Published Sep 14, 2004
Hello, all. I am a new lpn that has been assigned as a nurse on an 18-bed alzheimer's unit. I usually enjoy my job but am having an issue with combativeness out of my patients. At times, some of the residents can be very violent toward me, the assistive personnell, even their own families. I understand this is part of the disease process of Alzheimer's but I find myself not being able to deal well with it personally. I was abused as a child by a relative and I tend to either feel myself losing patience with residents or I withdraw into myself. I would never harm a resident, but I worry about how to handle my personal feelings about the combativeness and still give good patient care. Can anyone give me advice?
You said you were abused as a child. Try to imagine these pts as children. Really, they are children - although, they are very large children. At the same time, you do have a right to be protected from out of control pts. If the stress gets to be too much, then take some time off (more than just a weekend). When you comeback, you will feel better. If you dont, look for another job. Good Luck
txspadequeenRN, BSN, RN
I am a alzheimers nurse and you have to look at these patients and realize that if they were in their right mind they would not be doing this. It is the disease not the person. If you want to cont to work with these patients you are going to need to put those feelings aside or find anothe job . This is a situation that is not going to get better, just worse. As their disease process cont there behavior gets worse. Do you have PRN medications for these people,if not you need some. I worked on a combative unit this weekend and I bet I gave over 100mg of ativan. You will learn there behavior, esclation points and behavior reducers. Another thing you have to be strong, I call it playing the game. Give me any line of BS or insults and I can come back with something calming. I have some people on the combative unit that look for the weak,it's like fresh meat for them. I wish you luck , alzheimers can be very difficult to endure when you are new to working with it.....:)
CoffeeRTC, BSN, RN
:uhoh21: Might not be a good unit for you to work on. It is very demanding and frustrating at times. Giving PRN antipsychotics or sedatives isn't always effective unless you snow them, then they will be zonked out for a few shifts, starting the cycle over again. In my facility very few if any residents have prn meds.. Instead we use other means..and no they aren't always effective and being short staffed alot doesn't make it easier :uhoh21:
This is a situation that is not going to get better, just worse. As their disease process cont there behavior gets worse.
This is why God created nurses. These pts are too much for their family to deal with.
I have worked with Alzheimer's clients for five years. Remember, residents are often combative out of fear. Try to take what they are fearful of (bathing, peri care, changing clothes, redirection) out of the equation and changing it into something the resident can understand. Don't rush ( I know, easier said than done in LTC). If the resident becomes extremely aggressive, make them safe and come back in fifteen minutes. Document what happens and make sure your Nurse Manager is aware of what is happening. Some behaviors only happen at certain times of day. PRN meds can be helpful, but often have rebound effect or become ineffective over time. Good luck and hang in there!
Take a few minutes to review your own actions and how you approach the residents. You may be doing something inadvertently to provoke a violent response. If a resident is doing something you would rather he not do just remember "is it hurting anything". I worked on a secured alz. unit and some residents would just look out the window and knock constantly. Some would try to divert this behaviour but why????? Learn to be very tolerant. Don't be afraid to say "An alzheimers unit isn't for me". If that is the case it certainly isn't a sign of weakness. I can't handle mentally retarded adults. I recognize it as something I would prefer not to do.
lovingtheunloved, ASN, RN
It just may not be your thing. Nothing wrong with that. I don't ever want to do PEDS. Be very, very, flexible. Like veteranRN said, if they're not hurting anything, let them be.
Like many post above. It will only get worse. Look into your heart and decide if this is the place for you. If not there are plenty of other places. No reason to feel like you failed YOU DID NOT some people are just not cut out to work in certain areas and excel in other areas. Good Luck.
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