Dressing a Resident With One-Sided Weakness
Mrs. H is 78 and is three weeks out from a left-hemisphere stroke that left her with right-sided weakness; her left arm and leg are strong. She dresses herself in bed each morning but needs about 25 minutes, and today her breakfast tray arrives in 10 minutes. She has told you, "I want to do it myself." Her right shoulder droops slightly and she winces when her arm is lifted. A button-front blouse and elastic-waist pants are laid out on the chair to her left. She is unsteady when standing and needs standby assistance plus a gait belt. She wears glasses, which are on the bedside table on her right side.
1. How would you set up and sequence the task so Mrs. H can dress herself, and why does each choice matter?
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Set up before she starts:
- Put her glasses on and place the clothing on her left (strong) side so she is not reaching across her body or twisting to find it.
- Have her sit on the edge of the bed or in the chair with feet flat, gait belt on, before any standing.
Sequence:
- Pants first, while seated - pull them over the weak right leg, then the strong left leg, then stand with standby assist to pull them up.
- Blouse: weak (right) arm into the sleeve first, working the sleeve up over the shoulder from the outside; then the strong arm.
- Fasten buttons with her strong hand; offer to start the top button only if she asks.
Why it matters: Dressing the weak side first leaves the garment positioned where it is easiest to guide, and undressing reverses it (strong side out first). Never pull the weak arm through a sleeve by the wrist - the drooping shoulder signals instability, and pulling causes pain and can worsen shoulder damage. Leaving her to do it protects her independence, which is the whole point of the task.
2. The tray arrives when she is half dressed. She becomes tearful and says, "Just do it for me." What do you do and say?
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Split the decision, don't take it over. Say something like: "You've done the hard part - the blouse is most of the way on. I'll get the last sleeve and you can finish the buttons while I set your tray up."
Reasoning:
- Her statement is about fatigue and being rushed, not about permanently giving up self-care. Taking over completely solves the schedule problem and creates a dependence problem.
- Offer the minimum assist that gets her finished: help with one sleeve, let her button.
- Keep food warm and within reach; she can finish dressing after eating if she tires.
- Note the fatigue - dressing earlier, or in two stages, is a real plan change to report.
What not to do: Don't yank her weak arm into the sleeve to save time, and don't leave her half dressed in front of an open door or with the tray on her lap while her clothing is unfastened.
3. What do you report to the nurse at the end of the shift, and what is outside your role here?
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Report:
- She now needs ~25 minutes and became tearful/fatigued mid-task today.
- She reported pain when the right arm was lifted, and the right shoulder appears to droop - a change worth an assessment.
- She needed standby assist plus gait belt to stand; no falls.
Outside your role: Diagnosing the shoulder problem, deciding she needs a sling, ordering adaptive clothing, or deciding on your own to stop encouraging self-dressing. Those are nursing/therapy decisions.
Documentation principle: Write what you saw and did ("resident dressed with set-up and verbal cues; became tearful, stated 'just do it'; accepted minimal assist to finish; pain with right arm lift noted; reported to RN") - not conclusions like "resident is depressed" or "unmotivated."