Demanding Patients - page 2

Hi, I am wondering if anyone has any advice/tips on how to cope with the stress of demanding patients. I work in Long Term Care, each shift I am responsible for 20+ patients. I do the night shift, so during the majority of the... Read More

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    I also work the overnight on a 29 bed unit. Five o' clock is the witching hour. The climbers do climb, and I also have a heavy 6am med pass with one aide. Since I have the luxury of working two units consistently, I can anticipate things. About residents wanting to wake up to go to the dining room, I usually bring snacks to the ones who usually wake up with "Boy, I sure am hungry!" And then I'm on to the next one. As for residents who want to go to the bathroom as soon as I wake them up, well, they must go to the bathroom! And while the aide is busy caring for those who are unfortunately incontinent, the one who must assist them is me. If I were them, "Sorry, I'm in the middle of my med pass" wouldn't cut it. When you gotta go, you gotta go.
    CompleteUnknown likes this.

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    I wish I had time to help patients toilet when I wake them up for meds but with 50 who all need meds, BPS, fingersticks, etc., and all up to me, they gotta wait for the aide. It sometimes takes 15 minutes to toilet someone, I just don't have time for that. I will send the aide in as soon as I see him/her though. I know that sounds mean but if I helped everyone to the toilet during med pass I would never finish, and everyone's meds would be late. =/ I wish it weren't so but it is. Granted, many of them want to get up and go but they are incontinent and have already gone (alzheimer's) and I send the aide to change them anyways I don't want to make people wait because it does make me feel guilty, but it is physically and time-wise not possible for me to toilet and do med pass on 50 people alone. On top of that, I also don't feel "above" toileting residents like many nurses I have met, but I can only do one thing at a time, and if I have 45 people waiting for meds I cannto justify toileting someone for 20 minutes and making those people all late with meds. I toilet patients all night when I am not doing rounds, treatments, charts, or med pass.
    Last edit by JZ_RN on May 2, '12 : Reason: error
    2yearrnba, not.done.yet, and CrufflerJJ like this.
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    One way I found to help stop the tantrums that those in their right minds have is that I calmly explain "I don't need to listen to you scream at me. I understand you're upset and if you want to talk to me like a reasonable adult I'll be more then happy to help you. But if you scream at me I will leave and come back later when you can calm down." I found most of the time, especially if it's meds they want they will calm down right away. Others it only takes once of you walking out of their room and returning later on that they will become very calm and explain their problem.
    not.done.yet and JZ_RN like this.
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    I've 2 lines that I try to use that seem to defuse alert & orient pts who are demanding. "What one thing would help you now?" and I keep repeating this until I can get them to be focused and be specific. Then my second line (which my CNAs love) is "you can be next, but you can't be now. I will help you. Next". This seems to help, but I make sure I do address their response and I let them know what I did.
    not.done.yet likes this.
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    I am a pretty new nurse but already learning how to draw boundaries. The 320+ lb patient who is uncomfortable and can't move themself who wants to be repositioned every 20 is unfortunate that I have to explain that I will not try to move them myself and that getting 2-3 other people to help me so that none of us hurts our back makes them upset, but it is what it is. When this person understood I WILL help them, but that there are parameters that are not negotiable (using the appropriate number of people to avoid injury..that that gathering that many people together at once takes time in the hospital) they at least acceped it even though it made them cranky. One can understand/empathize with why the patient is unhappy and it still not change the facts of what is possible to accomplish.

    I do struggle with the ones that come out of their rooms instead of using the call bell, demanding help NOW. We had one of those families this week. Literally every 15 minutes in the hall asking for their nurse because their loved one was in denial about how sick they were. The patient was/is a controlling, demanding, type A who had been thrown for a loop to suddenly be helpless (trauma fractures...wanting to get OOB when that wasn't even remotely an option due to embolus risk. The family's habits for dealing with this person has been to give what they want in order to keep the peace. Not a possibility in this situation and they just could not accept that we were not going to drug their loved one into a stupor and also weren't going to give this individual what they wanted because it was not in their best interest. Gonna need more practice with that type. Took two of us to help the nurse assigned to that room from going crazy with fatigue and exasperation. Again, understood this family had been turned on its ear and the patient, in the prime of their life and career suddenly thrown into a horrible, worst-nightmare (for them) situation..and that NONE of them knew how to deal with it or the hospital environment. But that empathy and understanding still doesn't change the facts of what is possible and what is safe.

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