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CNA2016:) CNA2016:) (Member)

Can you refuse to give care to a resident in LTC?

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CNA2016 -

I wrote this out then erased it, but since you have to work tonight and are already feeling the stress, can you try this? It's a process I myself have had to work through in my career:

I have learned to work internally (within myself) towards neutrality. It works like this (self-talk): "This individual knows nothing about me and is not an important person in my life. He also is indiscriminating (meaning, if I weren't there to be the object of his hate, he'd find someone else). I do not derive my sense of self-worth from my care-giving relationship with this individual".

This method empowers one to calmly maintain boundaries, to exist without the burden and malignancy of constantly "feeling" insult, and to continue providing excellent care to the extent that the individual allows. It will become second nature and you will learn to deal with all difficult individuals along these same lines, even in your personal life. It's very freeing because it frees one from burden.

Meanwhile, when you go into his room, take a deep breath, remember the things above, HAVE YOUR BUDDY WITH YOU, and remain calm.

"Hello Mr X, what can we do for you tonight?"

---yelling, rude language

"We will return when you're ready for help, just put your call light on."

[both parties must leave].

Try it tonight. Let us know how it goes.

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Thank you for your response. Yes I've sadly tried this many times. as soon as I say I will leave until you can speak respectfully he rings immediately...we go back in and he just yells again. it's just an endless cycle. But yes I will try to separate myself from him but it's hard when he is directing his hatred towards me.

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I mean that he will ask me specifically "what are you such a ******* *****?" when I've done nothing. hard to separate yourself from that :( should I just say nothing and let him abuse me or am I doing the right thing by saying I will leave until you can speak respectfully?

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I mean that he will ask me specifically "what are you such a ******* *****?" when I've done nothing. hard to separate yourself from that :( should I just say nothing and let him abuse me or am I doing the right thing by saying I will leave until you can speak respectfully?

All I can say is I don't banter back and forth with these people. That's just me. I don't want to nitpick your words. :) I have various very short phrases I use but I employ them very specifically so it's hard to say what I would do without encountering him myself. At times I have just said, "Let me know when you need my help" (come back later, same type of behavior...) "You are not going to fluster me. Let me know when you need my help."

"I am not flustered by your words"

"I am here to help you"

"I want to help you"

"Let me know when you are ready for my help"

"That has no effect on me"

"If you do not want help, we will respect that"

"I respect your choice, I will document that you have declined my help right now. I will check back with you later"

Personally I avoid add-ons like "when you can behave" "when you can treat me with respect" "when you stop talking like that"....they know dang good and well what they are doing, I refuse to give them the satisfaction of having me acknowledge it. That's what they want. They want to hear that they are frustrating someone with their words/behavior.

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thats good advice. thank you for your response. I'm trying to have tough skin but I also have a big heart. hard to always have both in every situation

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I'm wondering if it is acceptable to tell this resident "we will come back in 15 minutes so that we can have an appropriate discussion of how we can assist you." If the resident is swearing or yelling and we make sure he is safe and has bell can we say that?

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I'm wondering if it is acceptable to tell this resident "we will come back in 15 minutes so that we can have an appropriate discussion of how we can assist you." If the resident is swearing or yelling and we make sure he is safe and has bell can we say that?

Drop the triggering words like "appropriate"

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I guess everyone would handle this situation in a different way. From what you're describing about this resident it sounds to me like you may want to handle your communication with him in a different way. Just because he is acting like a child doesn't mean you need to talk to him like one. I'm thinking the constant talk about how he is acting inappropriately and let me know when you're ready for me to help you is equivalent to telling a kid to take a time out in the corner. I get your frustration and not wanting to be abused. I can tell you only how I would try to handle this guy. First, I would like to know what kind of a guy he was before he became my patient. It could be that he talks like this everyone in his life and everyone he knew talked the same. It sounds to me like the guy is frustrated in his situation and his personality is simply to beat up on everyone else around him. It could be he only respects people who talk tough and curse and despises those that try to change his behavior. I always changed my personality to mirror my patients. Usually it worked, sometimes it didn't. If he asked me to get his effing water, I could picture myself laughing getting the water and jokingly saying here's you effing water, now I will get the eff out. I've encountered a lot of patients like this and getting on there level as long as you're not being confrontational with them can do wonders for the nurse patient relationship. I would make an effort to get to know the guy. You would probably be the only one who tried in a long time.

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I can tell you only how I would try to handle this guy. First' date=' I would like to know what kind of a guy he was before he became my patient. It could be that he talks like this everyone in his life and everyone he knew talked the same. It sounds to me like the guy is frustrated in his situation and his personality is simply to beat up on everyone else around him. [b']It could be he only respects people who talk tough and curse and despises those that try to change his behavior. I always changed my personality to mirror my patients. [/b]Usually it worked, sometimes it didn't. If he asked me to get his effing water, I could picture myself laughing getting the water and jokingly saying here's you effing water, now I will get the eff out. I've encountered a lot of patients like this and getting on there level as long as you're not being confrontational with them can do wonders for the nurse patient relationship. I would make an effort to get to know the guy. You would probably be the only one who tried in a long time.

Definitely! I'd actually say that this ^ general instruction should be Step 1!! It's always best to know where someone's coming from. Knowing which type of communication is going to be most effective is where the real problem is....it requires one to be non-confrontational, neutral, non-reactionary, and very perceptive. You have to know and understand the intentions and the "whys"...

Helpful advice!

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Just because he is acting like a child doesn't mean you need to talk to him like one. I'm thinking the constant talk about how he is acting inappropriately and let me know when you're ready for me to help you is equivalent to telling a kid to take a time out in the corner.

The poster right above you mentioned "triggering" words such as "inappropriate", which I think is a good way to label them. They (the words) aren't wrong, per se, but they almost surely will incite a patient like this. That's what I meant by avoiding "bantering back and forth". Personally I'm not the type to say stuff like "your behavior is inappropriate", which may be true, but sounds like a judgment.

On the other hand, if one has made a thoughtful, open-minded, good-faith effort to connect with a patient over time, the behavior just needs to stop at some point. If you [patient] want to spending time talking about why I'm "such a f****** b****", then clearly you do not have a physical need right at this moment. Secondly, you do not get to personally insult someone over and over and over just because you have a captive audience and in some twisted way believe it's your "right" to do so since they are "getting paid." I employ the "I'll be back" tactic very rarely....but when I do, it's for a very particular reason. You have to understand these are all part of a "bag of tactics" and none of them can be applied to every situation.

And one of the main keys to all of this is to just work toward being non-reactionary/not offended by strangers, etc., in the first place - because the ability to do THAT is what is going to afford you the ability to figure out what to do next.

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Make sure you don't work with him alone. If possible get another assignment. Document the verbal abuse and inform your supervisor.Keep a paper trial. Do not put yourself in jeopardy of harm. Stay professional at all times despite the provocation.All luck!

This.

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I am sorry that you are having difficulties with this patient. He sounds delight full and I bet he would be the great at public speaking events!

Seriously, this is a TEAM situation!!! We cannot refuse total care to a patient, but a patient is not entitled to abuse staff members.

I agree, a buddy system should be used at all times. Verbal deescalation should be used as well. If he is verbally abusive to staff then a treatment team approach should be implemented. Nursing should be asking for a psychiatric consult, whether medications are ordered or a behavioral treatment plan is formed, you at least have MD's addressing the behaviors and documenting appropriate interventions.

I work with a variety of med-surg patients, some are waiting for LTC placement, and barriers to discharge include the many "four letter," words my patients "choose," to use. Legally there are things that can be done. A patient is not legally entitled to watch television, IF they are verbally and or physically abusive. They are not entitled to order anything they want for meals. They can get a standard meal tray with scheduled snacks, reviewed by dietary.

All interventions should be documented and approved by treatment team. Rewards and positive reinforcement for positive behaviors should be listed, documented and emphasized. If your team is not performing these actions, your stuck. If you are being professional with the patient, using verbal deescalation, and the patient is still being abusive, you are also stuck if your team is not supporting you.

One great role model for patient care is Kyra Sedgwick's response in the Closer. Every time the patient curses, redirect, educated, limit set, and if they keep %$^&&, then say "Thank you. Thank you very much." Sometimes its the reaction they feed into, and sincere kindness can sometimes extinguish a fire.

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