Eleven Dead at Florida Nursing Home - Could the Nursing Process Have Saved Their Lives?
By JOCELYN MONTGOMERY, RN, PHN
The most fragile members of our society live in nursing homes. Though resilient in spirit, they are physically vulnerable and disruptions to their routine care can quickly result in swift and highly negative health consequences. Several studies of nursing home residents’ response to evacuation have illustrated this vulnerability. Research has shown a significant spike in nursing home residents’ mortality and morbidity after a disaster, not just during the event, but for as long as 90 days following an evacuation.(1)
Finger pointing is inevitable after any disaster where people lose their lives. But in the case of the Rehabilitation Center of Hollywood Hills, the consequences are much more severe following the deaths of eleven residents who suffered in sweltering heat for several days after Hurricane Irma hit Southern Florida and knocked out the power. This nursing home is under a criminal investigation, has had their license suspended, and the lawsuits are pouring in.(2) Media reports stated that for three days the Rehabilitation Center tried in vain to get assistance from the local power company but help did not come. When staff from the nearby hospital got their second 911 call from the nursing home, they investigated and found eight residents dead and 40 residents in critical condition.(3)
In the calm of a retrospective review, it is easy to see the mistakes that are made during the stress of the emergency. But in this situation, there is one issue that stands out for me: Namely, where were the nurses?
Registered nurses are trained in the nursing process which begins with assessment, leads to a nursing diagnosis and plan of care, and requires vigilance to evaluate whether that plan of care is working. Licensed vocational nurses are also trained in basic assessment including the collection of data and the identification of abnormal conditions with specific residents. So how were the residents in this nursing home allowed to deteriorate to the point of death or near death when trained nurses were providing their care?
I write this as a call to action for all long-term care nurses. First of all, we must address the knowledge gap regarding the negative impact disasters have on nursing home residents. Hydration and cooling measures may not be enough and it is the responsibility of the nurses to quickly identify their residents' change of condition through frequent and thorough assessment during emergency situations and act accordingly on their behalf. Secondly, long-term care nurses must be empowered to be the “first responders” for their residents. They must advocate for their best care no matter how chaotic, stressful or political the situation becomes. The first principle of nursing ethics, nonmaleficence, or do no harm, is directly tied to the nurse's duty to protect their patient's safety. Saving residents from the initial impact of an emergency is just part of the nurses’ job in a disaster. The rest is to vigilantly assess them for a change in their condition, and to ensure they receive timely nursing care until the situation resolves.
As a society, we can measure our humanity by how we treat and care for the least among us - including the poor, sick, disabled, and elderly. We have come far since the days of Hurricane Katrina, but SNF nurses continue to be the most overlooked group of first responders in a disaster. While there were many successful activations of emergency operations throughout Florida during the recent hurricane, we must continue to strive to protect every resident's well-being no matter what challenges present themselves.
Article Background
1. To Evacuate or Shelter in Place: Implications of Universal Hurricane Evacuation Policies on Nursing Home Residents
David Dosa, MD, MPH,1,2,3 Kathryn Hyer, PhD, MPP,4 Kali Thomas, MA,4 Shailender Swaminathan, PhD,2,3Zhanlian Feng, PhD,2,3 Lisa Brown, PhD,4,5 and Vincent Mor, PhD2,3
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3264770/
2. The Effects of Evacuation on Nursing Home Residents With Dementia
Lisa M. Brown, PhD,1 David M. Dosa, MD, MPH,2,3 Kali Thomas, MA,4 Kathryn Hyer, PhD, MPP,1 Zhanlian Feng, PhD,4 and Vincent Mor, PhD4
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711109/
3. 11th Resident of South Florida Nursing Home Dies
http://wearependulum.us4.list-manage1.com/track/click?u=651bf693f14f37e8d37c8d653&id=f52738e96b&e=fd8a6b9c5a
4. Eight Dead From Sweltering Nursing Home as Florida Struggles After Irma
https://www.nytimes.com/2017/09/13/us/nursing-home-deaths-florida.html?mcubz=1
4. Pleas for Help at Florida Nursing Home Where Heat Took Lives
https://www.nytimes.com/2017/09/15/us/florida-nursing-home-deaths.html
