tips for dealing with an uncooperative pt

[signet123]

I'm a new LPN working as a med nurse in a nursing home. I have this one patient who is very uncooperative. She is diabetic and gets accuchecks at 4 pm and 9pm. She gets Novolin N at 4pm as well as coverage determined by the accucheck. She also get 5pm and 9pm oral meds. The problem is she refuses to allow me to do any of this. When i first started working at the facility she did allow me to take her accucheck(under protest). One time it was 500. We had to call the Dr. The charge nurse told me to retake it prior to calling the DR. which I did. Since then she says that I stuck her 5 times and she won't let me do it again. I am a male nurse and I think she doesn't like men. She had a problem with a male CNA previously. This lasted for a month. She finally got over it. although she requests female only care for washing ect.. She has Depression and slight dementia with agitation. We have three halls on our floor. Each nurse passes meds to one hall. At the begining of the shift, one nurse does all the accuchecks. Usually the one with the shorter hall. If I do accuchecks this lady won't let me do hers and I have to get another nurse. I also wind up getting another nurse to give her insulin and her oral meds. Although sometimes she will take the pills if I have a female CNA stand in the room with me. They tell her to take the pills from me. This is really frustrating having to get a nurse from the other hall for everything. They are very busy and I get the feeling it's getting old for them. She also has taken to following me up the hallway in her w/c as I do my med pass calling me nasty names. I just ignore this. She will also tell other residents not to take their medication from me. I was wondering if anyone has any ideas on what I can do to make peace with this lady?

[jmgrn65, RN]

I am sorry this is happening, I am not sure of what the solution is, hopefully someone else might have some insight.

[SFCardiacRN]

Some older women still prefer care from females. You may have to patient swap when this occurs. Good luck!

[GooeyRN, ADN, BSN, CNA, LPN, RN]

Thats one thing I didn't like about doing med passes in LTC, the confused residents following you up and down the hall. And taking things off of the med-cart when you went into a room. I feel for ya! Maybe try to kill her with kindness and she will eventually accept you?

[JKDON]

That's too bad, but common. If she has a fear of men, perhaps a change in wings. Also, this is nto the first line of solutions, but is there an obsessive condition that is not being treated? Is she fearful? Distressed over it? It may be a behavior due to some mental changes secondary to the diabetes. I dont' advocate for psych meds a lot, but have seen some hopeless cases go untreated to find that there is a fairly normal person behind that illness once the meds are started. I hate anyone to be distressed to that point when there are some safe alternatives out there. Talk to the behavior committee, ask family etc. And yes try to win her over, get to know her well, grease the squeaky wheel. Diabetic candy? Rewards for when she does let you do her procedures?

[Stitchie]

A patient swap with a resident such as this is probably your easiest solution. Please try not to take it personally -- many older women ( and younger also) feel more comfortable with personal care being done by someone of their same gender.

My favorite instructor in nursing school gave us great advice when dealing with dementia/alzheimer's patients: They aren't in our world, so we have to go to theirs. This rather minimizes the personal feelings when faced with this situation.

Best of luck to you!

[LPN1974, LPN]

I say see about moving her to another wing, as another poster reccommended.

Or just accept the fact that you and this lady will NOT have peace.

Don't try to make her do anything she doesn't want to do for you.

I would think that would be against her rights. The other nurses really don't mind, I'm sure, to come and do the accu checks and meds for you. I wouldn't mind if I were working there. It's just one of those things that happens.

Just accept it and let it be. Let the old lady have her way, and if her way is someone besides you, then so be it. That's what I would do. It's just not worth both of you stressing out over it.