Dealing with tedious and demanding patients

[Ms. Nurse Assistant, LPN]

Sometimes, I feel so overwhelmed.

I have a patient who has alot of steps when it comes to getting them out of bed. It's very overwhelming. And if you miss a step or don't do it at all, she throws a fit. And will not get up or move until you complete that step. She needs lotion on a certain part of her back..let the lotion dry, then place some babypowder over it. Then you have to put three or four different lotions on other parts of her. And once you get her out of the bed, you have to place her in a chair, but before you sit her down you have to perfectly align two towls on the recliner. It's just exhausting and it takes forever.

She's always one of those patients who will have you stop, to move the clock in a particular position, and then she'll see something else like a paper envelope and have you move it to the right side..just tedious things, very controlling.

How do you deal with patients like that? I try to remain calm but it's so easy to get combative with her. I just want to do a good job

[caliotter3]

You get the good ones don't you! If you find yourself losing your patience, you either need to assess yourself for need of time off or a full blown vacation, or whether or not you need to find a patient that meshes better with your temperment. Brush off most of the annoyances, but beware that the patient may turn on you one day and complain about your behavior or even make out that your behavior is worse than it is. Also patients and their families have been known to reinvent reality when they want to complain about or get rid of a caregiver. So watch yourself.

[Ms. Nurse Assistant, LPN]

I'm new to the agency so I am getting patients that no one else wants! lol She has gone through a few HHAs, and left one agency because a HHA got testy with her.

The lady likes me a lot so far, because I just nod my head and go "mm hmmm" to her every demand. Even though deep down inside, I want to just :angryfire...

[caliotter3]

Understandable that you are getting the cases no one else wants. If you can put up with her, then do so as long as possible. But keep asking the staffing coordinator at the agency for a chance at new cases or to pick up shifts with other patients so you can work your way off cases that make you miserable. Headache medicine, tummy medicine, yoga, exercise, church, time with family, a little puppy, anything to look forward to for relaxation and satisfaction when these patients get to you.

[wildheartedangel]

tackle the hard cases first to get them outta the way. ask a co worker if they will switch that case up with you.alot cases like that so be prepared to bite your lip.if all else fails and you cannot seem to get past this case inform your charge nurse of the situtaion and take it from there.

good luck

breath in breath out

[DA314]

Try to be compassionate. Put yourself in her shoes. This woman has probably taken care of a husband and kids most of her life. Now it is her turn for someone to care for her.

I'm guessing this is home health... if so, with only one patient, is it really that much out of your day to go the extra mile?

Also, remember that she may not be in her right mind. Things that seem unimportant to you may be extremely important to her, because that is all she has left to control.

Good luck. And PLEASE, don't ever be combative with her! I know it is hard, but nobody deserves to be treated badly. She is, after all, paying you to do this!

[truern]

She may feel that she's lost control in her life and that's the way she's dealing with it...by controlling YOU.

For what it's worth, I had a client just like yours all thru my geriatric rotation in NS (we kept the same person the whole semester)...the first week I wanted to strangle her!! By the last week I was in tears at having to leave her.

It's frustrating...but you're making a difference in her life. It's up to you as to what kind of difference :)

[fuzzywuzzy, CNA]

You're in home health, right? So you must only get a certain amount of time with this patient before you have to leave for the next one. Can you ask for this woman to be your last visit? That way, you'll be anxious to get home, obviously, but at least you won't be worrying about being late the rest of the day.

I have to deal with residents like this at the nursing home. Acting fussy like that is usually their way of feeling like they actually have some shred of control left in their lives. Or at least, that's what I tell myself, even though I am sure a couple of them just suck anyway! haha (I'm really just thinking of one person who verbally and physically abuses us). They don't care that they're taking up all your time at the expense of other people more helpless than them. I've found that fighting them is useless. I just do everything their way, no matter how inefficient it is, or they'll dig their heels in deeper. Once you start doing everything their way they'll probably relax after a few visits and let up on you. Never rush. Pretend you have all the time in the world. After they ease up on you, you can throw something"extra" in, which will become your "trademark," and they usually LOVE that. You have to move fast, but distract them by talking to them the whole time. If you start acting jumpy or interrupting conversation to ask, "what's next" then you're back at square one.

It's so much easier when you can make them your last one, though. I have this one assignment where everyone except one lady wants to go to bed immediately after supper. So I rush around like a nut trying to get them all in, and of course this lady is one of those fussy controlling types who tries to keep you in her room as long as possible, and even though she doesn't GO to bed until much later, she wants to get ready when everyone else is. So I would always end up rushing, which would **** her off. I tried to explain to her that if she wants me to be slow, then get ready an hour later. But she won't. So I just follow the advice I gave above and I'm out of there faster than if I'd try to pull a fast one on her by doubling up on tasks or attempting to "beat the bell" or something. I have a couple people who are perfectly fine if you "check in" with them constantly. It takes time but you just have to figure out what works on them (to a point), and give up the rest.

[systoly]

Don't fight her. As long as she senses your apprehension things won't get any better. Try to enter her world. For instance, when she asks you to move the clock, show a genuine interest. Ask her, "Did I get it right?" Assure her that you are willing to do things just the way she likes it even if you have to adjust the towels five times. I would even say, "I'm sorry it's taking me so long, but I promise I'll get it just the way you want it". I would expect to see a change in her attitude before too long. She'll always be persnickety, but she might say something like, "That's not exactly right, but you can leave it that way", she might even say, "thank you". Look, you're there for a certain amount of time. You can spend that time fighting her or convincing her that you're one of the few people (in her opinion) who has any sense. It's also a valuable lesson. Situations like this taught me how hard it is to give up control.

[Nina2bRN]

Hi Ms. Nurse Assistant! I can't really tell you that I've gone through the same thing...because I'm not a CNA *yet* but I wanted to tell you that to me..it sounds like maybe she might have OCD (obsessive compulsive disorder), has anyone checked for her that? I have an extremely BAD case of OCD and I'm hoping and praying that it does not affect my job (when I do start to work). It sounds so familiar to mine...everything has to be perfect or I just can't move on. It's so hard to deal with everyday and every second and if that's her case..I really do feel extremely bad for her. Try to ask her what you could do to help her out. I'm sorry you have to go through that its hard, believe me. So I'm asking that maybe you talk to her and try to understand her better, she might surprise you. I hope I've given you something to consider to help you out. I hope your job gets *less* stressful. Take care!

[yousoldtheworld]

I've had a couple of residents just like this...and as frustrating as it must be as a home health case, imagine how it is in a busy LTC facility! I know how frustrating it can be, but unfortunately there probably isn't a whole lot you can do besides gather yourself before you go in there. Maybe in time as she sees that you know her routine and aren't going to forget anything, she'll relax a little bit.

[ghillbert, MSN, NP]

I'd agree that she probably has a control issue, rather than OCD. Many elderly patients get this way, when they are ill and helpless and they've lost control over their life. Being pleasant and ignoring the snark is the only way to cope with it. Trying to fight it doesn't get you anything but aggravation on both ends. Trust me, been there done that!