Communicating with
the Elderly:
Choosing Respect in
Caregiving
Exercises for Beginners
Margot Phaneuf, inf., Ph.D.
1
Choosing Respect in Caregiving
Margot Phaneuf, inf., Ph.D.
2
WARNING
The case studies in this presentation illustrate
situations that are unacceptable and the
dialogues are unfortunately all too real.
These cases unfortunately diminish the
accomplishments of exemplary caregivers.
We offer them our sincerest apologies.
Margot Phaneuf, inf., Ph.D.
3
Ethics: a bastion against abuse
Providing care to the elderly raises serious ethical
questions, namely:
. How to always maintain the elderly person’s dignity;
. How to always respect his autonomy, even if he is in a
state of confusion;
. How to limit the caregiver’s temptation to build relations
based on authority and the potential for manipulation;
. How to maintain the caregiver’s integrity and to limit
the possibility of mistreatment;
. How to receive the patient’s family.
Margot Phaneuf, inf., Ph.D.
4
Objectives
Generating the student’s reflection
on critical situations with the elderly
patient.
Raising awareness that despite the
best intentions, some of the patient’s
significant needs may be left
unanswered.
Getting the student to realize that
warm and empathetic relations can be
Margot Phaneuf,
inf., Ph.D. gestures.
established through
minor
5
Objectives
Getting students to understand that
ethical principles apply to everyday
caregiving activities.
Generating awareness that abusive
behaviour exists and is more common
than we think.
Getting students to understand that
abusive behaviour is often subtle or
hidden.
Margot Phaneuf, inf., Ph.D.
6
Satisfying the needs and expectations of
the elderly
 One of the foundations of quality caregiving is to
satisfy the needs of the patient.
 Downsizing and repetitive standard operating
procedures often impede this objective.
Organizational routine often becomes an end
instead of a means.
 This often results in caregivers providing
inadequate responses, which demonstrate a lack of
ethics, simple manners and quality of care.
Margot Phaneuf, inf., Ph.D.
7
Needs, expectations and preferences vary
Every person experiences different needs. Some
hate washing themselves while others enjoy baths.
Some like getting up and walking while others
need stimulation to engage in activities.
Quality care takes these differences into
account.
It is what we refer to as personalized care. This
is based on proper organization and, more simply,
on politeness, respect and good manners.
Margot Phaneuf, inf., Ph.D.
8
Task organization and personalized care
Establishing good relations with the patient usually
depends upon minor, everyday details and
answering simple requests to meet his needs or
those of his loved ones.
Sometimes, this can mean:
Breaking the routine
Demonstrating goodwill
Being creative
Margot Phaneuf, inf., Ph.D.
9
Responding to the patient’s physical needs



The following situations illustrate
inadequate responses in which the patient’s
needs are not met.
How would you respond if you were in the
caregivers’ position?
More practical responses will be made
available later on.
Margot Phaneuf, inf., Ph.D.
10
Could you let me sleep a little?
I haven’t slept all night.
So you think you’re
the only one here!
Do you think you’re
at a hotel?
Which articles of the
code of ethics have been
ignored in this case
and those that follow?
Which ethical
principles are ignored?
Dysfunctional and arrogant response
Better response to follow
11
That’s not possible!
Could you wake me up earlier
so that I can take my bath?
I like getting up early.
You’ll just have
to wait your turn.
Dysfunctional and authoritative response.
Better response to follow
Margot Phaneuf, inf., Ph.D.
12
Well don’t come complaining
to us that you’re constipated!
I don’t want to take a laxative.
It hurts my stomach and I’m
embarrassed to repeatedly ask
to go to the bathroom.
Retaliation, mocking and intimidation are
considered acts of psychological abuse.
OIIQ, Le Journal, Chronique déonto
novembre/décembre 2001, Vol. 9 No 2.
Better response to follow
Could you put on a second
gown? The opening in
the back gives me the chills.
That’s odd! Why don’t
you just pull up your
blanket?
You’ve got hands…
This is a case of mocking.
The patient’s need is unmet.
Better response to follow
You’ll have to wait a week.
The attendant is on
holiday.
I wish someone would give me a
bath. I used to wash myself every
day. I like feeling clean.
The patient’s values always supersede those of the nurse.
The quality of the therapeutic relation relies on the ability to
establish a respectful, reliable and trustworthy environment in which
the primary focus is the patient.
OIIQ, Le Journal, mars/avril 2001, Volume 8,
Numéro 4. Chronique déonto. Les obstacles à la relation thérapeutique »
Better response to follow
Margot Phaneuf, inf., Ph.D.
15
I wet my bed.
Could you change
my pants and sheets?
We’ll have to hoist you and you
know that using that machine is
complicated…
It is the nurse’s fundamental duty to guarantee the
safety and well-being of the patient. It is our duty
to provide him with the care required by his
condition while respecting his physical and
psychological integrity. OIIQ, Chronique déonto,
Le Journal, novembre/décembre 2001, vol 9 no 2.
Better response to follow
We have to
hoist him.
I saw a great
movie yesterday.
I was with Paul.
It was a terrific
evening.
2- Staff indifference is noticed. For example, it consists of talking about unrelated
subjects with other staff members while the elderly person is being moved like an
object and is not even acknowledged by them.
(OIIQ. (2000) L’exploitation des personnes âgées).
17
I’m bringing back Mr. Dubois
I’m hungry, Marge!
Can’t you see that it’s too late
for supper?
Now he’ll have to wait until
tomorrow.
Unanswered need and threat.
Margot Phaneuf, inf., Ph.D.
18
Responses to slides 11 to 18
Code of Ethics of Nurses, OIIQ
Division I
6 – Availability and Diligence
25. In the practice of his or her profession, a nurse shall
display due diligence and availability.
Division II
3- Prohibited behaviour
37. A nurse shall not use verbal, physical or psychological
abuse against the client.
(threats and pressure are a type of abuse).
19
Ethical principles for slides 11 to 18
We should never forget the ethical principles which guide
caregiving. The following principles were neglected in the
previous cases:
. Respecting the person’s dignity regardless of his physical or
psychological state. Courtesy is mandatory.
. Respecting the person’s freedom, autonomy, values and decisions (if
he is competent). We must obtain his consent before proceeding with a
medical act and he has the right to refuse care.
. Respecting the person’s integrity, inviolability (respecting essential
needs, avoiding all forms of violence, preventing risks to his health and
well-being).
20
Responses which are not time-consuming and which
require little effort exist and go a long way.
The following are a few examples of
appropriate responses for the preceding
cases.
It is often easy to respond and meet the
person’s needs and expectations.
However, hiding behind standard
procedures and regulations can be
convenient.
This shadows the fear of getting
involved and of being overwhelmed by the
patients’ demands.
Margot Phaneuf, inf., Ph.D.
21
Best response for
slide 11
Please rest! I’ll start with
someone else.
I haven’t slept all night!
Logical and comprehensive response
22
Could you wake me up earlier
so that I can take my bath?
I like getting up early.
I’ll switch your turn
with someone who likes
to stay in bed.
Best response for
slide 12
Respecting the patient is also respecting
his values andMargot
autonomy
whenever
possible .
Phaneuf, inf.,
Ph.D.
23
I don’t want to take a laxative.
It hurts my stomach and I’m
embarrassed to repeatedly ask
to go to the bathroom.
Best response for
slide 13
We’ll try to find
a better balance.
Division II- 3. Prohibited behaviour. 37. A nurse shall not use verbal, physical
or psychological abuse against the client. Imposing a treatment is abusive.
24
I’m cold wearing this gown.
Best response for
slide 14
I’ll get your sweater. You’ll
be more comfortable.
Code of Ethics of Nurses; Division I – 6, section 25. In the practice of his or her
profession, a nurse shall display due diligence and availability.
Margot Phaneuf, inf., Ph.D.
25
I like having baths - often.
As soon as one of us
is available,
we’ll give you a bath.
That would be nice.
Best response for slide 15
Whenever possible, put aside what you are doing and pay attention to the client and
his family. If you are unable to do so, inform the client and his family. By reacting
promptly, you are in fact demonstrating that you are listening to their concerns. This
will help maintain their confidence. (OIIQ, Le journal, mai juin, 2005.
http://www.oiiq.org/uploads/periodiques/Journal/vol2no5/ss04.htm)
26
I wet my bed.
Could you change
my pants and
sheets?
I’ll ask for help and we’ll be able
to change your pants and sheets
without moving you too much.
Best response for slide 16
Same comment for slide 15
27
We’re here to lift you.
How are you
feeling today?
You’ll feel
better getting up.
Best response for slide 17
We should address the patient, get him to talk and avoid
engaging in personal conversations in his presence.
28
I’m hungry, Marge!
You’re bringing him back late,
but there’s surely a way to
find him something to eat.
Best response for slide 18
Margot Phaneuf, inf., Ph.D.
29


Alleviating pain is a primordial element
to consider.
Neglecting to carry out this responsibility
appropriately is a serious breach of ethics.
Margot Phaneuf, inf., Ph.D.
30
Alleviating pain
Alleviating pain is an essential need which raises
certain problems:
Responding to the patient’s complaint requires
attentive listening;
Evaluating pain is difficult among the elderly,
who are often confused;
Determining the relevance of offering a
prescribed analgesic can contradict our fear of
creating addiction. Nurses should avoid judging
another person’s threshold for pain based upon
their personal limits;
Administering a medication to provide optimal
relief. Nurses should not wait too long and should
follow the correct intervals between doses.
Margot Phaneuf, inf., Ph.D.
31
I’m still suffering.
Could you give
me something?
Again?
You’re taking way
too much medication.
Dismissive attitude which
demonstrates lack of
empathy.
Margot Phaneuf, inf., Ph.D.
Next
I’m still
suffering!
I understand you Ms. White.
The pain has got to stop.
I’ll talk to the doctor.
We’ll find a solution.
Best response for slide 32
33
My back is
killing me!
I don’t have anything
prescribed for you.
You just have to talk to your
phsyician!
I really can’t do anything.
I don’t have
a magic lamp!
This dysfunctional response
blames and casts guilt upon the
patient and illustrates a lack of
empathetic understanding.
Next
I’ll call the doctor.
He might be able to prescribe something.
I’ll massage your back to alleviate your
pain before bedtime.
Now my back is really
killing me!
This answer illustrates that the nurse
has listened and responded to the patient.
Best response for slide 34
35
Inappropriate behaviour resulting in
mistreatment:
using rudeness and infantilization.
Avoid at all cost!
Margot Phaneuf, inf., Ph.D.
36
Mistreatment or abuse
It is not our job to judge fellow caregivers as
if they were slaves to an assembly line;
however, we should be aware of the potential
for abuse and denounce it in all of its forms.
Abuse is unfortunately present among
families and healthcare institutions. There is
plenty of abuse, even hidden.
« Abuse occurs when a caregiver or an
institution commits, tolerates or provokes an
act that a healthcare professional would not
commit against his own family member or a
loved one." Source: Yves Gineste, 2004, Silence on
frappe. Collectif, p. 17.
37
Ernest it is time you went to bed
like everyone else!
We’ve got more to
do than just putting you
to bed.
Which articles of the
Code of Ethics of
Nursing are
breached in the
following situations?
Which ethical principles
are disregarded?
38
Can you change my diaper?
Again?
You’ll just have
to wait.
Rudeness, threat and failing to respond to a need
2- "It should be noted that incontinence pants are widely used. The Association
des CLSC et des CHSLD du Québec reported that it is imposed upon 66% of
residents whereas ‘it is known that 13% of these residents can manage their
own hygiene if only adequate supervision were provided, and that 15% of these
residents would be continent if they were provided more frequent assistance to
go to the bathroom.’"(OIIQ. (2000) L’exploitation des personnes âgées).
Margot Phaneuf, inf., Ph.D.
Suite
Albert, you unplugged your
collector pouch again.
Could you be more careful?
40
Inappropriate and infantilizing manner of addressing patient.
Bernadette!
You stupid, stop going through
the drawers! This isn’t
your room, you know.
Using insults is a prohibited behaviour,
considered an acts of psychological abuse. OIIQ,
Le Journal, Chronique
déontonovembre/décembre 2001, vol. 9, no 2. 41
Lise, I’m hungry.
You didn’t want to eat
earlier. Too bad! Now you’ll
just have to wait until
dinner.
The nurse lacks empathy,
is impersonal and fails
to consider the other person’s
needs and
expectations.
This response blames the
individual and is punitive.
I just changed your sheets.
I hope it’s the last time
today that you leave
me with a surprise.
You got chocolate
all over the place.
Retaliation, mocking and intimidation are
considered acts of psychological abuse.
OIIQ, Le Journal, Chronique déonto
novembre/décembre 2001, vol. 9, no 2 .
Reflection
I don’t understand
why people enter my
room without knocking, why
they are impolite with me,
why they bark orders, why
I’m constantly being blamed,
and why I’m being treated as
if I were a nobody.
2- The OIIQ will not tolerate any situation involving lack of respect
observed during a formal inspection or which is reported by interveners in
residential and long-term care centres (CHSLD). OIIQ. (2000)
L’exploitation des personnes âgées.
44
Responses for slides 38 to 44
Code of Ethics of Nursing, OIIQ. Section II3. Prohibited behaviour.
37. A nurse shall not use verbal, physical or psychological
abuse against the client.
Retaliation, mocking, intimidation or indifference are
considered acts of psychological abuse.
OIIQ, Le Journal, Chronique déonto novembre / décembre
2001, vol. 9, no 2.
Ethical principles:
- Respecting the person’s dignity, freedom and autonomy.
Margot Phaneuf, inf., Ph.D.
45
Mistreatment:
Violence
•
•
Abuse is more common than we may think.
Families often avoid filing a complaint because they
fear reprisals against their loved one.
Complaints are not always well accepted or taken
seriously when families undertake this process.
•
Margot Phaneuf, inf., Ph.D.
46
Types of violence
Abuse exists in many forms, including:
 Physical abuse, which can be identified through bruising;
 Psychological abuse (pressure, threats, insults, raising
tone of voice);
 Passive neglect, which is omitting to help an elderly
person walk or to take care of his hygiene and nutritional
needs;
 Active negligence by depriving a person of his freedom,
unnecessarily using physical constraints, hurrying care
and disregarding standards;
 Therapeutic violence through relentlessness or denial of
treatment (i.e. neuroleptic abuse, casual administering of
laxatives, omitting medications). (Yves Gineste, 2004,
47
Silence on frappe. Collectif, p. 18).
Other forms of abuse
Other forms of abuse:
Denying the elderly person’s sexuality;
Sexual abuse or indecent assault;
Robbing or extorting assets or money;
Living in a situation in which the
individual loses the desire to live.
Abuse is often subtle and hidden.
Excuses are often found to justify it.
48
If you want me to comb your hair
and look good, be kind to me!
There is such a thing as tipping.
Financial requests or exploitation are abusive
gestures that contravene with
ethical standards.
"The OIIQ denounces the exploitation of
elderly persons who are among the most
vulnerable in our society."
OIIQ. (2000) L’exploitation des personnes
49
âgées.
I don’t want to get up
and take a bath.
Whether you like it or not, it’s time
to take a bath. I’ll show you who’s
the boss here.
The nurse is in a position of authority, but that
never justifies abusing it or developing relationships of power.
50
I need to
urinate.
Pee in your pants!
I don’t have time and we
didn’t put you a diaper
for nothing.
Rudeness, profound lack of respect and
failure to meet a need.
51
Albert, if I catch you smoking again,
you’ll be the last one
looked after in the morning.
Rudeness, threats and blackmail all contrary to ethical standards.
Margot Phaneuf, inf., Ph.D.
52
Albert, you pig!
Leave Ms. Aphrodite alone!
Rudeness, insult and value judgement.
Margot Phaneuf, inf., Ph.D.
53
I’m soiled.
Could you change
my pants?
Soiled again, eh!
Always stuck
with your shit!
Totally unacceptable insult.
54
Arthur, you baby!
Stop playing with the
IV pole.
Infantilizing and disrespectful behaviour.
Margot Phaneuf, inf., Ph.D.
55
Albert, if you keep
on wandering and
poking around,
I’ll have to
restrain you.
Infantilization and use of threat contrary to ethical guidelines.
1- "…depriving a person of his freedom and well-being through the
inappropriate use of contentions. According to the Association des CLSC et des
CHSLD du Québec (1999 : 4), nearly 3 out of every 10 persons in residential
and long-term care centres experience physical restraints."
56
OIIQ. (2000) L’exploitation des personnes âgées.
Why do they want
to separate us?
Denying the sexuality of elderly persons
is abusive.
Margot Phaneuf, inf., Ph.D.
57
Undressing a person without permission
and care is showing lack of respect.
I don’t want to undress
in front of others. I don’t like it
when a member of the opposite
gender washes me.
1. "Even when the person is confused, showing lack of respect deeply affects
their families who regretfully put up with these situations. In many centres,
elderly persons are unable to choose an intervener of the same gender for their
intimate needs." (OIIQ. (2000) L’exploitation des personnes âgées.)
58
Paul, I saw Lise hitting
Mr. D. His arm is covered
with bruises.
Pretend you didn’t
see anything.
We’ve got to protect
our own.
You’re right!
She’s a coworker.
3- "[Abuse] is often known, but some employees remain silent, fearing
retaliations or being marginalized, etc. In some environments, violence is the
norm. Being attentive, compassionate or polite towards residents is not
accepted." OIIQ. (2000) L’exploitation des personnes âgées).
59
All forms of violence are prohibited when administering care
I don’t undestand why
they insult me,
why I’m left in my
excrements, and why
they treat me brutally.
3- "When examining elderly abuse, we must discuss physical and
verbal violence, which unfortunately is common in certain
environments.’’ OIIQ. (2000) L’exploitation des personnes âgées.
Margot Phaneuf, inf., Ph.D.
60
Responses for slides 49 to 60
Code of Ethics of Nurses, OIIQ. Section 2- Integrity
10 – A nurse shall fulfill her or his professional duties with
integrity.
Division II- 3. Prohibited behaviour
37. A nurse shall not use verbal, physical or psychological
abuse against the patient.
It is understood that inappropriate behaviour means any
form of verbal, physical or psychological abuse. Hitting,
pushing or using force without reason against a client are
examples of physical abuse. Finally, retaliation, mocking,
intimidation and cultural indifference are considered
psychological abuse. OIIQ, Le Journal, Chronique déonto,
nov./ déc. 2001, vol. 9, no 2.
61
Responses in slides 49 to 60
There is a serious disregard of the following
ethical principles:
- Respecting the person’s dignity and right to
autonomy;
- Respecting the person’s integrity and
inviolability;
- Respecting the person’s intimacy.
Margot Phaneuf, inf., Ph.D.
62
Questions and criticism raised by
families
It is true that it is difficult to receive
questions and criticism from families;
however, not all are without foundation.
Staff must be willing to listen.
Defensive or aggressive behaviour does
not solve the problem.
Margot Phaneuf, inf., Ph.D.
63
My mother is anxious. Why
doesn’t she get her
Ativan when she
needs it?
She gets it, but can’t
remember.
Excuse or reality...?
Which articles of the
Code of Ethics of Nurses
are being breached
in this example and those
that follow?
Which ethical
principles are
disregarded?
Margot Phaneuf,
inf., Ph.D.
64
My father’s face is bruised.
He claims the night-time
attendant struck him.
No, he hit himself against
the bed stand.
3- "What do we mean by physical and verbal abuse? Abuse includes slapping,
threatening, intimidating, touching or, abruptly moving, etc. There is talk of
people who escaped and fell on the ground, of bruising and inexplicable injuries.
These terms describe the everyday reality of some elderly persons in loss of
autonomy." (OIIQ. (2000) L’exploitation des personnes âgées).
65
Every time I come here,
my wife is sleeping.
Well, she screams all the time
whenever she doesn’t.
I wonder whether she’s
taking too much medication.
1. "Is it not tempting when staff is limited to resort to ‘medicinal restraints’
that are capable, in the form of a little pill, of calming individuals but which
fail to meet their needs?" (OIIQ. (2000) L’exploitation des personnes âgées).
66
My sister is filthy and
smells bad. Why is that
the case?
She’s mean and impossible. She
is agitated and assaults
us.
She defecates just
to annoy us.
Defensive, impolite and aggressive behaviour which
fails to solve the problem. Repeated incontinence is
not necessarily voluntary. It is the result of brain injuries or
Margot
Phaneuf,
Ph.D.
67
problems
with
theinf.,sphincter.
My wife says you hit her.
She assaulted me
first!
There’s no excuse for assaulting a patient.
Violence is violence.
68
I don’t understand why my
father is always tied to his bed.
He wanders continuously.
‘‘Medical substances, constraints and abusive isolations should
only be used as control measures when there is an imminent threat
to safety.’’ Association des hôpitaux du Québec (2004) Utilisation
exceptionnelle des mesures de contrôle : contention et isolement,
2004, p. 21).
69
Responses for slides 64 to 69
Code of Ethics of Nurses, OIIQ. Section 2- Integrity
10 – A nurse shall fulfill her or his professional duties with
integrity.
Division II- 3. Prohibited behaviour
37. A nurse shall not use verbal, physical or psychological
abuse against the patient.
It is understood that inappropriate behaviour means any
form of verbal, physical or psychological abuse. Hitting,
pushing or using force without reason against a client are
examples of physical abuse. Finally, retaliation, mocking,
intimidation and cultural indifference are considered
psychological abuse. OIIQ, Le Journal, Chronique déonto,
nov./ déc. 2001, vol. 9, no 2.
70
Responses for slides 64 to 69
There is a serious disregard of the following
ethical principles:
- Respecting the person’s dignity and right
to autonomy;
- Respecting the person’s integrity and
inviolability;
- Respecting the person’s intimacy.
Margot Phaneuf, inf., Ph.D.
71
Dealing with difficult behaviour
Caring for patients who express difficult
behaviour requires not only patience, but an
adapted approach.
Employees must never respond to difficult
behaviour with violence.
The caregiver’s attitude often involuntarily
provokes violence and agitation among patients.
72
Dealing with difficult behaviour
A soft and respectful approach with a delicate
touch generally provide better results.
Responding to the person’s essential physical
needs and need for recognition as a human
being is a key to success.
Constraints are not the only solution to
overcome difficult behaviour.
Constraints should be used only under
extraordinary circumstances.
73
Rules for engaging with a patient
whose behaviour is difficult
One of the nurse’s fundamental duties is to guarantee the
safety and well-being of the client. This is not always easy in
the existing context, but it nonetheless remains: to provide
the care required by the client and his condition while
respecting his rights and physical and psychological integrity.
It is the nurse’s duty to withdraw or to ask for assistance
when she feels she is about to commit an unforgivable act.
OIIQ, Le Journal, novembre/décembre 2001, vol. 9, no 2.
Chronique déonto, Comportements inadéquats envers la
clientèle : quand les émotions dépassent la raison.
74
Confidentiality involves
the patient, his
background, his record
and his family.
Margot Phaneuf, inf., Ph.D.
75
Were you aware that
Mr. Lemire had a young
mistress?
Which articles of the
Code of Ethics of Nurses
are being breached
in this example and
thosethat follow?
Which ethical principles
are disregarded?
Margot Phaneuf, inf., Ph.D.
What a Casanova!
76
I read Victor’s record.
Did you know he has a
sexually transmitted
disease?
I sure didn’t!
77
Guess what girls! Mr. Bell’s son has just
been arrested for robbery.
2- "The OIIQ will not tolerate any situation involving lack of respect observed
during a formal inspection… Invasion of privacy and exposing another person
to ridicule can occur in caregiving or residential care."
( OIIQ. (2000) L’exploitation des personnes âgées).
78
Responses for slides 76 to 78
OIIQ, Code of Ethics of Nurses Section II
Provisions to protect the secrecy of confidential
information
31- A nurse shall abide by the rules set forth in the Professional Code
in regard to the obligations to preserve the secrecy of confidential
information that becomes known to her or him in the practice of her
or his profession and the cases where she or he may be released from
the obligation of secrecy.
36- A nurse shall refrain from holding or participating in indiscreet
conversations concerning a client and the services rendered to such
client.
Ethical principles:
- Respecting the person’s dignity
- Respecting the person’s social and psychological integrity.
Margot Phaneuf, inf., Ph.D.
79
Leadership in nursing
against rudeness and violence
Margot Phaneuf, inf., Ph.D.
80
Leadership in nursing
Employees sometimes engage in
inappropriate behaviour.
Teams often have grudges against
patients or do not accept the families’
criticism.
Through her training, it is the nurse’s
duty to exercise leadership and to protect
those under her responsibility.
Margot Phaneuf, inf., Ph.D.
81
You shouldn’t speak so
impolitely to the patients. It’s
inappropriate.
Nobody complains!
When confronting inappropriate behaviour,
leadership and the intervention of coworkers
are important and often prove to be positive.
82
Listen up girls! We’re here to
answer the patient’s needs.
Raising him
is extremely important.
I’m really fed up!
Mr. L. want us to raise him. It’s
the second time today. We have
other things to do.
Leadership is important in a team to put things into
perspective and to ensure that the patient’s needs are met.
83
Did you see Ms. V. putting
her gown on
all by herself?
So why is she asking us
to dress her?
She won’t catch me
falling for that one again.
Next
The team must avoid spreading stereotypes.
They’re contagious.
84
Don’t you think that she
suffers more on certain days?
We’re there to
help her.
You’re right! We didn’t
think about it.
Considering the various aspects of a situation can
make a difference.
85
I got crap all over my hands.
Ms. C. crapped in her wheelchair.
It was disgusting.
Some do it intentionally.
It’s called grey power.
I felt like kicking
her ass.
Next
Margot Phaneuf, inf., Ph.D.
86
Be careful with what you say!
Don’t forget that we’re
here to help the patients.
Avoid using comments that could encourage others
to slide down the path to insults and violence. Any
nurse can influence comments by exercising leadership.
87
Mr. E. always bothers us
during our break.
Could we tie him
to a chair?
Never! Constraint is to
be used only under
extraordinary
circumstances!
88
Mary’s family is once
again complaining that
we’re neglecting her dad.
They’re always
complaining. They have
nothing else to do.
Don’t take it that way!
We’re here to improve the
patients’ quality of life.
89
Its not what you think. He probably
needed to urinate and forgot to
do up his zipper.
Hamelin is wandering with
his pants open. Old pervert!
Just remind him
to zip up.
Avoid value judgements
and stereotypes!
Margot Phaneuf, inf., Ph.D.
90
The Nurse’s Role
Our philosophy in this department is one
of helping relations in which we provide
warm, empathetic care which
corresponds to the client’s needs. Our
focus is on care that is adapted, humane
and respectful.
The nurse must exercise leadership
to guarantee the patient’s quality of life.
The nurse provides warnings and
guidelines when necessary.
Margot Phaneuf, inf., Ph.D.
91
Teamwork
Teams often compete because of different
visions of the provision of services. The nurse
must disseminate her knowledge and caregiving
philosophy so that team members agree to
provide quality care.
Margot Phaneuf, inf., Ph.D.
92
You’re in team A. You
guys spoil the patients and
then we’re stuck with
more work!
Don’t you think that we’re
here to answer the patients’
needs?
Which ethical
principles are
being breached
in this example and
those that follow?
You just want the families
to like you.
You’re wrong! We just want
to offer the best care
possible to the patients.
Margot Phaneuf, inf., Ph.D.
94
They don’t understand
our point of view. They don’t
respect us.
They think they’re
better than us.
Margot Phaneuf, inf., Ph.D.
95
You guys in the day team
are numerous and
all touchy-feely. We don’t have your resources!
Then we get blamed for lacking
compassion.
Margot Phaneuf, inf., Ph.D.
96
Responses for slides 93 to 96
The ethical principles which apply to patients also
apply to coworkers. They are:
- Respecting the dignity of other staff
- members;
- Respecting their integrity;
- Respecting their right to be unique and to
- have their own opinions (alterity).
Margot Phaneuf, inf., Ph.D.
97
Teamwork
Once again, the nurse must demonstrate
leadership to help other
teams function
in harmony.
Margot Phaneuf, inf., Ph.D.
98
Family Requests
Teams sometimes gang up on families.
Their impression is that families lack confidence in
caregivers.
Their reactions to the requests of patients and
families do not always demonstrate professional
maturity.
Margot Phaneuf, inf., Ph.D.
99
My wife is frightened
when you forget to raise
her bedrails.
Respecting a person and
his significant others is a
prerequisite for a
partnership in
caregiving.
You are mistaken. We never forget
to raise them. It’s a standard
operating procedure.
Which articles of the
Code of Ethics of Nurses
are being breached
in this example and
those that follow?
Which ethical
principles are
disregarded?
100
We don’t want to criticize
you guys, but he’s always
sleeping. Is he getting too
much medication?
It’s not our fault if he
sleeps a lot.
Margot Phaneuf, inf., Ph.D.
101
My wife hates sleeping in
the dark. She feels shut in.
She’s afraid of everything.
That’s not our fault.
Margot Phaneuf, inf., Ph.D.
102
We’ll change him during
our run, as always!
He’s soiled every time we
see him.
Margot Phaneuf, inf., Ph.D.
103
My father tells me you put
him to bed at 5 or 6 p.m.
That’s ridiculous.
You surely understand that
we must follow
procedures.
Margot Phaneuf, inf., Ph.D.
104
Families cannot begin to
grasp our workload.
My father says that nobody
answers him in the night
when he calls for assistance.
It’s easy to criticize when
you’re not in our position.
Margot Phaneuf, inf., Ph.D.
105
It is vital that the nurse establish a
relationship based on trust with the
families and that she understand
their concerns and accept their
questions and comments.
She must also provide the
necessary explanations.
Family members must be free to
express their criticism.
A nurse shall provide her or his client
with all the explanations necessary for the
client’s comprehension of his care and
services being provided to him by the nurse.
OIIQ, Div. III, 1-40.
106
Responses for slides 100 to 105
 OIIQ, Code of Ethics of Nurses, Division II,
1- Relationship of trust
29- A nurse shall act respectfully toward the client and the client’s
spouse, family and significant others.
 In relationship to section 29
‘‘Recognize whenever necessary that a problem has occured and have a
frank discussion about the events and the measures that you will
implement. Offer apologies if warranted. Some situations require
sincere apologies which illustrate sensitivity to the experiences of
others.’’ OIIQ, Le Journal, Chroniques de déonto Mai/ juin, vol. 2 no
5 - Le respect dans la relation entre l’infirmière et le client.
Margot Phaneuf, inf., Ph.D.
107
Responses for slides 100 to 105

OIIQ, Code of Ethics of Nurses, Division II,
Relationship of trust
3- section 37. A nurse shall not use physical, verbal or psychological
abuse against the client.
 Division III
Quality of care and services
3- section 45. A nurse shall not be negligent when administering
medication. In particular, when administering medication, a nurse shall
have sufficient knowledge of the medication and abide by the principles
and methods applicable to its administration.
3- section 48. A nurse shall not harass, intimidate or threaten a person
with whom she or he interacts in the practice of the profession.
108
Responses for slides 100 to 105
Ethical principles
 Disregarding the dignity of a person and/or his
family or significant others.
 Disregarding the person’s integrity.
NOTE
 It is an extremely serious offense to tolerate
abuse against others.
109
Those who take care of us
are our only recourse.
When they understand
and help us, they
are our guardian angels.
Margot Phaneuf, inf., Ph.D.
110
As part of our conclusion, here is a
statement regarding the rights of
dependent elderly persons which our
organization of care and our conscience
should allow us to respect.
Margot Phaneuf, inf., Ph.D.
111
In recognition of the rights of elderly persons,
we propose:
That any person to whom we provide care has the right :
1- To be received in a physical environment that is adapted to his age,
abilities and needs;
2- To be managed by competent staff and to receive quality care;
3- To enjoy a certain quality of life: adequate nutrition, and adapted
physical, social and recreational activities;
4- To be treated respectfully as a person, as a physical being and find
respect of his suffering.
5- To have his values, religious beliefs and freedom of conscience respected;
6- To develop relationships with whom he or she chooses and to maintain
family and social relationships;
7- To his or her intimacy (physical integrity and confidentiality);
8- To live in a safe environment, free of violence, mocking, non-essential
constraints and other safety hazards;
Next
we propose:
That any person to whom we provide care has the right:
9- To live in an environment that recognizes him as a human being and which
treats him or her with respect and dignity;
10- To be treated by personnel with whom he or she can develop a relationship built
on trust, thereby creating a genuine partnership in caregiving;
11- To live free from exploitation, retaliation and being addressed impolitely;
12- To have his or her assets secured and, if capable, to manage his or her own affairs;
13- To receive preventative care to offset degeneration and dependency;
14- To be provided with all the information needed about the care being
administered to make a clear and informed decision;
15- To have his or her autonomy and decision-making ability respected according to
his cognitive abilities and to be consulted so that he or she can accept or decline
care;
16- To receive warm and empathetic end-of-life care without therapeutic
relentlessness;
17- To have his or her family and significant others welcomed courteously and
respectfully;
18- To feel protected by the right of oversight of his or her family and that this right
be respected by staff members. ( Margot Phaneuf)
113
BIBLIOGRAPHY











Gineste, Yves (2004). Collectif : Silence on frappe. De la maltraitance à la bientraitance. Milly-la-Forêt, Animagine, Sarl.
Gineste, Yves et Jérome Pellissier (2004). Humanitude. Comprendre la vieillesse, prendre soin des hommes vieux. Paris,
Bibliophane, Daniel Radford.
Khosravi, Mitra (2003). La communication lors de la maladie d’Alzheimer. Paris, Doin.
Mérette, Marguerite (2004). Pour la liberté d’être. Montréal, Les Éditions Logiques.
OIIQ. Code de déontologie des infirmières et infirmiers. Montréal, OIIQ.
OIIQ (2000). L’exploitation des personnes âgées. Montréal, OIIQ.
Pancrazi, Marie-Pierre et Patrick Metais (2004) Éthique et démence. Paris, Masson.
Phaneuf, Margot (1998). Le vieillissement perturbé. Montréal, Chenelière/McGraw-Hill.
Phaneuf, Margot (2007). Le vieillissement perturbé. La maladie d’Alzheimer, Montréal, Chenelière Éducation.
Phaneuf, Margot (2002). Communication, entretien, relation d’aide et validation. Montréal, Chenelière/McGraw-Hill.
Phaneuf, Margot (2006). Ethics Elements - Serious Thoughts in a Cartoon (3 parts). Infiressources, Professional
Crossroad, section Day-to-day Ethics :
http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics1engl__04march06_revised.pps http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics2engl__4March06_revised.pps http://www.infiressources.ca/fer/Depotdocument_anglais/Ethics3engl__5March06_revised.pps





Plamondon, Louis, Sylvie Lauzon et Marc Bourdeau, (2003) Abus et négligences chez les personnes âgées tel que perçus
par les intervenants dans les services à domicile. Réseau Vieillir en liberté :
http://www.fep.umontreal.ca/violence/dossiers/index.html
Forst , Luc, Louis Plamondon, Sylvie Lauzon, Charles-Henri Rapin et Marc Bourdeau (2006 ) Vieillir sans violence.
www.pinel.qc.ca/Download.aspx?nav_id=1499&lang_id=F
Rapport mondial sur la violence et la santé :
http://www.who.int/violence_injury_prevention/violence/world_report/en/chap5fr.pdf#search=%22infantilisation%20personnes
%20%C3%A2g%C3%A9es%22
Rigaux, Natalie (1998). Le pari du sens. Une nouvelle éthique de la relation avec les patients âgés déments. Le PlessisRobinson, Institut Synthélabo.
Selmès, Jacques et Christian Derouesné (2004). La maladie d’Alzheimer au jour le jour. Montrouge, France, Éditions
John Libbey, Eurotext.
114