Behaviors and Call Lights! Help!

Specialties Geriatric

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Specializes in LTC, Hospital, Staff Development.

I just started a new position as a Staff Development Nurse. Talking and working closely with the CNA's and Nurses, I have found a common thread to poor morale. It's the one patient on the unit who is not demented but has behavioral problems. We all know the one.....the one who puts on the call light 15 minutes after the CNA or Nurse has met all the resident's needs.....and continues this behavior, often with the resident yelling at the poor CNA who has eight other resident's she must attend to. This is also a survey nightmare. You have your DON's and Administrators telling you that you have to answer the call lights within three minutes. What a horrible nightmare. To top it off the resident has been assessed to death! Nothing physical, nothing environmental AND the resident refuses mental health!! It is just the way they have been all their life. How does one deal with this type of resident and their demanding family members? Can't force psych on the resident who refuses, nor can you make them see mental health? Does anyone out there have sucessful experience with this kind of patient?

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Maybe you can have a chat with the patient & family & tell them that the call light should only be used when it's necessary because if it keeps getting hit for minor things than the one time it may be an emergency someone may not come quickly enough because they may think it's nothing that is really an emergency, plus that there are other residents that have a right to care as well, and she has to realize this........... Maybe she's just lonely & this is her way of getting attention even if it's negative attention.............Or....maybe tell or ask the family members if she hits the call light alot, that one of them may need to come in and sit with her to "aid" her with things because other residents require assistance as well and there just isn't anyway the staff can be in two places at once..........I can imagine the frustration you must be feeling.......:uhoh3:

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Carol - I don't really have any answers for you - we've had problems like this before, too.

Our administrator has talked to families and residents a couple of times, especially when the resident has been abusive to staff - she has told them that the resident will be asked to leave if the behavior continues.

We recently got a res. that was on the lite all nite long - nice lady, but she just couldn't understand that at nite, there are only two of us. She would ring and ask to be put on the BSC, then ring after a minute or so to go back to bed - without doing anything!! This lady had a cracked pelvis from a fall - I finally talked to her and asked that when she was on the BSC that she sit for awhile - I explained that the constant up & down was going to be hard on her. She tried that and found that it worked.

You can also ask a resident before you leave the room, if they need anything else - and give them a bit to think about it, and explain that you have to do other things and won't be able to come back for 15 or 30 minutes or whatever - and then don't go back until that time is up.

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I have that resident. The one where the spouse thinks they are getting a buy 1 get 1 free deal and expect you to take care of them while they are there too b/c they have all kinds of medical (and mental) issues also?:bugeyes: Or they call you 3-4 times, just during your medpass, to give you a hard time about something that te resident has called and told them that's not even true? The family/resident that can't understand that you can't just give them whatever whenever without an order, even tho you explain it to them almost every day? The one that puts their light on for the aides to crank up their bed, when you just walked out of the room not 5 mintues ago after cranking it down some for them? The one that's been thrown out of other facilities b/c of their behaviors and the spouse's as well? But yet when they complain about care, and you tell them that the doctor says that when they will do this or that for themselves, or when the spouse can take care of them they can go home, the spouse says "oh no, we can't do that". Yeah, got that resident.

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Specializes in ICU, ED, Transport, Home Care, Mgmnt.

Consider setting limits on the behavior. You can even go as far as writing up a contract with the patient and asking them to sign it. Have a care conference with the doctor and all staff involved with the patient ( as many as possible) Openly discuss the issues at the care conference then with the patietn. Tell them what behaviors are expected from them and what the staff will do to assist them. Explaining that there are other pateitns or limited staff will only set off the patientws and family members with personality disorders. You have to set limits with them, write them down for everyone to see and every staff member must enforce the limits. No second chances, no giving in, that only reinforces the bad behavior and will help the patient to try and pit the staff agianst each other. Good luck.

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Specializes in MDS coordinator, hospice, ortho/ neuro.

I had one who was putting on the light continually.........she was using it as ummmm, a sex aide............:eek: ........

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Specializes in Public Health, TB.

We have used "contracts" in our hospital for frequent fliers who abuse the staff. They aren't perfect but definitely help, but all staff must follow the contract. Our social worker has a template and helps to draw it up.

If your resident won't accept mental health, perhaps you can get some for the staff. That is, perhaps a mental health counselor or social worker can coach staff members on dealing with disruptive behaviors, setting limits, and carrying them out. You might need an extra staff person at first to respond to the frequent calls and remind the resident of the contract.

At our hospital all patients are given a brochure on admission detailing rights and responsibilities and those who do not comply are asked to leave. O

Good luck!

Julie

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Specializes in Geriatrics.

Is there anything that you can do to distract the resident?? Did they have a hobby before they came into the facility that they don't have access to now?? Such as crocheting or some other type of crafts?? Reading or listening to music?? Will they leave their room and maybe do some sort of activity in a common area where there are others around that may keep them stimulated enough to distract them??? We have a gentleman that we have trouble with always trying to get out of his chair and since we are a restraint free facility it sometimes poses quit a challange. We read in his chart that he used to be an accountant so after supper time (which is when he seems to get very "antsy") we toilet him and set him at a table with papers, a pencil and a calculator and he will sit there quietly until the girls are ready to put him to bed. Sometimes it takes a little research to find that one thing that could make a world of difference in even the most difficult patients. One other lady we had similar behavior problems with we found out used to be a florist. We went out and purchased a bunch of plastic flowers and she will sit for hours making arrangements and then she delivers them to other residents.

The problem could be as simple as boredom and finding something interesting for the resident to do may help. Just my thoughts. Good Luck!!

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Specializes in Pediatrics.
Consider setting limits on the behavior. You can even go as far as writing up a contract with the patient and asking them to sign it.

This is the approach that has been suggested to me (not for clinical, but as an example) as a nursing student. If the patient has been assessed to death, then a psychological assessment has surely also been done. The results of that assessment must be discussed with the patient. Limits need to be set, and some straight talk needs to happen. My teachers also suggest rewarding (behavior modification 101) positive behavior by promising to spend x amount of time at a specific time of day with the residentif they refrain from using the call bell for x amount of time-on the condition that all their basic needs are first attended to and that they call immediately for a real emergency.

P.S., since you say resident, this sounds like LTC. Can this person be put in a wheelchair and moved into a day room? Nursing care doesn't end after all physical needs are attended to.

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Is there anything that you can do to distract the resident?? Did they have a hobby before they came into the facility that they don't have access to now?? Such as crocheting or some other type of crafts?? Reading or listening to music?? Will they leave their room and maybe do some sort of activity in a common area where there are others around that may keep them stimulated enough to distract them??? We have a gentleman that we have trouble with always trying to get out of his chair and since we are a restraint free facility it sometimes poses quit a challange. We read in his chart that he used to be an accountant so after supper time (which is when he seems to get very "antsy") we toilet him and set him at a table with papers, a pencil and a calculator and he will sit there quietly until the girls are ready to put him to bed. Sometimes it takes a little research to find that one thing that could make a world of difference in even the most difficult patients. One other lady we had similar behavior problems with we found out used to be a florist. We went out and purchased a bunch of plastic flowers and she will sit for hours making arrangements and then she delivers them to other residents.

The problem could be as simple as boredom and finding something interesting for the resident to do may help. Just my thoughts. Good Luck!!

What a smart thing to do!!:saint: Maybe he could balance my checkbook?;)

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Specializes in LTC.

Carol,

I know EXACTLY what you are talking about. I read your post and had to look at your name and location because I also have that resident. I am one of the CNA's that get the short end of the stick when it comes to one particular resident. She is only 48 years old, and honestly the meanest, rudest, most miserable person I have ever met, seen, or heard about. Her parents are her POA and she is completely sane. Her parents tell her that she needs to treat us with respect, and they have been called a million times about her behavior. She is 4'11" and 375 lbs. She cannot walk, but she sure can order everyone around, threaten to call state every other breath, and SCREAM at the top of her lungs every single day, evening, and night. She has hit us, threw things at us, and she verbally abuses her roommates. She refuses her diet that could save her life, she refuses psych, she refuses just friendly conversation unless it is about food. I have worked with her for 3 years, and last week I snapped. I just couldn't take it anymore. I told our DSD that I can no longer be assigned to her. Other aides are just as frustrated with the woman but they do nothing about it. After 3 years of charting behaviors every day and pleading with our DON, ADON, and administrator, there is still nothing being done. I don't understand how a company can allow one person to run off their help and literally abuse us like this. I asked why we accepted her in the first place and the reply was that cencus was low. That is just ridiculous. They say that they can't "kick her out" either. They know how terrible she treats us all but still nothing can be done? There's got to be something!!??

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Nikki - that's horrible!! Our administrator has talked to a couple of them who have been really awful, and told them that if they don't shape up, they'll be asked to leave. Don't know if she can really follow thru on that or not.

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