I Feel Like a Bad Nurse: Alzheimer's/Combative Patients

[Tait, MSN, RN]

I feel like a bad nurse.

I feel like I am not doing the best by my patients, those of confused/combative/Alzheimer's/dimentia status.

I don't want to go into any details about my patient care, but I find myself anxious lately about taking care of combative patients. Now some of you are probably thinking "well duh, combative patients suck". However this hasn't always been the case with me.

I have had many families tell me I have the "patience of Job" with their families, but lately it just seems like I can't manage combative patients.

Last night a patient started grabbing me when I was attempting to recheck her BP. I looked at her sternly, like you tell a child, and told her not to grab me. Another patients family member walked by and overheard me reprimand the woman and I felt like I was about two inches tall.

The patient did stop hitting me, for a second, but I just can't shake the feeling I am losing patience.

I try to look at them and think of them as they might have been, I try to be calm, smiley, and agree with whatever tangent they are on, but I seem to lose compassion quickly when someone hits me, or tells me I killed their family (like last week).

Maybe I am just worn out this month since it seems the floor is littered with combative patients.

I am not really looking for support or sympathy.

I just don't know some days if I am beating myself up, or letting go of my compassion...which scares me to no end.

Tait

[oramar]

I think when you start to having feelings like this it is you body and your psych telling you it is time to take care of yourself. It is OK, you are not a bad person or bad nurse just a human being. Have a look at what is going on in your life and see where some changes need to be made. Good luck and God bless, you sound like a great person and a good nurse.

[Whispera, MSN, RN]

I think taking care of combative patients gets to anyone, at one time or another. It's not how you imagined nursing would be. You want to be kind and you don't want to get hurt.

Maybe you need some time off? I know that always recharges me.

Maybe the patients need a calming medication? Sometimes I hum a lullaby, both for the patient and for myself, as a calming thing. I move slowly and not ever suddenly. It's likely the patient is feeling fear about something (hallucinations, delusions, anger at loss of independence, etc.) and you are just there for the lash-out. It would be nice if you could figure out what he/she is afraid of. I know that's seldom likely.

You have a right to tell a patient not to grab you. Somewhere inside the Alzheimer's, the person is still there, and for a moment you might reach them. Then you can do what you need to do.

Don't be hard on yourself. I think they're lucky to have someone who cares as much as you do.

[Forever Sunshine, ASN, RN]

You are not a bad nurse. A bad nurse would give up.

I have a few combative patients at my job too. We are not afraid to give them medications to calm them down. Its for the safety of them, us, and the other patients. Don't be afraid to be firm and tell them to stop hitting you. Whispera is right, they may realize what they are doing is wrong

Excuse me if this sounds odd but maybe the b/p cuff could be hurting them? Is it one of those digital ones or is it a manual?

[roser13, ASN, RN]

I think your body and soul are giving you warning signs. It may be time for a change.I doubt that some time off would do it. I think you should look into exploring other options, another area of nursing. There is a reason that nurses sometimes move into diametrically opposed types of nursing - they burn out on one and need to get the hell out of dodge.I once knew an older nurse, very experienced, who alternated her whole career between neonatal and psych - polar opposites, if you ask me. Just about the time she'd feel herself becoming hardened to the death of a preemie, she'd recognize the need to move on and transfer to psych. Just about the time she started feeling less empathy for the psych residents, she'd return to neonatal.

[NurseLoveJoy88, ASN, RN]

Tait -You are not alone. I know Exactly how you feel. I work in an alzheimer assisted living and deal with combative behavior on a regular basis. I too am full of compassion and patience. Family members often say im an angel.

However, when im kicked in the face or curses out or threatened it does affect me a little and it i too find myself having to use a stern voice to tell a resident to stop or not to hit me or others. We are not bad nurses and they are not bad patients, its the disease. reading your post also made me feel that im not alone. thank you

[Virgo_RN, BSN, RN]

It sounds like you're just worn out, Tait. The fact that you are aware of this, and feel badly about it, tells me you are just fine. I think maybe you need a bit of a break. Caring for others is extremely draining, physically, mentally, emotionally, spiritually. We have to find ways of renewing/refreshing ourselves, and filling that cup back up. What do you do to refill your cup?

[SuesquatchRN, BSN, RN]

It gets to you after awhile.

I do find that kneeling down to eye level helps a lot. I also call them ma'am and sir, and Mr or Mrs. It sort of helps them remember a little bit of dignity.

Hugs.

[Tait, MSN, RN]

You are not a bad nurse. A bad nurse would give up.

I have a few combative patients at my job too. We are not afraid to give them medications to calm them down. Its for the safety of them, us, and the other patients. Don't be afraid to be firm and tell them to stop hitting you. Whispera is right, they may realize what they are doing is wrong

Excuse me if this sounds odd but maybe the b/p cuff could be hurting them? Is it one of those digital ones or is it a manual?

I did agree that the digital was probably very painful, I know they hurt me as well, however I used the manual and barely got it pumped up before she started stressing. My mother suggested that it may have been because she thought she was being "grabbed" more than anything and it scared her, which I think is also completely logical.

I appreciate all the kind words of encouragement :) It is funny how over the past three years the anxiety of nursing has slowly crept into my life. I don't believe it used to be there, but yet is now becoming very apparent to me. I may also be letting the stress of many changes in my life (marriage, house, working on children unsuccessfully), creep in the door with me unawares at work.

For now I will try and breath when I got back to work tonight, and focus on doing the best job I can for all my patients and co-workers.

:icon_hug:

Thank you all,

Tait

[leslie :-D]

Maybe the patients need a calming medication? Sometimes I hum a lullaby, both for the patient and for myself, as a calming thing. I move slowly and not ever suddenly. It's likely the patient is feeling fear about something (hallucinations, delusions, anger at loss of independence, etc.) and you are just there for the lash-out. It would be nice if you could figure out what he/she is afraid of. I know that's seldom likely.

You have a right to tell a patient not to grab you. Somewhere inside the Alzheimer's, the person is still there, and for a moment you might reach them. Then you can do what you need to do.

i agree about remaining low-key and gentle.

what also works with me, is explaining/warning them (the bp cuff is going to get tight around your arm) re potential adverse effects.

of course the most helpful, is when the pt knows and trusts you.

but that takes time.

until then, it's time to replenish your soul, however you can do that.

wishing you peace.

leslie

[franciscangypsy]

i agree about remaining low-key and gentle.

what also works with me, is explaining/warning them (the bp cuff is going to get tight around your arm) re potential adverse effects.

of course the most helpful, is when the pt knows and trusts you.

but that takes time.

until then, it's time to replenish your soul, however you can do that.

wishing you peace.

leslie

That's what I usually do, but one time when I was an aide, I had a patient get belligerent and angry when I explained what I was doing (ma'am, I'm going to unbutton your gown and take off you monitor. now I'm going to take out your IV). Explanations had always worked well for me in the past -- I had started out LTC CNA and was taken aback when she demanded I stop talking so much and leave.

Maybe it was because she was foreign (African, I believe) and thought that I was speaking down to her. I don't know. But heads-up, while the explaining method seems to work for most patients, some are agitated by it.

[jkimzey]

Hi Tait,

Don't be too hard on yourself. I own a home care agency in San Francisco that specializes in taking care of Alzheimer's patients at home. I want to share a document that we give to hospital nurses in the Bay Area that seems to help them. You can download it from this link--Hospital Nurse's Guide to Alzheimer's Care.

You may already know this, but here are a few basic tips (the booklet has a lot more information):

• Aggressive behavior is the patient's way of communicating.
  
• The patient is likely confused, scared, in pain, or all three.
  
• Always approach from the front.
  
• Call the patient's name and identify yourself every time (even if it's only been 10 minutes since you introduced yourself--the patient doesn't remember you).
  
• Tell the patient what you are going to do in short, simple sentences.
  
• Use a relaxed, calm voice, smile, and try not to appear rushed.
  
• The patient may not be able to understand language very well, but he or she can read body language extremely well.
  

Good luck on recharging your batteries; you have a tough job, but as the son of an Alzheimer's patient, I appreciate everything you do for our loved ones while they are in the hospital.

Thanks,

Jim