Dealing with noncompliant client?

fuzzywuzzy, CNA · Nov 25, 2011

Come back in 10 minutes with an altered approach and hope they've forgotten that they didn't want you changing them.

Sometimes that doesn't work and people don't want to be changed for hours. Maybe this is cold, but in those instances I think "not my problem." I'll just go and take care of other people who are cooperative. I'm not gonna stress if there's nothing I can do.

The other day this patient of mine who is "with it" was throwing a hissy about something and didn't want to be changed or have oral care done. So I said OK and left. I think she thought I was going to try and coax her into it. She is capable of feeding herself but wouldn't eat. Someone else spoon-fed her. I thought that was ridiculous. I'm not going to buy into those childish games. If you want to think that sitting there sulking and not eating is hurting me, think again! It's not my belly! Obviously if they have dementia it's a little different, but there's only so far I am willing to go when there are other people who need me.

canigraduate · Nov 25, 2011

First, try to talk them into it. If that doesn't work, try to be firm and explain that this is something you HAVE to do. If you still don't get anywhere, tell the nurse and move on to the next one.

I usually just tell people that I have to change them per policy and go ahead and do it. The only times I stop are if they are alert and oriented and tell me "no" repeatedly, or if they start trying to hit me. Always notify the nurses of the refusal so they can chart it.

Poi Dog · Nov 29, 2011

If a resident is refusing care, I will let the charge nurse know what is going on and what I did to try to de-escalate the situation.

NurseCubanitaRN2b, BSN, RN · Nov 29, 2011

If they are combative then let them be. If they aren't combative sometimes you have to talk to them in a calm voice, almost a whisper. When you start whispering they tend to calm down more and are more prone to listen to you. Make it a suggestion and not a direct order. They seem to respond to that a lot better.

PsychNurseWannaBe, BSN, RN · Nov 29, 2011

Try a staff change. See if another CNA has better luck at it.

LaterAlligator · Nov 30, 2011

If they have dementia or other cognitive problems, I would get a helper to hold their hands/prevent them from injuring me or themselves with combativeness. If they're 'with-it' and refusing, I'd ask why, see if we could work around it. If they're just plain being ornery, I'd say fine, let the nurse know, and tell them I'll check back with them later.

Aeyre · Nov 30, 2011

Come back later and try a different approach, if that doesn't work have someone else try. If that doesn't work report it to the nurse.

interceptinglight, CNA · Dec 1, 2011

In the dementia unit I used to work we had a little lady who often liked to sleep until 1 or 2 in the afternoon. She would refuse to get up to go the bathroom so changing her in bed was necessary and she was almost always combative with this. I would always just talk in a nice gentle matter of fact voice and say 'I know you don't want to get up yet, so I'm just going to make sure you're nice and clean and dry.' As I pulled the covers back she'd start swatting at me and saying No! I'd just keep going on about my business and in a smiling voice I'd say "....and I'm not taking no for answer, either...' and...'This will just take a minute......' It wouldn't take that much longer than it did for a compliant resident because I'd be gentle and firm at the same time. Of course, with our 250+ lb residents who were known to be violent, I'd usually need a little help so we'd double-team those.

systoly · Dec 2, 2011

Great suggestions.

If you get to first base, be very gentle. Maybe mix some lotion in with the soap and make sure the wipes or wash clothes are warm. I know it's extra steps, but it will pay off many times over.

rainbowskin · Dec 3, 2011

I have had a resident like this... I learned that asking doesn't work. You just have to tell them and hold their hand and say CMON we are gonna go get changed now. They need the assertive direction.

I don't believe in GIVING UP ever, there is always something that can be done to get a person changed, whether it be a different approach or a different caregiver.