afraid of my patient

Nurse Salt · Oct 18, 2008

You will develop quick reflexes to get out of the way! Also, you will develop a sense of anticipation for their next movement... Just never let your guard down around unpredictable pts. She may not be intending to hurt you but that could easily be the case if she pulled you down and injured your back/knees/etc... Just be "on" at all times. Good luck, I know how unnerved you feel, but don't let this stop you from giving good, quality care. Dangerous or not, she deserves your 100%!

TopazLover, BSN, RN · Oct 18, 2008

She may have been trying to communicate with you the best way she has. She probably is very fearful of another new person. Consistent caregivers is a critical component of quality care for people with Alz.

Don't ask questions she can't answer. Share her pictures and cards if she has any. Make comments of beauty and caring. Offer her tea or coffee. BE PRESENT. You don't have to say anything. Smile and be attentive to her.

It is understandable to be fearful of the unknown. Try to look at it from her point of view. She has reason to be fearful of you. She cannot reason due to her disease. Ask yourself, "I wonder what it would be like to sit with someone I don't know, in a place that is not home, away from all that I recognize", then you will be more able to assist her.

Nurse Salt · Oct 18, 2008

Aknottedyarn, excellent advice! It is extremely important not to forget our patients are first people with thoughts and feelings (although not always rational from our point) and second patients who deserve our respect and expertise not fear... If you remember to treat the patient not the diagnosis you will be a wonderful nurse.

Nurse Salt · Oct 18, 2008

Aknottedyarn, excellent advice!

OP, it is extremely important not to forget our patients are first people with thoughts and feelings (although not always rational from our point) and second patients who deserve our respect and expertise not fear... If you remember to treat the patient not the diagnosis you will be a wonderful nurse.

**canoehead, BSN, RN** · Oct 18, 2008

She may not have been meaning to hurt you, just trying to make contact with another human. Think of her like a kitten who scratches, but doesn't realize she's hurting you. (or a big ole grizzly bear)

CT Pixie, BSN, RN · Oct 18, 2008

I have been working with geriatrics more years than you have been alive. (I don't mean that as condescending or insulting.) And in all those years, I have worked with countless Alzheimer's patients (worked with them before they were even called Alzheimers. It was OBS organic brain syndrome..the "old timers" probably remember this).

Anyway, in all those years honesly, I can count on both hands how many times I've been scratched or had any physical harm by an Alzheimers pt that wasn't upset, irritated, anxious, agitated at the time. Normally, they aren't going to scratch you to pieces if you are having a conversation (no matter how silly the conversation is) and their behavior is calm at the time. There are always exceptions to that rule but I've not encountered that too often. One big exception is if they are bruing up a good ol' UTI! Biggest cue for me is a normally non-physical pt lashing out, out of no where, is a huge sign of a UTI. Just my :twocents: . Actually most geri pts will act out of the norm for themselves when they are getting or have a UTI.

Now, an Alzheimers pt who is upset, angry, scared, anxious etc THEY can prove to be ones to lash out and physically hurt you. And you have to be on guard with them. You actually always have to be on guard with ALL patients because you just never know..

I understand you being a bit afraid of the pt but try to understand where he/she was coming from. It could have been that you "touched" her and for a split second she was back in our reality. That reaching out to your face could have been just her/him, reaching out to stroke your face or to feel the youth and softness of your face, you might remind her of a granddaughter, a daughter when young, someone she cared for years ago.

Try not to show fear or anxiousness around these types of patients. They tend to feel that emotion you have and react to it, if you are anxious or fearful, they in turn will feel the same way and might react to it. Go in with a genuine smile with a caring attitude and usually you are greeted with a smile back and a cooperative pt.

A soft compassionate voice, a gentle touch, a genuine smile, showing you truely care about their well-being all help to put these pts at ease most times. Try to remember that in that shell, lives a person who is lost in our reality. Even the simplist thing can scare or frighten them. Best advice is treat them how you'd like to be treated if you were in that same position.

Your patient made a move that you perceived as an attempt to scratch you. You may or may not be correct in that assumption, but try to give that pt the benefit of the doubt and give her a second chance.

(want to add that most of my most serious injuries came from patients who didn't have Alzheimers. They were pts that you would never think would lash out at anyone. These pts who lashed out were ones considered "with it". So, its always a good rule to keep on your toes and never forget that anyone of those patients could be one to scratch your eyes out.) Nothing would irk me more than a patient who was "with it" who would slap/kick/hit/pinch/bite etc because they felt that you were a piece of garbage that they could do with what they wanted, no other reason than that they felt it was their right to do to you what they wanted. Instead of saying no, I'd rather you not change me right now, they would go into a full blown tantrum with kicking, hitting etc. At least the Alzheimers pts had a reason (they don't know where they are, who you are, and they dont understand why some stranger is "playing around" in "that" area..)

In time you will learn how to deal with these type patients. You will become more comfortable and your "I better watch out, it looks like I am going to get kicked/slapped etc" rader will be in tune and you will be able to anticipate and react to those things. Like you, I remember being terrifed of a few pts for the mere reason that I thought they were trying to pinch/scratch/hit me. 20+ years later, my favorite patients in the LTC setting are my confused, demented or Alzheimers pts. They can be some of the most loving and appreciate pts you encounter. :)

Straydandelion · Oct 18, 2008

Taking the time to assess the patient while talking in a calming voice, smiling, calling them by name can be VERY helpful to confused patients.

.... its always a good rule to keep on your toes

In the same vein however, as with anyone unknown, it doesn't hurt to watch out for yourself. Without any warning a patient grabbed my stethescope from around my neck and tried to hit me with it....needless to say I quit wearing one around my neck unless absolutely needed.