I have had patients who are ALWAYS on their call light despite multiple staff and attempts to dissuade them from inappropriate use, but this lady I have now takes the cake! She will press her call bell, and if no one comes within ten seconds, she will start shouting. Her behavior has escalated in the past two weeks to now include screaming "HELP! I FELL! I BROKE SOMETHING AND I'M BLEEDING EVERYWHERE! HELP! OH GOD PLEASE HELP ME!" Of course, staff run to her room only to find her comfortably sitting in her chair or bed unharmed. She will then ask for something trivial, like having her room light turned on or off (which she can do on her own, she just can't be bothered).
This woman is in her late 60s and cognitively intact. She loves the attention even if it is to reprimand her for gross misuse of her call bell. Any suggestions on how to get her to change her behavior? Her family is aware, and I've told her point blank that she needs to stop this because there will be a time when she actually does need us, and we won't respond immediately because of her abuse of the system.
Also, any tips on keeping your cool with these patients? I find I'm getting snippy with her and telling her that she needs to either be patient, or I'll say firmly, "Do (insert her request here) yourself. I am busy right now with people who actually need my help." It's getting harder and harder to keep cool, especially when I've got patients and visitors alike who are genuinely concerned for "that poor lady screaming".
Document EVERYTHING! Careplan EVERYTHING! Psych consult, behavior contract, IDT meeting with resident and family involvement and document the results. Limit setting, rotate staff, involve activites, get the resident out of the room as much as possible, move the room closest to the nurses station, call the ombudsman to get them involved.
Chart the behaviour thoughougly of behaviors observed, strategies used and pt response. Over time this will help develop a strict behaviour plan between exactly that management, nursing staff and the physician. Include time limits if needed, communication tips and tricks, consequences mentioned to pt if not compliant with staff requests. The more team members you have on board, and comply the easier the behaviors become to manage.
Thank you so much for this answer. We actually found that what was most effective was rewarding her appropriate call bell use, telling family of the misuse, and ignoring her when she yelled inappropriately (after a quick check in her room to be sure she wasn't actually harmed). We also implemented strict 30 minute rounding. It greatly reduced her behavior.
Before I became a nurse, I worked in the ED as a tech. I had this drunk patient pull the code blue button on the wall and faked a tonic-clonic seizure. He did a series of other things that eventually got him escorted of the property after treatment. My employer allows us to file safety reports and I did just that. I wrote a full account of everything I witnessed in that report. Using the code blue button on purpose for no good reason, like imitating/faking a tonic-clonic seizure, isn't funny.
CoffeeRTC, BSN, RN
3,734 Posts
If this is LTC....I feel your pain.
Document EVERYTHING! Careplan EVERYTHING! Psych consult, behavior contract, IDT meeting with resident and family involvement and document the results. Limit setting, rotate staff, involve activites, get the resident out of the room as much as possible, move the room closest to the nurses station, call the ombudsman to get them involved.
Good luck!