Demanding Patient - page 2

Please help. We are at our wits end about a patient in our facility. Each night he is on the call light-CONSTANTLY. I am talking every 5 minutes-sometimes more! I counted one night-87 times in... Read More

  1. by   grimmy
    [font=book antiqua]i can't tell you how many times i was a sitter when i was working as a pct in nursing school. sometimes it was to keep a lol safe while she was working off her dts, and other times it was the copd guy who just could not get comfortable. i've sat for toxic rf pts who were so delusional they were sure i was mom, and so on. from my experience, these manipulative folks fall into several categories. some just have unrealistic expectations due to (a) generational notions of what a nurse does, and/or (b) fears of being abandoned. another category is the pt who pits staff member against staff member, almost without seeming to realize that they're doing it. i've seen it go from shift to shift. "well, my nurse before would give me pain medicine when i asked for it!" or "i want last night's nurse back! you're mean!" geez...you just can't win some days. you can do something for the unrealistic expectations folks after you figure out what the expectations are. give them a reality check, and follow up on it, particularly for the fearful variety. as for the borderline personality types, set very clear boundaries and be firm but kind. be sure all shifts are aware of the manipulative behaviors without undue labeling of the patient as "difficult." use sitters (if you have them available) for people who are simply afraid of being alone. i've read the paper to quite a few patients, and they calm down quickly. one person i sat for finally confided in me that she was afraid her roommate would die, and she'd be alone with a dead person. that's valuable information a nurse can work with.
  2. by   bikeracer5313
    I honestly don't know what to think of this guy. He has been in our facility for about 6-7 months. He tells staff, "It's your job to wait on me." He is a former alcoholic-drank heavily. The latest is when he gets his room tray--no kidding--he has staff put his fork in the food and get a bite for him, then put it in his hand to eat! With EACH food! He is on Seraquel as his only psych med.

    On a different note--responding to the post about akisthia--After I had surgery-I was to use Phenergan every 4 hours as needed-I was VERY nauseated--didn't have my contacts in-had two bottles, one Phenergan, one Compazine--Learned VERY VALUABLE lesson! Do not, I repeat DO NOT get those mixed up and use Compazine every 4 hours---MOST UNPLEASANT. The worst thing was, I didn't know what was going on until 2 days later. Absolutely the WORST feeling I had in my life. I thought I was having an anxiety attack. The doctor on call gave me Zyprexa which helped a little bit but it took about 2-3 days to wear off. It was AWFUL!!
  3. by   Lawnurse
    Quote from bikeracer5313
    I honestly don't know what to think of this guy. He has been in our facility for about 6-7 months. He tells staff, "It's your job to wait on me." He is a former alcoholic-drank heavily. The latest is when he gets his room tray--no kidding--he has staff put his fork in the food and get a bite for him, then put it in his hand to eat! With EACH food! He is on Seraquel as his only psych med.

    Okay, IMHO, its time to realize "the line" is now miles behind where you are now.

    Now that I know a little more about this patient, it is my opinion that any nurse who gives in to this patient's fork demands needs to seriously consider that he/she has lost sight of everything nursing is. I'm being dramatic, but drastic situations sometimes incite drama.

    If he can't use a fork...shoudln't he be on tube feedings? I'm joking...but I believe if someone presents you with a bull@#$* problem, give them a bull@#$* solution.
  4. by   CoffeeRTC
    I love the idea of a log book to keep track of their requests and the time you are in the room. This definalty needs careplanned. The IDT needs involved. How do the nursing staff get anything done??? Family def needs approached on this one...What are their solutions for this behavior? I bet they say NO. I'd get the ombudsman involved too...wouldn't like him or family making a complaint. Get the ombudsman on your side first
    We've had residents like this before!! How about PT/ OT/ SP or restorative nursing involvement?
  5. by   LPN1974
    Quote from bikeracer5313
    I honestly don't know what to think of this guy. He has been in our facility for about 6-7 months. He tells staff, "It's your job to wait on me." He is a former alcoholic-drank heavily. The latest is when he gets his room tray--no kidding--he has staff put his fork in the food and get a bite for him, then put it in his hand to eat! With EACH food! He is on Seraquel as his only psych med.

    That is weird. This man needs a reality check.
    I worked with a very difficult patient in LTC on the opposite end of the spectrum.
    He was a severe diabetic, on BS checks qid, and insulin, among other meds.
    He would not comply with his doctors orders and started refusing his meds, even his insulin.
    The man was very very difficult, would curse at the staff, etc.
    There wasn't much we could do except document and report to the doctor.
    He died, but I'm not sure exactly why he died. I'd already quit there when I heard he'd passed, but I'm sure it had alot to do with his refusal to comply with his meds/treatment.
    Sorry, I got off topic. Your patient just reminded me of this one.
  6. by   heron
    [QUOTE=bikeracer5313]I honestly don't know what to think of this guy. He has been in our facility for about 6-7 months. He tells staff, "It's your job to wait on me." He is a former alcoholic-drank heavily. The latest is when he gets his room tray--no kidding--he has staff put his fork in the food and get a bite for him, then put it in his hand to eat! With EACH food! He is on Seraquel as his only psych med.

    Wel-l-l ... sounds like you ruled out drug effect ... seems like the only thing left is a behavior plan. I agree with all the suggestions to involve as many folks as possible... IDT, medicine, ethics committee if you have one, and document like crazy to support your position. Are you getting any support on this from your admin? Heron
  7. by   Stitchie
    Quote from bikeracer5313
    I honestly don't know what to think of this guy. He has been in our facility for about 6-7 months. He tells staff, "It's your job to wait on me." He is a former alcoholic-drank heavily. The latest is when he gets his room tray--no kidding--he has staff put his fork in the food and get a bite for him, then put it in his hand to eat! With EACH food! He is on Seraquel as his only psych med.
    Well, a little light just went off for me. My dad, now deceased, was also a heavy drinker for many years. He developed some mental problems -- Werneke's encephalopathy. If you can move him closer to the nurse's station (not a pleasant thought) and/or give him stuff to do, it might help. (This was in acute care, of course)

    When my dad was getting really beastly with the staff, I insisted that his oncologist get him Ativan before I called the chief of staff. He was getting violent with his own family, even though he couldn't remember much in the way of our involvement. I took action with the doctor because he got volatile and crazy, and she didn't want to intervene. At his least offensive, he would literall make up stories (confabulating) that didn't happen.

    If you're not getting what you need for this patient and non-medical interventions don't work, is moving up the food chain at your facility a possibility until you are satisfied that his delusions and demanding behavior are at least under control.

    That being said, some people/patients are just plain @&&#^(s who don't care about anyone else, even though there are hundreds of patients and only one of you. It's ok to set strong limits, just realize that your documentation has to reflect his constant demands.

    Good luck to you. You have a very difficult job to do!
    Last edit by Stitchie on Apr 1, '05
  8. by   grimmy
    Quote from stitchie
    well, a little light just went off for me. my dad, now deceased, was also a heavy drinker for many years. he developed some mental problems -- werneke's encephalopathy. if you can move him closer to the nurse's station (not a pleasant thought) and/or give him stuff to do, it might help. (this was in acute care, of course)

    [font=book antiqua]oh, this brings back memories of putting one of these folks into a "pink" chair by the nurses station, taking a bunch of unfolded towels and letting them fold them. kept them busy for hours. yes, they'd chatter, but they were so focused on getting those towels folded, they were fine, and someone was always at the nurses station to keep an eye on them. this worked especially well for lol who would try to get up on their own and make their own bed and such. (hip fx waiting to happen).

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