So for the last two days I have worked with two different demented elderly gents at a local hospital. Both are very demented, neither can get placement outside the hospital because they are combative...and it seems the Doc's and Family members are going 100% against us nurses and CNA's that must care for them!
First day I got hit very hard in the right temple by one of the patients...I thought I was out of arms reach..but he was trying to get out of bed, and it was between me and the floor for him...LUCKY for me he had mittens on because he keeps pulling out his foley and his iv's so now we have a picc that must be protected...NOT THE STAFF..but the picc! UHGGGG~! Then a discharge planner chewed me out for the mittens saying "he will never be discharged if you guys don't let him free of the mitts! (remember..just mits, not tied down or restrained!). I explained that it was to protect the picc and foley and at discharge would not be needed since those should be d/c'd by then....she said point blank "yeah right, you guys are just tired of getting hit!".
Okay...even if that was the case...why not be tired of getting hit..he is a huge very strong man!
Second patient....no mits no nothing. Family wants him free of medication so no prn or any meds to stop him from constantly getting oob, or spitting/hitting/grabbing...and yesterday he aimed himself and peed on my CNA!!!!!!(he is MRSA precautions in urine!!!). I came in to stop him (while my other patient was starting to stroke!!!!) and both the CNA and I got our butts kicked royally!!!!!!! She had bruises all over her arms and sides...I had several on my arms and one on my left cheek!
So I called the MD and begged her to help us with some PRN medication. NO GO! "no, the family doesn't not want medications for him...they say he has a reaction to all medications". I almost said "well I will tell you for darn sure he is going to have a bad reaction from me next time he hurts me!!!" but I didn't! After begging...I got to give 10 mg of a med IM...which worked thank GOD!
I bring both these cases up to RN management...and got a huge lecture on chemical and physical restraints (like I don't already know that and quote the book better!)...and that they were sorry and not to accept that patient again if I couldn't handle him. HANDLE HIM??? I can handle patients quite well thank you...but how to you handle someone that is demented and wants to hit/spit/scratch/grab/urinate/throw feces/wants OOB/ and I can't use any type of restraint to protect myself and staff? It is like saying..okay box this kangeroo with your arms tied, legs bound, and blindfold please!
I know others have had the same experience...what did you do to try to solve it???? THe two men are actually quite nice when they are with it...and I do care for them deeply and they are sweet..but when they are demented they forget they like me and I am helping them and start swinging!!!!!
I work in a facility for mentally challenged people......and believe me, it can be a challenge for the staff at times, too.
One person we had that was admitted when just a small child, was so cute.......and the family of course, the grandparents especially, had this mentally challenged child just spoiled rotten.
They didn't want any type of behaviour plans implemented that would include him going on home on the weekends if his behaviour was good during the week. This child was given everything.....he could have anything he wanted, and could do anything he wanted. What other people could not do, he could usually get away with, just because of who he was and who his grandparents were.
Well, this cute little child grew up to be a very large man, and overweight because he had no limits on his diet....and strong.
Well, it just all resulted in some very bad situations, because this young man who had never had any real behaviour training, attacked several staff members over a period of time, injuring a couple.
The last time he was with our facility, he WAS at home on a visit and his behaviour got so out of control with the family that they could no longer handle him.
Several of our male staff members had to go to their home to pick him up, and he had to be transported on a "papoose board" for his safety and the staff's safety. He was taken to the emergency room, with our administrator in escort, and I am so glad of that, because SHE got to see first hand what this child/man could do to people.
After treatment at the ED, to calm him down, processes were immediately put in place to transfer this person to another facility that could manage people with his type of behaviour.
At my facility we are not allowed to give chemical restraints without an Act of Congress. It can be done, but it requires approval from so many people. Just having a Dr's order is no longer sufficient.
Sometimes, families just do not understand until they actually are in the middle of it....when nurses and cnas are giving all the care and dealing with all that the person can dish out, it's easy for the family, to say, "No, we don't want any psychiatric meds or anything to calm him down."
I don't believe in sedating people just to keep them quiet, but there ARE situations where people do need some type of chemical restraint to help control their behaviour.
I am not yet a nurse, but I would report every incident to upper management. If nothing is done, I would let the management, doctors and families know they will have to take care of the patients themselves.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Futurenurse...little advise here for when you become a nurse. Never tell a doc or management "take care of the pt yourself", or anything like that. The reason, you accepted the patient and it is your patient for the next 8-12 hours (dependant) and they will be most happy to remind you of that...uhgggggg! If you even mention that you can get abandoment charges if someone wanted to teach you a lesson...Not to mention you will get one heck of a bad rap with folks. I am not dissing you...I felt the same way big time...and really wanted to...but uhggggg rock and hard place kinda deal.
Nope, once accepted you get that patient for your shift. I accepted him, so I had to deal. Sadly I got hurt despite trying hard not to...but still provided care for a man that couldn't do it for himself...that is my goal and pleasure being a nurse.
I was candid with the Doc when she came up and assessed the PT. I basically stroked her ego by telling her that the IM injection (I talked her into) was very effective for the first 2 hours...Then showed her what we did to try to quell things (which she thought was great)...and then did say "well...I did in some dark horrid place in my mind hope he would act out so you could see it...I mean...diagnostically speaking of course!"
Thank Goodness this Doc and I are on good standings and she laughed..."I bet you do! And everyone else here too! LOL!". Then she looked over the CNA to make sure she was okay and sent her to ER for wound cleaning since the patient threw that MRSA tainted pee on her".
So basically I let the MD know...one, good job on helping (even though it was far little)..two here is what we did (helps with any questions that we nurses are being "lazy" or slacking...which some Docs feel that sadly)...and three, letting the MD know how it felt (this differs in communication styles between MD's...tread carefully!).
With family...I tried...got them in for 4 hours of the shift and the patient did much better. But most families work or have children and tending to a loved on all day isn't possible for them..that is just a reality we get to live with (or the ones that simply won't). So I try hard to work with family schedules the best I can while being direct about the situation. Sometimes I am lucky and can get a one on one in the room (dependant on scheduling)...and can try to organize having a one on one, family, then me.
And yes...always report these things and document document document!!!!!
yeah, used to do this on night shift with diaper changes on a violent pt. I would open the bed from the bottom, not the top, so the blankets were laying on her arms while I did a speedy change, and them would pull them down quickly when I was done. the advantage was she did not get as cold, she couldnt find her arms fast enough to hit or pinch or scratch, and she would actually thank me when I was done. Go figure. Hope this was legal!
TriageRN from all that you have done to try and help this man you sound like an awesome nurse.
I'm not a nurse, but I am a CNA on a dementia unit so my ideas might not be quite right.
You seem to have taken a good approach talking to the family about meds, that dementia is a disease that needs treatment just like any other. Have you maybe tried to explain what is going through his mind. The fear and loss of freedom he must feel from being confined to a bed all day long. Chances are he doesn't understand that he's sick in a hospital and needs to stay in bed for safety reasons. Maybe talk to them about a PRN stressing that once he's in an environment where there is structure and he has the ability to wander that his behaviors may change so he doesn't need medication.
It's hard for people to understand what maybe going through the mind of someone with dementia and the fears that they face. So I would definately try to stress things from his perspective.
TriageRN from all that you have done to try and help this man you sound like an awesome nurse.
I'm not a nurse, but I am a CNA on a dementia unit so my ideas might not be quite right.
You seem to have taken a good approach talking to the family about meds, that dementia is a disease that needs treatment just like any other. Have you maybe tried to explain what is going through his mind. The fear and loss of freedom he must feel from being confined to a bed all day long. Chances are he doesn't understand that he's sick in a hospital and needs to stay in bed for safety reasons. Maybe talk to them about a PRN stressing that once he's in an environment where there is structure and he has the ability to wander that his behaviors may change so he doesn't need medication.
It's hard for people to understand what maybe going through the mind of someone with dementia and the fears that they face. So I would definately try to stress things from his perspective.
I got hit by an elderly, demented patient. Then he proceeded to enter the elevator, tell me he was leaving, and walked around the hospital, and to the end of the street. I called security, they were with me, and proceeded to call the local police dept. The elderly man became very SOB, (with the dx of CHF and COPD), and physically had to stop walking. We got a wheelchair, wheeled him back to the room. The police asked me if I wanted to press charges! The family then came, and the police said legally I could press charges for battery, and the power of attorney would also be held liable. Info I didn't know.....The family took action quickly to talk to the physician for behavorial management issues. Of course, I didn't press charges, and wouldn't. It only took one time for me to get hit, now I am more aware, better assessing dementia associated with hostility, and calling hospital security, if needed, to be with me all day, entering the patients room. I am not willing to be beat up, and it is the hospital's responsibility, as an employer, to protect the employees.
I feel your pain, although I am not a nurse yet i will be one soon and i work in a nursing home and get hit bad all the time. I just went to a conference and they had some videos that they were showing that showed you how to avoid getting hit when someone was attacking you, basically the idea of ducking before the punch with out actually ducking. Check with your DON or your admin for some ideas. I hope you can find a peaceful solution to your problem. Good luck!
I had worked with a few alzheimer's patients that would get very out of hand also. Again, family refused to have any medication administered. The nurse that I had worked with would call the family members and have them come in to see if they could calm the patient down. Sometimes it worked, but sometimes not. Eventually, after the family had been called very frequently, and saw the behaviors (that they didn't beleive in the first place), they finally agreed to the use of prn meds.
On my floor we have been getting alot of dementia elderly, combative patients. Just the other day we had a gentleman start that nonsense, kicking and biting and what not. We porceded to call security who put him in 4 point restrains after taking him down. We are not expected to handle 250lb plus old men who are punching us, dementia or not. If anyone gets hurt, its a big deal. We restrain, then call md. If he as a problem with that we invite him to babysit the pt. If we have to call security and the md doesn't want to cooperate, it goes over his head. restraints are not to be used lightly, but no one gets abused where I am, NOBODY.
:angryfire I bet the family that is very particular about how YOU take care of dad is the one that never lifts a finger to help him themselves. They would freak out at the sight or smell of poop and don't want to know that he pees too. They are so particular about how you do your job because the very same things making them guilty. They think that you are being paid, so they bought you.
Girls you don't have to take that crap.
Problem with nursing is that it is a woman's job and people are used to giving **** to women and women are used to taking it. Think REFUSE! There are other jobs, other places.
Where I work, they always try to give you an eighth patient, and those nurses who don't complain end up getting them. I always refuse, be nasty about even anyone offering me an eighth patient and no one dares offer me one.
I would rather lose the job than the license. After refusing a couple of times and getting sent home, they have realized they cannot do that to me. So they even don't ask me.
I would call Osha/Jcaho/lawyer/safe harbor whatever applies to your case. Remember DOCUMENT! DOCUMENT! DOCUMENT!
Make photocopies of all correspondence. Ask them to give you all communication in writing.
LPN1974, LPN
879 Posts
I work in a facility for mentally challenged people......and believe me, it can be a challenge for the staff at times, too.
One person we had that was admitted when just a small child, was so cute.......and the family of course, the grandparents especially, had this mentally challenged child just spoiled rotten.
They didn't want any type of behaviour plans implemented that would include him going on home on the weekends if his behaviour was good during the week. This child was given everything.....he could have anything he wanted, and could do anything he wanted. What other people could not do, he could usually get away with, just because of who he was and who his grandparents were.
Well, this cute little child grew up to be a very large man, and overweight because he had no limits on his diet....and strong.
Well, it just all resulted in some very bad situations, because this young man who had never had any real behaviour training, attacked several staff members over a period of time, injuring a couple.
The last time he was with our facility, he WAS at home on a visit and his behaviour got so out of control with the family that they could no longer handle him.
Several of our male staff members had to go to their home to pick him up, and he had to be transported on a "papoose board" for his safety and the staff's safety. He was taken to the emergency room, with our administrator in escort, and I am so glad of that, because SHE got to see first hand what this child/man could do to people.
After treatment at the ED, to calm him down, processes were immediately put in place to transfer this person to another facility that could manage people with his type of behaviour.
At my facility we are not allowed to give chemical restraints without an Act of Congress. It can be done, but it requires approval from so many people. Just having a Dr's order is no longer sufficient.
Sometimes, families just do not understand until they actually are in the middle of it....when nurses and cnas are giving all the care and dealing with all that the person can dish out, it's easy for the family, to say, "No, we don't want any psychiatric meds or anything to calm him down."
I don't believe in sedating people just to keep them quiet, but there ARE situations where people do need some type of chemical restraint to help control their behaviour.