Call light

Lev, MSN, RN, NP · Jan 28, 2015

Is she on psych meds? Get a psych consult and get her some meds for anxiety and depression. Find her stuff to do besides pretending she needs to be changed. She is obviously attention seeking.

peramos12gmail.com · Jan 28, 2015

she had a psych consult and is on numerous psych meds scheduled and prn. none of which seems to be helping. obviously attention seeking but nothing we have tried to redirect her has worked.when she is up and in the main tv room she is cursing and yelling at staff and when shes in her room she is on her call light constantly. my next step is documenting ever time she presses her light and reason she gave for pressing it and showing her son he is in charge of her care seeing if by him talking to her it might help.

Here.I.Stand, BSN, RN · Jan 28, 2015

^^^ That's a good idea. I was going to suggest a family care conference. That actually might be better since it's being addressed as an issue for the facility and a search for a solution; vs. one nurse bringing it up as in you showing her son the list yourself. In a care conference setting, you won't run the risk of looking like you, peramos12, can't manage her care.

A while back, in my ICU we had a woman who was on the call light literally q 1-2 min for a couple of hours. She was A&O, ready to go to the floor in the morning...I think she did have a psych hx but was not confused. We'd ask her, okay is there anything else we can do for you now? and she'd assure us before we left that she was fine and would go to sleep, or "Now I won't bother you for a while." And then she'd be back on it, like white on rice. Finally our most senior RN on the station told her "You know, we have critically injured and ill people in here that we are trying to keep alive, and this constant ringing is not appropriate. If it doesn't stop, we're going to have to take the call light, watch your vital signs from the desk to make sure you're okay, but address your requests only when we come in--once an hour." I guess that wouldn't fly in LTC though. :no:

JustBeachyNurse, LPN · Jan 28, 2015

I think hard data collection complete with objective (time, findings (water wet diaper, pt observed pouring water into diaper, etc) quotes of patient statements will be your best option. All behavior has a reason whether boredom, psychiatric, loneliness, agitation, etc.

Does her family visit at all?

The data can be used by the care team (nursing, psych, physician, social work, family) perhaps to come up with a solution. It sounds like a couple of shifts would give sufficient data.

peramos12gmail.com · Jan 28, 2015

i worked at a rehab facility that also has ltc and hospice. i believe removing the call light is against policy. we told her she is keeping us from patients that are in need of care and she has that we get mas at her for pressing the call light and noone likes her. i had to send her out last week for sucidial ideation and she came back three days later.

peramos12gmail.com · Jan 28, 2015

**she has said that we get mad at her for pressing the light.

BSNbeauty, BSN, RN · Jan 28, 2015

I had a patient like this once. She would push the call light over 100 times in an eight hour shift. It was so bad that the adminstrator places her on probation and it she continued that behavior she was going to be discharged from the facility. That worked and she only used the call light when needed.

rpsychnurse · Jan 28, 2015

The first things that come to my mind are:

Age and/or cognitive abilities of the patient. Can she understand what she is doing or does she have cognitive impairments? That will change how you deal with the situation.

I see that you've consulted psych and staff redirects her but have you sat down and talked with the patient (of course this depends on her cognition)? Has anyone on the team sat with her and discussed her behaviours, her thoughts and feelings, and explained and reinforced what is appropriate?

Is the team providing guidance and positive reinforcement when she does well? And providing consequences when she exhibits behaviours she has been told are inappropriate?

I think it is important to remember this patient is ill in some way. Illness can cause stress- which is likely the case here. Stress can lead to inappropriate behaviour. Maybe she is lonely? Maybe she is insecure? All of this could be causing her behaviours.

Just some thoughts- remember there is a person in there that may need support!