Objective Documentation on Demanding Patient?

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  1. This is a discussion on Objective Documentation on Demanding Patient? in General Nursing Discussion, part of General Nursing ... Please, I need some help with proper documentation. I am a new LPN studying for my RN, and have...

    by Feb 20, '11
    Please, I need some help with proper documentation. I am a new LPN studying for my RN, and have been fortunate enough to have obtained a job in a large nursing home while I am in school. I have a patient with mild dementia who is exceedingly demanding; she uses her call bell at least every 3 minutes (I timed it!) to have "fluff her pillow," or similar things. If we don't respond immediately, this poor woman starts screaming "Help me, help me!" Often, she will hit the call bell while I am still in the room! I need to document this behavior in an objective manner, but am unsure how to do it. Can anyone help?
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    by al586 Feb 20, '11 11:21 pm
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  2. 13 Comments so far...

  3. Feb 20, '11 by
    Quote from al586
    Please, I need some help with proper documentation. I am a new LPN studying for my RN, and have been fortunate enough to have obtained a job in a large nursing home while I am in school. I have a patient with mild dementia who is exceedingly demanding; she uses her call bell at least every 3 minutes (I timed it!) to have "fluff her pillow," or similar things. If we don't respond immediately, this poor woman starts screaming "Help me, help me!" Often, she will hit the call bell while I am still in the room! I need to document this behavior in an objective manner, but am unsure how to do it. Can anyone help?
    Write what you observe, interventions used and response. This is objective. Make sure all her needs are met and she is safe. Does she have a temp, is this her normal behavior? She could have a UTI. Utilize the CNA if you don't know the resident. They are huge resources. Sometimes out of bed in front of the nursing station eating a snack or doing a small activity is all that is needed if medically she is fine. Good luck!
    leslie :-D, al586, Davey Do, and 1 other like this.
  4. Feb 20, '11 by
    Quote from al586
    Please, I need some help with proper documentation. I am a new LPN studying for my RN, and have been fortunate enough to have obtained a job in a large nursing home while I am in school. I have a patient with mild dementia who is exceedingly demanding; she uses her call bell at least every 3 minutes (I timed it!) to have "fluff her pillow," or similar things. If we don't respond immediately, this poor woman starts screaming "Help me, help me!" Often, she will hit the call bell while I am still in the room! I need to document this behavior in an objective manner, but am unsure how to do it. Can anyone help?
    Sorry, duplicate resonse. Good luck.
    Last edit by Chin up on Feb 20, '11 : Reason: Duplicate
  5. Feb 20, '11 by
    Just state the facts and leave out the word demanding.
    You could say: Pt on call light frequently. In last hour pt has placed 22 calls. Lights quickly answered with needs met.

    You could mention the state of mind ie...anxiety, anger.
    Faeriewand, systoly, al586, and 1 other like this.
  6. Feb 21, '11 by
    Although you should support it with your specific assessment info, there is nothing wrong with using "demanding" as a single word description of patient behavior, as long as you support it.
  7. Feb 21, '11 by
    You did just fine in your post. Document what happens; the timing thing is great and use her own words. Also; you should have the charge start a behavior sheet on this patient after all metabolic reasons have been ruled out then it's to the mental aspect. She could benefit from a psych eval but having documentation such as a behavior sheet can back up and make clear for further diagnosis.

    We like to make everyone comfortable but to have to consistently pamper is not good for the staff or the patient.
    al586 and Davey Do like this.
  8. Feb 21, '11 by
    Thank you, everyone! You've all been a tremendous help!
  9. Feb 21, '11 by
    you got it right. objective documentation.

    "attempting to converse with alaris pump" is more descriptive than "inappropriate conversation" and it reads better when your manager calls you into the office to ask what made you think this person was demented or delusional. "inappropriate conversation" could be anything from calling the pump "an uppity bastard" for refusing to answer or telling you your breasts are lovely and could you please climb into bed and let him examine them.

    charting "using call light every three minutes to request tv channel changed or pillow fluffing" is more objective (and specific) than saying the person is demanding. it also gives a very clear picture of what is going on.

    of course it's a less work to just chart "demanding and confused" and leave it at that. probably why so many nurses seem to leave it at that.
    al586 likes this.
  10. Feb 21, '11 by
    "Patient is preoccupied with call bell. Pt redirected but unsucessfully. Pt moved closer to nursing station for safety."
  11. Feb 21, '11 by
    "Demanding" is a poor word choice, because it is not a neutral, but a negative word. When I hear demanding, fully recognizing that some people are, I think about staff convenience or inability to recognize underlying problem.