Abused by A&O Residents

[MisMatch, LPN]

How does your LTC facility deal with alert & oriented residents who are abusive to staff? I have been a nurse for 2 years now, and still struggle with this.

I have no problem with the dementia residents who are unaware of their actions and language (which can get quite colorful!). There are ways I have found to work with this and I am not bothered by the words that come out of their mouths.

I do have a problem with alert & oriented residents who regularly verbally and physically abuse staff with no repercussions. They will yell, curse, hit, kick, bite, spit, ect. and the most we can do is assure they are safe, walk away and chart. I asked the supervisors and was told basically that "it is what it is" and that I should have known it was like this when I got into nursing. They also say it is their illness (ie: CVA, mental illnesses) Is this the norm? How do you deal with this?

[signet, LPN]

Just because residents appear to be alert and oriented doesn't mean they don't have psyche issues. Once they make the step from verbal to physical abuse a psyche consult is needed. Verbal abuse you just have to try to ignore. If they're being physically abusive toward staff it will not be long before they do it to other residents.

[CoffeeRTC, BSN, RN]

Really, an A & O x3 resident kicking and biting you? Do they have a mental illness? You gotta ask why? With the absence of a MI or MR...No...that is not acceptable. Can I ask how or when this might have happened?

I've been bit, scratched etc by a resident with dementia or who was in a psychotic episode that we were trying to preven them from injuring themselves or others, but never by an A and O X3 person.

As far as verbal abuse..yeah, I've had my share of that, but I'm kinda a "Sticks and Stones, Names will never hurt me" person. You have to try to put yourself in that bed....they are in a LTC, lost their independance, told when to do what, offered crapy meals (sometimes) might or might not have a friendly roomate, stuck in a place where there are old sick people, occasional odors....you get the picture...this can make anyone depressed or angry. Not everyone has the best coping skills all the time.

Have you spoke to SS or your behavior team about these residents?

[adampricecna]

I'm not a nurse....yet, but I am a CNA and my charge nurses always call the doctor and get a psych consult and they are send to something of a mental hospital....but they ALWAYS come back different...changed I guess. I don't know if it was medication or what, but it works.

Also I try to understand that the patients whose bodies have given out before their minds have are the WORST patients to have. Understandably so they are angry and depressed. I try to learn patience. I guess they feel as if their life has been cut short, because their life is surrounded by nurses and caregivers.

[BrookeeLou_RN]

Physical abuse should be dealt with.. promptly for everyone's safety. Report to MD, try to get psych consult, report to Social worker for facility, see if he/she could intercede at least to get an idea as what is causing this. Your care plan team needs to know and plan for interventions. If another resident gets hurt, the state will be in to find out why. I would want to have plans in effect long before this occurs.

[Bella'sMyBaby]

How Behaviors are handled depends on the Facility.

Social Services usually gets a Psych Consult & meds are usually started.

Many times if Behaviors are out of control, the resident is sent to a Psych Unit.

If the Behaviors continue, some Facilities will look for alternate placement, even if it means moving the resident out of town/state.

Private Facilities usually won't take Behaviors in the first place; they will say "They can't meet the resident's needs."

The Corporate owned "Census Driven Head in the Bed" Facilities usually will take Behaviors...until they get tagged by State or can't handle the Behaviors any longer, then will look at getting them out of their facilities.

It's not uncommon to have certain residents rotated in different Facilities in the same city.

No Nurse should have to tolerate abuse from any alert & oriented resident. Never.

[CloudySue]

My former facility has some nasty folks. I would try to kill 'em with kindness. I'd go in there and sass back, joke about what they are saying, but lovingly. One woman would tolerate me only. (Lucky me.) Sometimes dishing it back really works, and if they are really A&O one may earn a bit of respect. Obviously this a case-by-case theory, but to some people, a bit of "inappropriateness" is the only language of a relationship that they know. Of course, rapport is everything. If the state would have heard some of the conversations I've had, there would have been investigations! LOL!

Me: "Hi, H... how the F are you?"

H: "F'ing lousy. I want to get the F out of here!"

Me: "I know. I'm sorry. Can I give you your pills now?"

H: "I don't want that S. You can shove those pills up your A!"

Me: "I could, but then they'd taste even more like S, so you may as well just take them now while they're not so bad."

H: "Give me the G-D pills."

Me: "Love you, H."

H: "Love you too. Leave me the F alone."

[nursedeb1967]

some of those a and o patients like to see how far they can push you. and some of them are so miserable they want u to be that way too. some of it comes from lonliness. whatever the reason it is happening, it isnt right and should not be tolerated! Our jobs are hard enuff without getting abused by patients who probably know better. I try to set limits and only go in the room when absoulutly necessary and then with another staff member when possible. sometimes i call them on their behavior and it helps. sometimes!!!

[morningmom]

When I was working in SNF we had a resident who came in and was just horribly mean! She was my least favorite resident ever. She would refuse meds constantly, not just refusing but when we would get her to take them (in as) she would spit it out at us. Turns out she was bipolar, when we finally got a hold of a psych who had treated her in the past, she gave us the tools (basically what we could say) to get her to take her meds..she took them with no problem. Once she got her meds on board and in her system, she actually apologized to us for being so mean in the past, and she became one of my favorites.

She was totally A&O throughout the whole thing.

[MisMatch, LPN]

Thank you all for your responses. This is a government run facility and has many residents that no one else will take. Yes, some of these residents have mental illnesses. They have medications but have and exercise their right to refuse. There have been psyc consults and social services interventions to no avail. If they become a threat to other residents they can be sent to a psyc hospital. Some know how to play the game to keep from crossing the line.

For now, I have as little contact with these challenges as possible while continuing to learn how to deal with it.

[CoffeeRTC, BSN, RN]

Limit setting and care planning. We also have residents in a contract type thing. They must do xyx and we will do xyx. They are not allowed to yell, scream etc or staff will xyx.

If they are truely a and o x3 they should be able to do this.