A backbreaking patient...

TakeTwoAspirin, MSN, RN, APRN · Sep 9, 2012

I would explain to her very carefully why you will not be getting her out of bed without the appropriate equipment and offer the bedpan. When she starts to pitch a fit I would then explain very carefully why I am going to ask for a psych consult if she is unable to calm herself and behave reasonably for the safety of herself and the staff.

By giving in to her in the past you have been feeding the bear, and if you feed the bear the bear will come!

SaoirseRN · Sep 9, 2012

Boundaries! And every nurse has to say the same thing.

One thing I find works with dramatic people is to give them their (actual) choices, calmly and firmly. For example, when she asks to get up to void:

"Okay. You have two options. I can get you a bedpan now, or you can wait x minutes for the lift to the toilet."

If she starts up, I would say, firmly, "Do you need to use the toilet?" and when she says yes, you repeat, "those are your options and you must pick one. I cannot get you up with two staff. That is not an option."

Chances are, she'll either realize she doesn't really need to go just now, or see you are serious and agree to wait.

If she insists on a tantrum, tell her you will be back when she can speak calmly but you will not entertain a conversation while she is screaming.

Think "Supernanny" modified for adults.

Make sure it's written in her care plan or whatever system you use how staff are to deal with her. It might even be worth discussing in a staff meeting type setting so everyone -- management and staff -- are on board.

sjbrk · Sep 9, 2012

Is there a possibility of bladder training? I work as an aide in LTC and recently had a resident who would call every 15 minutes. Supervisor finally said "no more." We started out telling her she had to wait an hour, when she stayed continent that long, it was an hour and a half, and later on, two hours. Now she knows not to call unless it's been two hours.

Is this feasible in a hospital setting?

Pepper The Cat, BSN, RN · Sep 10, 2012

I feel your pain.

We had a pt who deteriorated while on our rehab unit. One of the last times he got up to the commode, it took 5 of us to get him back to bed, and even then we barely made it.

After that, he was told Hoyer lift or bedpan. He kicked up a huge fuss. Family kicked up a fuss.

Physio and nursing stood firm - hoyer lift or nothing.

He became bedridden because he didn't like the Hoyer, but that was his choice.

The nurses supported each other - he was a very manipulative person and would try to con a new person into getting him up. Luckily our unit is very supportive of each other and would update a new person pretty quickly about this person.

We were all very thankful when he left our unit.

As for your pt - just tell her - bedpan or wait for the lift. Those are your choices. Period. If she throws a tantrum, walk out. Tantrums are useless without an audience. If she has a roommate it will make things a little more difficult - I would just pull her curtains so the roommate/visitors are not an audience either.

allnurses Guide · Sep 10, 2012

Those kinds of patients I have simply told very firmly that if I try to get them up I am going to hurt myself and that is not something I am willing to do. Pitching a fit won't change that and I tell them that as well if needed.

Creamsoda, ASN, RN · Sep 10, 2012

Seems shes been there a while and has some behaviour issues that the whole team needs to address . Have you asked the doc about a psych consult? How about a meeting with the manager, nurse and doctor and have a care plan set up with expectations from both ends so there no confusion. Is she mentally there enough where this would be feasible? She needs major limit setting and expectations.

Creamsoda, ASN, RN · Sep 10, 2012

Seems shes been there a while and has some behaviour issues that the whole team needs to address . Have you asked the doc about a psych consult? How about a meeting with the manager, nurse and doctor and have a care plan set up with expectations from both ends so there no confusion. Is she mentally there enough where this would be feasible? She needs major limit setting and expectations.

Also, write out the care plan on a huge piece of paper in her room so its plainly clear what the plan for the day, each and every day is

redhead_NURSE98!, ADN, BSN · Sep 10, 2012

Hello everyone!
We have a young female patient on our acute care unit. She's been with us for about 5 months. She's EXTREMELY needy - one the call bell every 15-20 minutes during the day and evening. Lately, she has been able to get out of bed with assist. This wouldn't be such a problem, but she her legs are so weak that she is literally "dead weight". To make things even more problematic, our hospital only has one mechanical lift on the rehab unit. However, the patient will not wait for someone to get it, and often becomes dramatic and screams out if we are "late" answering her call bell. So many of us have resorted to getting her out of bed with the assist of 2 nurses. Again, making this more problematic, is that the patient is on dialysis and feels the urge to void about every 30 minutes - and usually only goes a few drops (literally). For a while, we had 3:1 ratio with her, but not our manager says that we can't do that anymore. We have a nurse out with a torn rotator cuff and another with a herniated disc - both thought to be from this patient. We have tried telling the patient that it is not safe for us to get her out of bed, but she doesn't seem to care that we are breaking our backs. She flat out refuses the bedpan. And, againg, becomes overly dramatic if she has to wait 10 minutes for someone to get a mechanical lift from another unit. Does anyone have some strategies or recommendations for how we can best deal with this issue?

I will sound insensitive for the sake of brevity, but....nah, she can piddle on a paper pad if she can't bear her own weight and she's hurting people. I'm sorry but it's a safety issue in more ways than one and I'm tired of having staff kill themselves on people like this. I bet she will be able to bear more of her own weight when she has to pee on a pad too, given that you say she is over dramatic and manipulating.

PeepnBiscuitsRN · Sep 10, 2012

When you say "young" how young are we talking? Teenager? Twenty-something? Not that her actual age excuses the snotty behavior, but knowing her age might make it easier to formulate a strategy for dealing with her behavior.

joanna73, BSN, RN · Sep 10, 2012

We have a very needy and very heavy patient. She made a fit when we explained the need for the lift, when she first arrived. She also had a consult with physio shortly after. Every one of us explained that for her safety and ours, we would be using the required equipment, whether she liked it or not. That was the end of that.

LCinTraining · Sep 10, 2012

We have one who has refused care from nurses who have set boundaries, so now it is a matter of tricking them into thinking it is their idea. This particular one has driven people off of the spinal cord unit. Employees begging to be put elsewhere so as not to deal with it. It sounds a lot like our spinal cord patients. Complete loss of control of their physical bodies, so now they are going to control their environment and too bad for anyone that enters that environment. It is a psych issue, and needs to be addressed so that they can earn to control their health, while not being demanding and rude.