Alzhiemers

JZ_RN · Jun 7, 2012

I don't condone "drugging" people but when they cannot be rationalized with or controlled for safety of themselves and others, talk to the doctor about getting some behavioral meds. I have the same problem and horrible staffing where I work and that's why I am leaving this job for a new one. I'm interested to see any other advice you get.

conroenurse · Jun 7, 2012

It is NOT your job to be beat on. If you company will not supply a 1-1 that helps to keep you safe, and there is not enough staff, meds are not available for those times or you have no company c/o line you need to call the state on this company.

I've worked with Psych patients, neuro, and Alzhiemers patients for over 30 yrs and yes I've had to duck a few times, but I've never been hit. IF close calls were attempted and nothing done to stop the incidents I started climbing the ladder and resolved it that way. There is just no way that it is your job to be hit. IF worse comes to worse and you want to risk job loss you might explain that regardless if patient or not assaulting someone is against the law and charges COULD be filed.

GOOD LUCK

Rob72, ASN, RN · Jun 7, 2012

... you might explain that regardless if patient or not assaulting someone is against the law and charges COULD be filed.
GOOD LUCK

Yeah. In cases of diminished capacity, the healthcare proxy (in out-patient settings) or the CMO (Chief Medical Officer) bear responsibility for the actions of the individuals.

Document explicitly what you observe, experience and do.

misschiatia · Jun 8, 2012

Being beat up is not your job. Seeing to the safety of this patient is. The way you approach late stage alzheimer's patients can go a long way to diffusing volatile situations. However, when all else fails....back off. It is perfectly appropriate when a patient (alzheimers or other dx such as psych) is agitated to cease and desist whatever you are trying to do and give them their space. As a matter of fact, it is recommended. If Jane Doe does not eat dinner or get their bath or take their pill tonight, so be it. Any other action by the nurse contributes to the agitation and decreases both staff and patient safety. For a patient who is just generally physically abusive, treat him or her like a psych patient. Approach with caution, bring help, never turn your back or let them get between you and the door, and keep safety as your first priority. Most of all, just back off. No patient is agitated 24 hours a day. Wait until they finally tire and go to sleep to change them. As the professional, it is up to you to look out for yourself and your patient.

misschiatia · Jun 8, 2012

Being beat up is not your job. Seeing to the safety of this patient is. The way you approach late stage alzheimer's patients can go a long way to diffusing volatile situations. However, when all else fails....back off. It is perfectly appropriate when a patient (alzheimers or other dx such as psych) is agitated to cease and desist whatever you are trying to do and give them their space. As a matter of fact, it is recommended. If Jane Doe does not eat dinner or get their bath or take their pill tonight, so be it. Any other action by the nurse contributes to the agitation and decreases both staff and patient safety. For a patient who is just generally physically abusive, treat him or her like a psych patient. Approach with caution, bring help, never turn your back or let them get between you and the door, and keep safety as your first priority. Most of all, just back off. No patient is agitated 24 hours a day. Wait until they finally tire and go to sleep to change them. As the professional, it is up to you to look out for yourself and your patient.

tyvin, BSN, RN · Jun 8, 2012

No...it's not your job. In fact you aren't doing your job correctly if a patient is successfully hitting the nurses daily. Document every instance in the nurses notes not just the behavior sheet. Be explicit about contact. What 3 non-Rx approaches did you take to diffuse the situation...changes in the environment (lights, music), one on one approach, snack, alone time, toileting, ect... What triggered the event, time line. Who, what, where, when, why...every single time it happens. Why hasn't someone made out an incident report on this?

When was his MDS done last (is this LTC)...check it out and make sure this is addressed at the annual or 90 day eval if it is LTC.

JZ_RN · Jun 8, 2012

LOL I know those might help but who has time to get music and snacks for patients in LTC? I know I don't. Wish I did but with 53+ patients I just don't. And the lights have 2 settings... on and off.

tsmason · Jun 8, 2012

No...it's not your job. In fact you aren't doing your job correctly if a patient is successfully hitting the nurses daily. Document every instance in the nurses notes not just the behavior sheet. Be explicit about contact. What 3 non-Rx approaches did you take to diffuse the situation...changes in the environment (lights, music), one on one approach, snack, alone time, toileting, ect... What triggered the event, time line. Who, what, where, when, why...every single time it happens. Why hasn't someone made out an incident report on this?
When was his MDS done last (is this LTC)...check it out and make sure this is addressed at the annual or 90 day eval if it is LTC.

We are a small hospital and don't have all those commities to go to. This person is thought of highly in the community and so we are catering to those needs. The other pt don't get treated this way, and if we complain, we catch it somewhere else if ya know what I mean. I was just trying to find out the legalities of what could do, so I can use that when reporting situation.

Saifudin · Jun 10, 2012

No nurse or care giver should expect that abusive or injurious behavior is part of a job. It can and does happen in the course of nursing care, particularly in mental health, but it is never part of a nurses job description. That is just a ludicrous expectation on the part of your employer.

The bigger question is why this patient is agitated, combative, etc., beyond the diagnosis of Alzheimer's. Has this patient been thoroughly assessed medically and psychiatricaly? Underlying conditions such as infections, certain medications (and combinations), pain, etc., may be causing increased agitation, acting out, etc. Was the patient placed in long term care for this reason? Read the file, do your own careful assessment, raise these questions and if appropriate, (sure sounds appropriate) request antidepressants and/or antipsychotic medications that will help protect the patient and staff from harm, as well as hopefully allowing the patient to rest and be more relaxed (not slogged out). If all else fails, I agree with others, start job hunting.

student forever · Jun 10, 2012

Yeah. In cases of diminished capacity, the healthcare proxy (in out-patient settings) or the CMO (Chief Medical Officer) bear responsibility for the actions of the individuals.
Document explicitly what you observe, experience and do.

This is the KEY: a paper trail! Take the time to doc every shift all the combats and be consistent with it. It enables the nurses to talk to others with concrete evidence in hand. Plus you will have this same evidence should you need it if the issue of everyone's safety is not resolved.

I understand the tempation to not take the time to doc. Is there a way you can keep copies of the docs for yourself?

amoLucia · Jun 14, 2012

It may only be a matter of time before this resident becomes increasingly dangerous to others including visitors and other residents. Has there been any episodes of patient to patient aggression??? I believe that this is an event that is mandatorily reportable to the Dept of Health Survey people and/or the Ombudsman Office. Also if the police become involved because of family notification, there will be an investigation.

As others point out, the paper trail is CRUCIAL. Administration will be seen as negligent in protecting others from injury and this opens up a whole can of worms re: liability and litigation possibilities for the facility. Also, has any employee been injured??? This would fall under Workman's Comp, and employers HATE having to deal with job injuries like these.

You absolutely MUST make out employee incident reports for scratches, welts, squeezes, etc from injuries sustained by all staff who are injured by this resident. The documentation has to be there! It is for your protection too, should there be delayed sequellae.

It is sad that the resident has so declined and is really not responsible for his/her actions, but others must be protected. Just as an aside, I've seen lightening-quick action occur when an administrator, manager or other dept head has been injured. One last thought, is there a corporate office that can be anonymously nottified? As much as I hate anonymity issues, sometimes the corporate route may help, or a union representative inquiry might just shake the tree!!! Good luck!