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Why don't they just call it how it is? How bad does it have to get. I float and watched a nurse take off a huge dressing on the patients bottom and saw a huge nasty sore with open areas and ooze. The discoloration was from the chemicals in the wipes we use and the open areas were skin tears. That is what she told another nurse doing an assessment, after they both got done refering to it as a pressure sore. She must have forgotten that CNAs don't change those dressings. So they decided to let it heal a week and documented how they hoped it will look. So we still boast no pressure sores. Would there be more documented pressure sores if CNAs just got blamed instead. We get blamed for everything, one more thing won't hurt. Then efforts can be made to treat them. Since that patients sore was not caused by pressure, even though it was, I heard them, they got defensive when I said I always find that patient flat on her back. She is not being repositioned. Wrong thing to say. The patient is on an air mattress, turning schedule and only up two hours. It is because she is not eating. And the way we are wiping the top of the bandage. Denying pressure as contributing to the worsening of her, I think they wrote abrasion, not sure, is preventing proper treatment. It will not get back to her not being turned, actually it has been denied. Maybe it is just where I work. I hope the big boss they are all hiding from does not deny it too.

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passivesambo. You are so right and so wrong in your observations about this patient's pressure sore and that is probably why no one else has replied to this after three days. They don't want to touch it with a ten foot pole. My first reaction to your post I will admit was anger. But anger is bad for my blood pressure which is already too high.
On calmer reflection.
There are many reasons why patients develope pressure sores and they are all related to the blood supply to an area. Some are definitely due to neglect and others due to circumstances. Have you ever got a sore on your heel from improperly fitting shoes or a blister on your hand after using things like scissors or a screwdriver? these are all pressure sores and if you continue to do whatever caused the problem they will get worse, bleed and may become infected.
This patient is clearly seriously ill and although you don't say likely a patient in a nursing home. She is comming to the end of her life and all her vital systems are slowly shutting down which means her blood is not pumping round her body as effectively as yours is. blood carries oxygen and nutrients to all parts of our bodies. Her bottom is not recieving enough and in her weakened state there will be skin break downs in areas where a lot of pressure is applied. I can not judge if she is being turned or not but assuming she is it is likely she would also be at risk for sores on both hips as well and maybe elbows and heels, ears, cheeks, nose and anywhere else pressure is applied.
There is failure to provide proper care in residential facilities as everywhere else. i don't know if this is the case where you work. Nurses have to be very careful in the notes they make in a patients chart because of the ever real fear of lawsuites. That is fact not defense of what you saw.
Now what you saw was clearly a pressure sore. I don't doubt your word. the dressing had to be so large so it could be taped to healthy skin and not have the tape cause further damage. The discoloration you observed around the open area was probably not caused by the wipes you used to clean, if it was you would not be allowed to use them on anybody. The purpleish skin was further extension of the sore and will eventually open up too, it has to because it is dead tissue and it has to be allowed to slough off for healthy tissue to regenerate underneath. red bleeding areas are actually good news. it indicates that area is healthy and has a good blood supply. In very severecases the dead tissue may be surgically removed.
You mentioned this patient is not eating which indicates she may be close to the end of life. if you ever work in the home with dying patients you will be appaled at what you see when skelital patients cling to life for some reason and despite the loving care they are recieving their bodies will be covered in sores. the caregivers feel so much guilt and second guess many decisions but the experienced nurse is able to reassure them they have given the best of care and even if they had done the turning every five minutes the outcome would not have changed.
I can not judge the treatment the nurses you observed were giving. I was not there and have not read the orders for this patient.
You are a CNA with minimal training and I have no idea how much experience, and clearly want the best for your patients so do the best job you can in what you are trained for and the day to day responsibilities and remember to report anything you may observe so that the RN.s LPN.s whoever is ultimately responsible for the patient's care that day can alert the Dr. You have done your part. No harm in asking questions but don't accuse, that makes people defensive and you won't learn that way. if you plan to continue further in a nursing career everything you learn as a CNA will be invaluable. There is a huge amount of information on everything from basic nursing care to the interaction of drugs on the internet. Not only will it help you become a first class CNA but greatly assist in any future training you seek. I trained as a RN almost 60 years ago in the UK and in those days it was more like an aprenticeship where we started out doing CNA type things and a lot of cleaning because nothing was disposable, but were ecouraged to watch anything going on that our superiors were participating in. I know it is a different world but I have been retired six years and still keep up my research and interest though a forum like this. Good luck to you in the future. Keep questioning but don't jump to hasty conclusions learn a lot and when you are in charge make sure everything is done right.
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Recently removed my Mother from ALZ two week respite facility for SAME reason. Also theft. Soant hidden issues. All denied. She was always soaking wet. Diaper not changed unless I did it. I was there day and night. Staff so nice toy face. Facility a chain. Supposedly high end. New here sine April. Still only 7 patients. We now have our wound center treating her for the bedsore. She is home with me. The ALZ facility told me to keep it covered with A&D ointment. Called me and told me to buy some and bring it to mom. Common sense told me something was wrong with that. They insisted. Up until that point it was a slightly pink pressure sore. I had it under control. Once she went there it became soaked in urine unless I showed up and cleaned her. One time I took her diaper up to the nurse to show her it's weight in urine. This night nurse was getting ready to go home and said that was impossible. That she had just changed her. Yes, some places really avoid the truth. Easy to do. Keeps their statistics looking good. Criminal. I took on out. She is home. Sore almost gone. Good luck. Keep your eye on your loved ones in a facility. There ate good nurses and bad nurses. The bad ones often know how to play the game and hide the truth. The good nurses are aware of this but can't do anything about it. Understaffed and overworked. The $$profits are shocking. Good care or bad care the owner is hauling it in.
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Well as a nurse having worked in the hospital and nursing home setting, I will tell you I never denied a decubitus (pressure sore) as what it was. Turning every two hours is standard care, however, when sores get very bad, at some point in time this is the body's way of saying the tissue is very compromised. No amount of turning and nursing care will help if this person is dying. Nurses and doctors are not Gods. We cannot prevent sores. If you have concerns, take them to the director of nursing at your work and discuss your concerns. Telling us will do no good for that patient. If the nurses are too busy to turn, ask them while you are perhaps bathing or changing sheets if you can reposition, if you are able. Do not hurt yourself. And if you are very unhappy with your work environment, work somewhere else or improve your education so you will be more in charge of patient care. Being part of the solution is much better than complaining. You have the ability to improve your life. Merry Christmas!
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elle3000, hugs to you for caring so much for your patient. You made a great deal of difference in her final time on this earth.
What you are now experiencing is probably simply grief.
Was this your first death?
Everyone experiences grief differently but look up stages of grief and you will find it takes a particular course and every stage has to be experienced. It is different for everyone and each stage does not have a predetermined length.
Once you begin your next assignment it will be easier to move forward. Every caregiver feels a sense of loss when they loose a patient but professionally you have to move ahead and file these feelings away in your inventory of experience. Some patients you will remember for ever others not so much. Now you have written about your feelings it will be easier to talk to your husband.
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I am so glad we (my dad and I) decided to keep my mom home and care for her there. We love her and do the best we can with help from hospice. Yes she has bed sores but we are taking care of her all day long. She is dying and there is nothing we can do about that she is almost 92, but we love her and bathe her and move her and talk to her and feed her. At least she is not being ignored at a facility that is only interested in the money.
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Veronica91. You are a rare jewel. Thanks. Not like the professionals I have run across in this area. Three years ago I was a professional artist and art teacher and believed the best in people. Thought they did their best. Thought they though like you. I am not angry. I am amazed and saddened at the care in facilities. The hard court press to "sell" the facility. The glossy brochures of residents playing miniature golf. Really! Car sales. We have one decent facility in this area and it has a two year waiting list. Like the Dr. in the hospital told me...the rest are holding tanks. Maybe it's time to move from this dying area. Thanks for your long post. You must have been a fantastic nurse!
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Having worked as a CNA for years, in a number of facilities, I can tell you this is nothing new. Some of the abuses I have seen are shocking. I am no longer working as a CNA for those reasons, as well as the low pay and understaffing. I now look after my 94 year old mom and 87 year old dad, who live in an assisted living facility. Now I get to see the corporate abuse as well. Constant overcharges in the billing, a refusal by the director to itemize the bill so that I can have an idea what the extra charges are for, medication theft, etc. First and foremost, assisted living and skilled nursing facilities are a business, run like any other. As a CNA, you are required to keep your mouth shut if you want to keep your job. My recommendation is to work in Adult Family Home where you only have six people to care for. There is more time to give adequate care, and the families are more often involved as well. That was my experience, anyway.
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My mom lives at home with me and I do have a lady who stays with her during the day so I can go to work. My mom is very thin and developed a pressure sore on her bony little hip. She sleeps on her left side, and no matter how she starts out at night always manages to turn to her left.
We finally got it healed, but it was an ordeal as she always managed to peel off the bandaid and land back on her left side.
I guess what I'm saying is that sometimes no matter what you do or how hard you try those pressure sores can still pop up.
Calling a pressure sore a skin tear, though, is absurd.
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Skilled nursing facilities are NOTORIOUSLY understaffed. The priority is maximum profit for the owners & dangerous staffing levels, practically no "extras" for the residents (like A&D ointment, television, laundry, etc.) It is not unusual for an RN to have a patient load of 40+ patients, and for an LPN to be responsible for passing meds to 40-60 patients in a day. Forget about the CNA's----they have so many patients to bathe, feed, change Depends, turn & position, get into wheelchairs & back into bed, etc. that they're lucky they can walk out the door at the end of their shift. Most long term care facilities are privately owned, & so the priority is profit, not quality care. Sure, the brochures & websites that show elderly people will big smiles on their faces & a nurse sitting next to them holding their hand are greatly exaggerated. A nurse doesn't have time to go to the bathroom, so forget about holding anybody's hand. But pretty, glossy, fancy brochures is great marketing---nobody would go to a place that put a picture of a huge bedsore on the front cover of it's brochure.

Bedsores that develop in a long term care facility are a MAJOR big deal----they are reportable to the state & then the state will come & do an inspection of the facility. They'll find problems & cite the facility for the problems. The facility has a set amount of time to fix the problems or else they lose accreditation. Most places put on a big show when they know they are being audited & inspected---they put extra nurses & CNA's on duty, they fudge the staffing sheets to make it look like there are more working than there really were, staff gets told to be extra nice & know where the fire escapes are, & everybody acts like they are so vigilant. As soon as the inspection is over, everything goes back to the way it was. There is little oversight of LTC facilities. The state is supposed to oversee them, but the truth is that there are so many LTC places that it is impossible to keep track of them all.
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Why do nurses (and others) refuse to admit there is a pressure sore (or other, similar problem)? Blame.

When you live - as we all do - in a culture where people focus far too much on who is to blame for a problem, rather than on dealing with the problem, everyone spends too much time dodging the blame. Thereby they also dodge the issue. It is bad news for everyone.

It also makes it very hard to ask questions or make observations without causing an automatic, defensive reaction: this leads to poor communication, which leads to poor care.

In a neutral world, you would be able to state calmly "this patient has developed a pressure sore" and all attention would be focused on getting it healed and attempting to prevent further ones developing - always bearing in mind, of course, that in very frail, ill patients it isn't even necessarily possible to achieve that. In our sad world, as you have so clearly described, half of the nurses' time and expertise is wasted on polishing the patient record. It is infuriating, it is wrong, it is detrimental to patient welfare.

Much cleverer people than me are doing their best to sort it out, with some success in some hospitals for example, and that is the most hopeful aspect I can see of the whole sorry mess.
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