Suggestions for dealing with pt's with disruptive behavioral problems

[Pat2012]

I work afternoons on a longterm care unit. One of the residents has absolutely no impulse control what-so-ever, and purposely will interupt you when she knows you are the most busy. What she does is ask for PRNs, which she doesn't need but asks for anyways, such as tums, tylenol, cough syrup, and eyedrops. If you don't give her immediate attention she gets loud and mouthy, and complains that you never address her needs (which is grossly untrue). This disruptive behavior, in my opinion, needs to be addressed because it increases the risk the of a nurse making a med error because she is always asking when you're passing meds--especially insulin. Also, she is somebody that doesn't need to be on a priority list because she is capable of doing multiple things herself and doesn't not have nearly the needs that some of the much older residents do. Many nurses feel this is a control issue for her, that she asks when you are busy to throw control on you. I feel this needs to stop and would like input from more experienced nurses on how to deal with this issue. Thank you in advance.

[lifeisgood2012]

I wouldn't say I am a more experienced nurse - I just put myself in her shoes and think "well, I am already in

a controlled enviornment where people tell me when to get up, eat, do activities, etc. what can I do to control

things?" and one of those things is meds/behaviors. You aren't going to win - she is wanting attention and asking

for it the only way she knows how to - by asking for PRN meds and then whining if she doesnt get the attention

right away. I know things are tight in LTC - and I know its hard to stop and pay attention to someone that doesnt

have as dire a need as other residents do - but to her it is a dire need. Can you simply tell her "I am working on another

residents meds right now, after I am done with those I will come and talk to you when I can give you my full attention"

or something like that? I know its annoying - but does it really take a long time to pull tums or tylenol? I don't know -

maybe someone else will have a different perspective than me. Best of luck.

[Nascar nurse, ASN, RN]

I wouldn't say I am a more experienced nurse - I just put myself in her shoes and think "well, I am already in

a controlled enviornment where people tell me when to get up, eat, do activities, etc. what can I do to control

things?" and one of those things is meds/behaviors. You aren't going to win - she is wanting attention and asking

for it the only way she knows how to - by asking for PRN meds and then whining if she doesnt get the attention

right away. I know things are tight in LTC - and I know its hard to stop and pay attention to someone that doesnt

have as dire a need as other residents do - but to her it is a dire need. Can you simply tell her "I am working on another

residents meds right now, after I am done with those I will come and talk to you when I can give you my full attention"

or something like that? I know its annoying - but does it really take a long time to pull tums or tylenol? I don't know -

maybe someone else will have a different perspective than me. Best of luck.

No, I tend to agree with you. She needs to control something and she will make life miserable until she gets that control. If I were doing the med pass I would just start with her. Run down the list of the usual complaints..."How's your stomach today"? "How is your headaches today"?, etc. Establish what she does/does not need. Don't bother arguing with her...you won't win, as you've already learned. Just do it and get it out of the way. Once you're all done with her make the statement in a funny, non-threatening way "Well good. I've got you in perfect shape (chuckle with her). Now I've got all these others that I need to make perfect. Give me an hour and I'll be back to make sure you are still perfect.

Not sure if you are new or how new you may be but I see an awful lot of nurses want/demand the resident fit into their schedule. I promise you, it will take you twice as long to convince them to fit properly into YOUR schedule then it would take just to work yourself into THEIR schedule.

[CoffeeRTC, BSN, RN]

Yeah, we all have had a difficult resident or two that just seems to make things hard or heck..is annoying BUT..I would approach her first like what Nascar mentiond. That way she feels like you do care and are giving her the attention that she wants/ needs.

[zieglarf, LVN]

I have one similiar to this that used to ride that button like it was going out of style. Hers meds are at an odd time compared to everyone else. So I always go in, greet her, and spend a few minutes with her. I always remind her when I leave that I'll be back in a little while with HER meds - I also add (and for most of the residents) holler if you need anything.

So doesn't call me as much.