Cannot redirect a dementia patient

[chickadee123]

I have a dementia resident that I cannot redirect. This person spends all day pacing the unit, grabbing anything within reach. This includes blankets on residents in bed, folding tables, chairs, art on the walls, all the christmas decorations, other resident's possessions etc. Also, this person walks up to others and invades there space, causing constant fights. When attempting to redirect, resident will become violent, slapping and screaming. I do incident reports weekly. Resident is nonsensical, and cannot answer even basic questions. What should I do? We do not have the staff for 1 to 1. Resident will continue doing behavior even after multiple attempts to redirect. Very concerned for other residents, as they are scared of this person. Any suggestions?

[ktwlpn, LPN]

I have a dementia resident that I cannot redirect. This person spends all day pacing the unit, grabbing anything within reach. This includes blankets on residents in bed, folding tables, chairs, art on the walls, all the christmas decorations, other resident's possessions etc. Also, this person walks up to others and invades there space, causing constant fights. When attempting to redirect, resident will become violent, slapping and screaming. I do incident reports weekly. Resident is nonsensical, and cannot answer even basic questions. What should I do? We do not have the staff for 1 to 1. Resident will continue doing behavior even after multiple attempts to redirect. Very concerned for other residents, as they are scared of this person. Any suggestions?

I would suggest working them up for a UTI and some labs (CBC,TSH ) medicating for possible discomfort with something like acetaminophen or ibuprofen, initiate a toileting program and obtain a psych consult. Are snacks a good intervention? Unless the resident has a sharp object in hand or is setting someone on fire (or on fire themselves) why are you attempting redirection at all? I'm assuming you are on a secure dementia unit,these behaviors can be very typical. A true dementia unit will have few decorations and crap sitting around for this very reason.Family members are educated upon admission regarding rummaging behavior and the likelihood that anything they bring in for their loved one will wind up in another resident's possession.You run into problmes when other residents are upset because they think they have been mugged.First I would try to redirect the other resident and avoid the problem completely.I have found the only safe and effective way to get an object from a resident if you absolutely MUST (ask yourself if you really should before you take action)is to hand the resident an armful of stuff-A big bunch of stuffed animals,blankets,cookies.While they are attempting to juggle the stuff ask if they need help ,then take back what you have to.Make sure you keep the nurse's station and med cart secure to prevent loosing your books.I have had to keep my medcart covered with a clean sheet during med passes due to resident's like yours. Smetimes it's a stage and they will progress through it.Others are busy like this until they can no longer walk.

When we have residents who are acting out against their peers it does become a 1 to 1 situation and "insufficient staff " is not an appropriate intervention. he family members don't want to hear it ,nor does the dept. of health. When she knocks someone over and breaks their hip you'll see staff come out of the woodwork...Maybe an inpatient psych eval is needed.

[Nascar nurse, ASN, RN]

Couldn't have said it better than ktwlpn! Excellent advice.