alzheimers res w/ combative behaviors

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What is the stigma of charting combative behaviors that upper level management have to hide?? For instance: I charted on one of our res behaviors - she was hard to redirect, slapping/hitting/pushing staff who tried to redirect her to sitting in her chair or eat dinner. She then proceeded to raise a hand to another res out of no where and removing her from the scene and placing her at nurses station w/ diversional activity. - i charted all that ( even the raising the fist as if she was going to hit another res w/ out reason ) yet, the upper managment state that i shouldn've charted this and removed it.. They tell us to CHART EVERYTHING.. yet behaviors and psychotic behaviors are a no no in charts!!!

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hmmm I have no idea. Did you ask them. Do you guys not treat the combative behaviors? Why not ask them.

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Specializes in Geriatrics, Med- Surg.

I also work on a locked Alzheimer's unit with ome resident's that can be really aggressive at times. I was told in a round about way from my preceptor that if a resident is a physical threat to other residents by regulation they wouldn't be aloud to stay at our type of locked Alzheimers facility. I was also told by management that since the residents can't control their actions due to their disease process it's not the same thing as if a non demented resident threatened or hit. I absolutely do not not agree with this! But have also been told that it isn't necessary to document specifics of any instances, just to note that the resident was given a prn for " increased agitation". I have been punched in the face by a resident and then told it really wasn't necessary to fill out an incident report! I really need my job so I've been sticking it out until something else comes along but I know exactly what you mean about the brushing of behaviors under the rug. My concern is what happens if someone really gets injured by another resident. I'd like to see what other people think too.

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Yes, I did ask. I basically was told "it is something that should not be documented". Personally, I was ticked off that the lady was not taken care of a week before.. she was having behavior problems 2 weeks previously to when i came to work--I kept hearing staff talking about "oh so and so did this, and that". And they were behaviors that need to be LOOKED at by psych services that were not being dealt with. Being me, I took it upon myself to write a nice LONG narrative note of her behaviors she was exhibiting that weekend. She went to a psych hospital albeit! but I was told I shouldn've wrote my notes, that i shouldve just went to the DON. YET!! they complain about NOT having proof of behaviors in chart when STATE comes.. *they have been known to pull all the "psych" res charts to a hiding place when state comes..*

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Huh. I just said the same thing about hiding behaviors in your other thread.

Have you dipped her urine for a UTI?

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yes, im sorry.. i tried deleting the other one.. but i couldn't see how.. * miss spelled alzheimers heh and i ended up accidently submitting the thread again*.. They tested her at the psych hospital for one, came back negative.

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My problem with the situation is that the other residents have a right to be free from harm. Personally I would keep notes and then make anonymous report to state

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She recieved the care she needed AFTER I forced them to come to terms w/ what they had it seems. I am glad she was looked at and assessed by professionals other than the ER that we send her to for multiple falls (yes, that too.. they are not happy w/ QI on the falls) Just I was ticked off w/ being approached that I SHOULD NOT of wrote a nurses note on her "possible hitting". I was just seeing if that was a "common" practice- and i figured if it was..someone would say they have seen it done. It sure shouldn't be practiced!

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Bull....you chart what you see, what you do and what the results of your interventions were. Period. Do not let them make you delete or revise your doumentation to lie.

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Specializes in geriatrics.

We have that problem by us also. Its ok to chart the residents actions as long as you chart what interventions that you put in place to try to reduce the behavior. If there are no interventions besides prn given, it may look like there was nothing done. Also, I'm not sure if I would chart any "possible" behaviors, only chart what actually happened

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Specializes in Gerontology, Med surg, Home Health.

Wow....we go around the building telling the nurses and CNAs to document every behavior! In Massachusetts the Medicaid residents are paid for by a system called MMQ and if we document behaviors for at least 15 shifts a month, we make 10% more than we do on the patients without behaviors. Chart what you see and the interventions you provided. A resident to resident altercation must be reported to the state even if both residents are demented.

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She was pulling her hand back in a fist about to hit another res right before we intervened.. so do they still have to report that to state?

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