How to deal with +++needy and loud pts

[Aeterna, BSN, RN]

Honestly, it's ridiculous. I like to think of myself as someone who has a lot of patience but there are a few patients on our floor right now who ring a lot (or if they can't ring for whatever reason, they scream) and for absolutely no reason. Today, I had two of them and found myself nearly at my wits' end!

One patient is clearly anxious about being alone, but she has to be due to being in isolation. She just doesn't feel safe unless there's a nurse (or better yet, two!) in the room with her, so she calls constantly. However, due to physical limitations, she often can't press the bell so she resorts to screaming.

This happens constantly (no exaggeration); I will literally have just taken off my gown and begun washing my hands upon exiting the room and she'll be calling out my name again. When we answer her, 99% of the time she doesn't need anything (she has actually told us this a few times or you can visibly see her think of things to say to keep us there); she just wants us to stay in the room with her. Her family tries to help by visiting every day and staying with her a few hours but she'll still ring or call out for a nurse, despite her family members' attempts to tell her to stop. A nursing student asked her one day why she called so much. Her answer was, "It's just a habit." ARGH.

Second patient is a confused elderly man. He is always calling out names (whichever ones he can remember) or "Help me!", even though he doesn't actually need help. He, too, I think just wants someone to stay with him - he does much better when he has family visiting or if I am with him to provide care. Because he doesn't require isolation, he always has at least one roommate who (understandably so) gets very frustrated and annoyed after a few days with him. His roommate today is one of the sweetest patients I've ever had, and by the end of the day was actually angry with him.

Obviously, I can't stay with these patients all the time. It's impossible. I know there have been requests for volunteers to come and stay with these patients to keep them company, but so far have not seen anything. I do my best to reassure them but it doesn't work. Only my (or whoever is their nurse that day) physical presence seems to comfort them. No one knows exactly how to deal with these patients, so they end up screaming all day and bothering all the patients and families around them. They have meds like Ativan ordered prn but it tends to sedate them and then the families get upset if that happens.

Any suggestions?

[lady constance]

personally, i would get your manager involved in these cases....they could be a litigation issue....

your manager needs to step up to the plate....

ask her for suggestions....

and on a side note, when i have a patients like this, i ask before leaving their room/bedside :" is there anything else i can do for you before i leave?"....

some times i am honest with the patients " i do have other patients. and i wish i could stay here with you. but i cannot.i have tried to find some one to come and be here with you, but i have not been able to. can you talk on the phone? can i call some one to talk to you? is here a tv program that might take your mind off of things that are scaring you? WE need to find a solution to this. i am open for your suggestions and ideas"...

there are other times that i SIT ON THE PATIENTS BED while talking to them. i hold their hand, i touch them, hold their hands.... PERSONAL TOUCH-- FOLKS SEEM STARVED FOR IT..and it allays fears like nothing else.... dont be afraid to touch your patients...

and lastly, if my patient seems to have faith, i ask them if i might give them a blessing before i leave til i come back--then i place my hand on their head or tracea cross on their forehead and ask the good lord to come and bless them and comfort them and stay with them, give them peace until i return.

in another question elsehwere here on this board, another expereinced nurse told her needy patients " here is a piece of paper.i want you to list everything you need and write me a list. and we shall do everything on that list"

[tokmom, BSN, RN]

Can you limit set? I would tell them you have other people you have to see and the hollaring out (for the oriented one) and will be back in 15 minutes and then stick to it. Maybe baby step your way to 30 min, then 60.

[Aeterna, BSN, RN]

Oh trust me, we tried limit setting and continue to do so. When she asks me to stay with her, I firmly tell her, "Mrs. Smith, you know I can't. You know I have other sick people to look after, but I will check on you within an hour." (name changed, obviously) Still, seconds after I step out that door, she is calling out for me again.

It's harder with the confused man. I told him near the end of my shift today to please be quiet because his roommate was resting, and he seemed to understand and even dropped his voice to a whisper. Still, five minutes later, I heard him calling out again, as if he forgot everything I told him.

I wish our manager got involved more! But she might have already, I'm not sure. These two patients have been with us for a long time now, so we ALL know them and what they are like.

[No Stars In My Eyes]

Anyone "old" enough to remember TEAM CONFERENCES ? When ALL departments involved meet about a specific patient to discuss and plan and problem-solve? Both patients are TOO MUCH for one person to have to deal with on the same day/same shift. Medicine can't be the only answer; maybe a DIFFERENT medicine, maybe a psych referral? I know if the pt. is riddled by dementia it compounds things....I don't know that there is any easy answer, but I would think giving both pts. to the same nurse is a little much. Spreading the fun would be acceptable for a start....

[KY RN]

Perhaps you could get the Dr. to consider a psych consult, anti-anxiety meds, and/or a sitter? When I have people like this, I usually ask to get another team the next time. Two days in a row of these types of patients really wears me out. At our unit, we prefer to "share the love" and let another nurse take a turn with them.

[MassED, BSN, RN]

all great examples of why I left floor nursing and went to an ED. You will have these patients, but they will either be admitted or go back home/ALF/NH, so either way, there's an end in sight to the trauma/frustration/driving you to drink type of shift with these people. It's so sad, but one can only take so much.

Come to the ED where you can be mentally, verbally, and physically (attempts) abused by narc seeking patients. Ahhhh good times. I had such a PIA last night who reported ear pain (was in the ED for something or other the previous night, and the night before that for some other nonobvious reason) and I had the luxury of irrigating his ear. Nice 14 gauge with warmish water jetted not so gently into his ear. BS that he had ear pain that was SOOO bad he had to yell all sorts of obscenities at me. I wanted to tell him, "why don't you just ask for your Oxy right now and let us all move on?" He was such a jerk, I cannot even tell you. It'll be THOSE patients that end up evaluating us for our next yearly reviews and raises, I swear!!!! Pfffft! There's no perfect place.

[Aeterna, BSN, RN]

Anyone "old" enough to remember TEAM CONFERENCES ? When ALL departments involved meet about a specific patient to discuss and plan and problem-solve? Both patients are TOO MUCH for one person to have to deal with on the same day/same shift. Medicine can't be the only answer; maybe a DIFFERENT medicine, maybe a psych referral? I know if the pt. is riddled by dementia it compounds things....I don't know that there is any easy answer, but I would think giving both pts. to the same nurse is a little much. Spreading the fun would be acceptable for a start....

I wish we (the primary nurse that day) got to sit in on the rounds for that patient! But it seems like it's not how this floor works. I think it's because it's such a big floor with a very mixed patient population (medical/oncology/palliative).

Also, normally, we tend to spread out these patients but unfortunately, right now, our floor is very acute and busy (we seem to have "busy phases" and this is one of them). Compounding the problem is that we have many people on isolation and so they're trying to group these people together to keep them further in isolation. Unfortunately, our patients on isolation also tend to be frequent callers (figures, eh? *sigh*). As one nurse put it, "There is no such thing as a good assignment lately."

I'm pretty sure psych consults have been done for these two. They both have been query diagnosed with depression, at least, but they obviously have some anxiety issues, too. It's just so difficult to get much done due to limited resources - I'm pretty sure the docs, like us nurses, are stretched at their limit, too!

[Been there,done that, ASN, RN]

Try other anxiety meds, hopefully you find something that works without excessive sedation. Ativan is known for that side effect.

If the families don't like the side effects, I explain, the patient is "tired" from the days activities, ,etc. After all we are not miracle workers. If the family doesn't want a patient medicated, they have the option to stay with the patient.

[DroogieRN]

...there are other times that i SIT ON THE PATIENTS BED while talking to them. i hold their hand, i touch them, hold their hands.... PERSONAL TOUCH-- FOLKS SEEM STARVED FOR IT..and it allays fears like nothing else.... dont be afraid to touch your patients...

I have found this to be quite effective as well, at times.

[SNIXRN]

One word: Ativan

JK!

I had a patient whose daughter would call or follow me to the med room, while I was walking out of another patient's room, etc. It was so exhausting. If it interferes with the care you provide to others, you should get management involved. Maybe they could get a sitter for the patient.

[Old.Timer]

regarding the confused elderly man, the national institute on aging does an excellent job of documenting the unique and intensive needs of hospitalized elderly and dementia patients and has some excellent information.

problem is....hospitals are not willing to commit resouces to adequately provide care to the aging population. what we're seeing right now is the tip of the iceberg. the onslaught is coming with the baby boomers and as usual, nurses will be forced to cope with the fall-out of a huge system failure.

http://www.nia.nih.gov/alzheimers/caregiving/professional/ (resource materials)

http://www.nia.nih.gov/alzheimers/publications/acute.htm (alzheimers and acute hospitalization)