dealing with racism on dementia unit?

[prob22]

I was wondering if you guys could put in your opinion or some advice. I work on a dementia unit a state nursing home. We recently admitted an african american male to our floor and since coming he has recieved some abuse from other residents. It mainly comes from three residents who, among other things, spit, swear, threaten and harrass this poor man. We even had an incident with one of the residents writing nasty words on the wall in his room. We make sure clients are separated to reduce the chance of problems but the new patient is begining to get depressed and is often very upset and wants to go home. Anyway have an idea how this could be handled better to give this client a better quality of life.

[Nascar nurse, ASN, RN]

We even had an incident with one of the residents writing nasty words on the wall in his room.

What level of dementia are you dealing with? This sounds like it would take quite a bit of cognition and planning for someone with dementia.

[VivaLasViejas, ASN, RN]

Right away, I hope that there is documentation beng done on these incidents. You're going to need a long paper trail in order to be able to justify to the State why someone needs to be moved, and sometimes even then it's not enough.

1) Behavior management charting for the perpetrators. Something needs to be written down each time these guys start in on the poor man, as well as what was done to stop it. Your CNAs can help with this.

2) Incident reports for resident-to-resident aggression. (Yes, you have to write out separate IRs for everyone involved....sorry.)

3) Progress notes. Don't name other residents in the chart; if there are multiple offenders, you can refer to them as Resident A, Resident B and so on.

4) There needs to be some intervention from the social worker as well as psych evals for the problem children, if they haven't been done already. Just because dementia is involved, it doesn't mean that the facility can get away with not doing anything to protect residents from each other.

5) Families also need to be notified of these incidents when they occur. Not only is it most facilities' policy, sometimes even seriously demented patients will respond to direction from their kids or grandkids. There used to be one fellow on my long-term unit who was meaner than cat dirt, but his daughter could make him behave with a few well-chosen words ("DAD!! Straighten up and fly right or I won't bring you any cookies on Sunday!"). Even over the phone.

Honestly.........after all is said and done and documented, the chances are slim that the troublemakers will be moved out. It would probably be easier to move the victim. You can't change these people; they grew up in a time and place where racism was a fact of life, and dementia only makes things worse. I feel bad for the fellow. Wishing you (and him) the best of luck.

[NurseLoveJoy88, ASN, RN]

Take racism out of the equation here. Any form of abuse needs to be reported immediately. The abusers should be discharged from the facility.

My heart aches for this resident. This is too sad.