Fluff my pillow! How do you handle people who need a shadow?

[guest1048932]

Without going into too much detail, we are convalescing a patient from the hospital for the next few weeks at my care facility, and she wants someone to be by her side 24/7 and attending to her every whim. Her family does not want to pay for a private carer. We've assured her that her needs will be met, but told her that she needs to do all her activities of daily living, except bathing, on her own as per her OT care plan. She is capable of doing these, but she rings a minimum of twice an hour for us to fluff her pillows, remake her bed, help her change her clothes, or help her drink some water. We've explained many times to the family that there are other people we have to look after too, so we cannot spend all our time with her.

I've been firm, and stuck to the statement that, "Everyone here is receiving care and we are working hard to attend to their needs too. We will help you if you need it, but we cannot spend an hour doing things that you can and need to do on your own. I will be back in another hour to check on you." So far, it's not working.

Does anyone else have any suggestions?

[JKL33]

6 hours ago, JollyBug92 said:

"Everyone here is receiving care and we are working hard to attend to their needs too. We will help you if you need it, but we cannot spend an hour doing things that you can and need to do on your own.

Most people don't really like to hear this regardless of the circumstances or the truthfulness of the statement. It doesn't even go over well in the ED when another patient is trying to die and someone totally well is demanding attention.

There are people who are....just not nice. They maneuver through life in a not-nice manner, and others enable them.

Then there are people more like what we learned in nursing school - - their behaviors are defense mechanisms and there is something underlying them that we can address therapeutically. But...the way we sort it out is by investigating/talking to get to the bottom of it.

I think your patient may be one of the latter, and so it's important to consider the individual dynamic. She wants help and/or attention and is capable of doing many of the things she asks others to do for her. So is it a matter of fear? Lack of confidence? Loneliness? Anxiety about being declared well enough to return to previous living arrangements? Just used to being waited on? I am guessing it is most likely one of the first 4 and less likely the latter thing.

If it were me, I would make the time for a heart-to-heart. You know? One of those times where she wants someone to hold her water cup, go in the room like you have all the time in the world, relaxed (not resentful), help her take a drink, then pull up a chair and gently say something like, "[Name]...can we talk a little about what you're feeling? It seems like something is keeping you from getting some of your independence back..."

Then listen to what she says about it.

I totally get the therapeutic/tough love kind of approach you posted, but (especially when we are so pressed for time) it can come off as a little bit defensive/excuse-making + parental + chastisement. If there is even a tinge of anything that can make the patient feel chastised or unimportant as a person...it just won't work, and makes many people downright contentious even if they are just a little anxious or scared.

Just some food for thought! Good luck ~

[Nurse SMS, MSN, RN]

I had a patient just like this. She suffered from extreme anxiety and terrible loneliness.

You cannot make the family hire someone from the outside, but I did call a family meeting and got everyone in the room along with the patient. I went over the things the patient was demanding, the amount of time the patient was taking and explained that the patient was requiring a level of care we were unable to provide without increased family support. In this case, the patient was a little embarrassed and the family stepped up to help more. That won't always be the case and you will want to proceed with the blessing of your manager if you take this route.

Consider also requesting a psych consultation. These behaviors are not normally due to the patient simply being a jerk. Usually it is a combination of anxiety, depression and powerlessness combined with feeling ignored by family and friends.

[canoehead, BSN, RN]

I will usually encourage them to do things themselves in the name of regaining independence, and mobilizing more. I'll stand there and watch to make sure they don't have any trouble, do some verbal cuing, and ask them about how things are going generally. It takes about 4 times as long than doing it myself, but the patients start to take more initiative, or I find out about physical issues I didn't understand. Often, they just need more attention, a little pep talk, and they may need it several times a shift, but it's nicer for both of us to know what the real problem is.

[Snatchedwig, BSN, CNA, LPN, RN]

I had a patient like that last week. I ended up getting 'fired' from her because I told her this is a hospital and not a Marriott. I had a lovely shift, thus forth.

[caliotter3]

We had one like her when I was a CNA. Particularly grating was the turned on tape recorder inside her bedside table. After getting no support from the charge nurses other than “answer her call bell we can’t have her disturbing others throughout the night”, we confronted her about the tape recorder and her attempts to trap us with it. I then started making a point to attend to each of the three roommates who were unable to seek help before I walked over to her bed to move her pillow one half inch. I let her know what I was doing to help the others in the facility and I am sure she knew why I went to the other residents before her. I am surprised this did not end with me being written up or fired. But then the nurses were known for seeking the path of least resistance.

[Forest2]

I have had lots of these types of patients. They can't reach the bed control which is 2 whole inches from the end of their finger. Yep, it's a real nuisance. If you don't have time to get down to the nitty gritty cause of it all, then see if you can get a psych consult or at least social services to have a meeting with everyone. There needs to be a special plan in place for this patient and everyone has to be on the same page or else she will drive everyone crazy and the care overall will deteriorate. Get everyone involved. One person can't fix this problem for this patient.