e. Resists Care -
Resists taking medications/injections, ADL assistance or help with eating. This
category does not include instances where the resident has made an informed
choice not to follow a course of care (e.g., resident has exercised his or her
right to refuse treatment, and reacts negatively as staff try to reinstitute
treatment).
Signs of resistance may be
verbal and/or physical (e.g., verbally refusing care, pushing caregiver away,
scratching caregiver). These behaviors are not necessarily positive or negative,
but are intended to provide information about the resident�s responses to
nursing interventions and to prompt further investigation of causes for care
planning purposes (e.g., fear of pain, fear of falling, poor comprehension,
anger, poor relationships, eagerness for greater participation in care
decisions, past experience with medication errors and unacceptable care, desire
to modify care being provided).
Process: Take an objective view of
the resident�s behavioral symptoms. The coding for this item focuses on the
resident�s actions, not intent. It is often difficult to determine the meaning
behind a particular behavioral symptom. Therefore, it is important to start the
assessment by recording any behavioral symptoms. The fact that staff has become
used to the behavior and minimize the resident�s presumed intent (�He doesn�t
really mean to hurt anyone. He�s just frightened.�) is not pertinent to this
coding. Does the resident manifest the behavioral symptom or not? Is the
resident combative during personal care and strike out at staff or not?
Observe the resident.
Observe how the resident responds to staff members� attempts to deliver care to
him or her. Consult with staff that provides direct care on all three shifts. A
symptomatic behavior can be present and the RN Assessment Coordinator might not
see it because it occurs during intimate care on another shift. Therefore, it is
especially important that input from all nurse assistants having contact with
the resident be solicited.
I resident that is alert and oriented X3. Refused meds, ordered treatments. We got sited because the MDS did not code for resisting care. It is the SS impression that he is simply stating his right to refuse. I remember reading something last week from the group about this.
Can someone give me a source to back up failing to code resisting of care due to right to choose. Thanks.
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