrictive interventions and re-approaching the resident if care was refused.