I have had patients who are ALWAYS on their call light despite multiple staff and attempts to dissuade them from inappropriate use, but this lady I have now takes the cake! She will press her call bell, and if no one comes within ten seconds, she will start shouting. Her behavior has escalated in the past two weeks to now include screaming "HELP! I FELL! I BROKE SOMETHING AND I'M BLEEDING EVERYWHERE! HELP! OH GOD PLEASE HELP ME!" Of course, staff run to her room only to find her comfortably sitting in her chair or bed unharmed. She will then ask for something trivial, like having her room light turned on or off (which she can do on her own, she just can't be bothered).
This woman is in her late 60s and cognitively intact. She loves the attention even if it is to reprimand her for gross misuse of her call bell. Any suggestions on how to get her to change her behavior? Her family is aware, and I've told her point blank that she needs to stop this because there will be a time when she actually does need us, and we won't respond immediately because of her abuse of the system.
Also, any tips on keeping your cool with these patients? I find I'm getting snippy with her and telling her that she needs to either be patient, or I'll say firmly, "Do (insert her request here) yourself. I am busy right now with people who actually need my help." It's getting harder and harder to keep cool, especially when I've got patients and visitors alike who are genuinely concerned for "that poor lady screaming".
There are no good answers to this one. I'm sorry. You and your coworkers will just have to figure out how to deal with it as best you can. Your management will likely be of no help. Just reading your post causes me to have evil, un-nursely fantasies. Some people may jump on here to remind you this is someone's mother, sister, Avon lady, whatever.
I hope you're at a hospital, not a nursing home. At least then your suffering should end a bit sooner. Hang in there.
We had one like that in the LTC facility when I worked as a CNA. I got to the point where I would check on each of her three room mates before going to move her pillow 1/2 inch to the left while explaining to her that the others also deserved attention. She was very aware of her behavior and also happened to be the one with the "rolling" tape recorder stashed in her bedside stand.
When I worked med-surg, we had patients like this. We usually would implement a behavior plan that involved management, the floor staff, and the patient's physician so that everyone was on the same page. For this type of situation, we would have a "contract" with the patient where we would round on them every 30 minutes or 60 minutes, and they were only to ring inbetween for emergencies. We would adhere to the timeframe very rictly. If the patient rang inbetween for a non-emergency, their request would not be granted, and the clock would start over for the 30 or 60 minutes from there. It was usually pretty successful.
I think they don't know how to be alone. These people need a family member to sit with them. Unfortunately, the family is probably throwing a party that someone is having to put up with them. I know we did. My grandfather was awful during his last days. He wasn't mean or anything, just worse than a two year old. I'm glad he's dead and I hope I never live long enough to become that way. Ugh Nobody says this stuff... Everybody is always like 'poor, old aunt so-in-so.'
Chart the behaviour thoughougly of behaviors observed, strategies used and pt response. Over time this will help develop a strict behaviour plan between exactly that management, nursing staff and the physician. Include time limits if needed, communication tips and tricks, consequences mentioned to pt if not compliant with staff requests. The more team members you have on board, and comply the easier the behaviors become to manage.
Quote from Jb92
Any suggestions on how to get her to change her behavior?
Say, "No thats not my job" and leave the room?
Unless its something you are medically or morally required due to by the terms and conditions of your employment then dont do it. It doesnt matter if they are calling you to provide sexual favors or scratch their ass, it abuse. Dont allow yourself to be a victim or party to it.
Barring the above suggestions, rotating which nurse is assigned to this patient can help. It is easy to get burned out from these types.
I have had patients like these and we would care plan and make rounds to ensure this patient is taken care of. If there is an emergency then that is another story. The patient and family would be included in the care planning meeting. Transparency is key but also reassure the patient that their call bell light will be within reach and if there is an emergency we will respond. In the beginning this patient continued to call out however after time we kept to the schedule and the patient felt more comfortable to the point when we rounded with her once every 45 mins that seemed to be the key to success. Notice the patterns emerge and start with those times you can graduate to a more expanded time interval after you have shown you r willingness to abide by what you promised. Hard work but it was successful.
Quote from VivaLasViejas
Psych consult, STAT.
That's the answer. Even though she appears cognitively intact, she is not. Hopefully, some benzos are ordered.
You will not change her behavior.. but the benzos might.
We take turns answering those lights. They're so frequent, it's easy to keep tabs on whose turn it is to go. It's a simple kindness we do for each other.
If this is LTC....I feel your pain.
Document EVERYTHING! Careplan EVERYTHING! Psych consult, behavior contract, IDT meeting with resident and family involvement and document the results. Limit setting, rotate staff, involve activites, get the resident out of the room as much as possible, move the room closest to the nurses station, call the ombudsman to get them involved.