How do I get my pt to cooperate?

[cazach0122]

I have a patient in the first grade who is generally pleasant but cooperative only 50% of the time. The other 50% she will cry and scream as I try to get her out of bed and into the bathtub. Eventually I get her to do what I want, but it's mostly me waiting until she decides to do it herself.

How do I get her to cooperate with me? I always TELL her what to do because, given the choice, she will always go in the opposite direction of what I want. I tell her nicely, of course, but I think I'm being too nice. I just don't feel comfortable being too stern because I'm not her parent and I'm just not sure how much of a harda$$ I can be.

Sometimes we cut it very close to the end of my shift because it is taking so long to get her to cooperate with me and that needs to stop.

One time she wouldn't put down her iPad for bed, so I took it our of her hands and put it on the bedside table saying, "You can watch it in the morning." The child had a MELTDOWN and didn't stop until the dad came downstairs and scolded her.

I really don't want to have to have the parents intervene just so I can do my job.

For the record I don't have kids and I have very little experience with the pediatric population so this is very much a learning experience for me.

[ventmommy]

Is she developmentally delayed? If not, there is no reason that her parents aren't setting boundaries for her (ex. after dinner, Nurse Cazach will give you a bath and then you may use the iPad for 30 minutes.).

Have you spoken to the parents about how they want meltdowns, tantrums and outright refusals to be handled?

Try a timer. I have always found that timers are a good thing. You can use them in different ways: if she's competitive, you can say "I bet we can't get bathed and in your jammies before the timer rings" and if she needs boundaries, "when this timer rings, it's time to stop playing and go take a bath."

[SDALPN]

Its hard to comment without observing the interaction. Some kids are like this with every nurse. Sometimes its the parents. Other times its the nurse. I've found that once you get to this point, its hard to turn things around. If the child finds out they can act this way with you, they will. But that doesn't necessarily make it your fault. The parents may allow or encourage the behavior. Parents with special needs kids tend to let them get away with more because they feel bad for the child or feel guilty. But not all parents do this.

You could try talking with the PCP about the behavior or a social worker if you feel it is severe enough. Notify your supervisor. Make sure to document the behavior and encourage the other nurses to do so. Good luck! Kids with challenging behavior are always tough to work with.

[KATRN78]

Ask the parents for advice.

Depending on the developmental age you may try a sticker reward system.