How do you deal with these types of patients? - page 2

by dudette10

The chronically dissatisfied patient, getting better for admitting diagnosis, but with uncontrolled, officially diagnosed psych issues that cause them to call you to the bedside every 30 minutes--keeping you at the bedside with... Read More


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    Our patients couldn't remember from one day to the next who they had.
    We make a point of rotating these patients so no one has to deal with them more than 1 or 2 days in a row.
    Last edit by loriangel14 on Jan 19, '13
    CrufflerJJ likes this.
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    GrnTea, thanks for the suggestion. It IS important to build trust with patients that have psych disorders that are exacerbated by being hospitalized for other medical conditions. However, it takes time to build trust with them, and while the idea of the same nurse each shift is great--if it can be done with the buy-in of all the nurses or at least a charge nurse who insists upon it.

    We shouldn't make promises that we can't keep with these patients, but the very nature of acute care means that we can't always be in that room the very second the mood strikes the patient. I have put on the white board the time at which I will be back--a trick I learned from a nurse who works on another floor that has a lot of patients with prescribed med addictions d/t histories of post-operative pain management gone awry. But if you miss that time even ONCE, the trust-building has to start all over again. Plus, for each shift, the patients violated the rounding agreement we had with the white board times, and the trust was lost before it even began. This is compounded by needing to build trust within a relatively short LOS for the medical condition that got them hospitalized in the first place. Can enough trust really be established in a non-psych acute care environment that can make a difference?
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    Interesting thread...
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    Very interesting. As much as I agree that consistency will help these patients, they know better than to cry wolf all the time. I know it sounds un-nurse-like and mean but they know you're busy as heck and they know they're making you run around more for silly requests and they know they're being rude. No one short of a person with a an intellectual disability diagnosis would not figure out that they're being a complete pain to the nurses and stop it. I don't blame the nurses for rotating. We already work long hours, understaffed, not enough supplies, too many patients, and to top it all off with one of the patients who has needs every 5 minutes? We're only human, too.
    OCNRN63, CrufflerJJ, 86toronado, and 3 others like this.
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    I had a resident who was bipolar and had BPD. Drove everyone nuts with the constant splitting of staff, complaints, and constant demands. However, she quickly learned who she could manipulate and who she couldn't. I was friendly, respectful, and firm at all times. Boundaries need to be set with these patients early and consistently. When I'd go to her room, I'd take everything I knew she would request, including pain meds without her having to ask. I would fluff up her pillow, say hello, get in, get out....but before leaving I let her know I would return later, which made her feel secure. Whenever she tried to keep me longer with her stories, etc...I'd listen for a few moments, politely interrupt and say, "I have others to see now. I need to go. Good night." And be out the door. Also, you need to ensure the other staff are on the same page, and document, document, document! In a nutshell, be nice, but get in and get out, or they will suck your energy and your time.
    CrufflerJJ, VivaLasViejas, GrnTea, and 1 other like this.
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    Quote from MJB2010
    We do not have this capability where I work.
    Re: rotating patients. We also do not have this option where I work. Sometimes the same nurse has to deal with the same patients all week. One nurse to 35 where I work. In order to save my own sanity, I have no problem saying no and setting limits because I will have to deal with the same patients for four to five 12 hour shifts in a week.
    loriangel14 and GrnTea like this.
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    I used to work in a place with one of these patients and was the only nurse on the unit. (S)He may have been part of the deciding factor in my quitting. Always there, never easier to deal with.
    loriangel14 and joanna73 like this.
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    In addition to identifying and taking care of their needs I liked to use distraction techniques. I woud find out if they liked music or movies. We have a mobile cart with movies to play for pts. We also can play music for them and that is very calming if you select the right type of music. One patient like that can ruin your entire shift and suck the life right out of you.
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    I think that in theory it makes sense for this type of pt to have the same nurse as often as possible-BUT in practice I think this sometimes may be unsuccessful. While it may be disruptive for the pt to have a different nurse all the time, if they are totally butting heads with their current nurse I think it could just escalate the situation for them to continue to have that nurse. When I'm charge nurse and have heard in report that certain pts. are this "type" of patient (for lack of better description) I try to check with their nurse for the day to see how things are going. If they are going well/pt is not completely sapping the RN's psychological energy (ha) I'll give them that pt tomorrow if they are there. Otherwise, no, or it just ends with an angry nurse and possibly a pt refusing that nurse.

    When I have a pt like this who clearly has some un-dx'd psych issues, sometimes I just end up winging it (or hoping they go to a procedure for a looooong time-LOL). Just keeping it real by saying this! Also, truthfully, sometimes I find it works well to just somehow carve out a few minutes in the day to give them a little extra time/attention/etc. The form that this takes is very dependent on what is going on with the pt, but I think doing this lets them know that you are trying to see them as a person and not just the nuisance in x room.


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