How do you deal with these types of patients?

[dudette10, MSN, RN]

The chronically dissatisfied patient, getting better for admitting diagnosis, but with uncontrolled, officially diagnosed psych issues that cause them to call you to the bedside every 30 minutes--keeping you at the bedside with demands for 15 minutes--despite your best attempts at clustering care and setting time parameters.I've had one of them for each of three shifts in a row, and I'm at a loss as to how to handle them, except to just plain ignore them for a little while.

[MJB2010]

I usually try to get them everything they need, a drink snack and pain med, restroom and whatever else. Then I tell them I will be back in 30 minutes and they need to wait until then. They usually still call, but you have to set limits. I also try to take turns with the tech so we alternate turns going in there. We call each other to save each other and get us out of there. Unfortunately they end up getting low priority on the call light because I know they have all they need and t hey end up just having to wait. It is what it is. Very frustrating.

[loriangel14, RN]

If they are not independently mobile we get them up out of the room ( wheelchair or geri chair) AWAY from the bell.We also set boundaries and stick to them.We try to do this consistently.

Lots of time these folks get Seroquel which works really well.

[HouTx, BSN, MSN, EdD]

Psych nurse consult STAT! Seriously, these situations need to be managed with a behavioral modification plan integrated into the general plan of care - and it needs to be followed consistently by all staff. Otherwise, the dear pt will be playing the "oh, you're the good nurse" game.

[dudette10, MSN, RN]

Psych nurse consult STAT! Seriously, these situations need to be managed with a behavioral modification plan integrated into the general plan of care - and it needs to be followed consistently by all staff. Otherwise, the dear pt will be playing the "oh, you're the good nurse" game.

Every time I've seen a psych MD consult, they mess with the meds and the meds can't do their job during an inpatient stay. As for a psych nurse consult, I've never heard of such a thing in acute care. FWIW, these patients didn't split staff. They just bit my head off each time I entered the room! Those patients were also rotated among staff so that a nurse never had them two days in a row in order to save our sanity.Please keep suggestions coming. We all need more tools in the toolbox for difficult patients!

[Morainey, BSN, RN]

I would suggest rotation... that's a quick way to get burned out after even one shift

[MJB2010]

Psych nurse consult STAT! Seriously, these situations need to be managed with a behavioral modification plan integrated into the general plan of care - and it needs to be followed consistently by all staff. Otherwise, the dear pt will be playing the "oh, you're the good nurse" game.

We do not have this capability where I work.

[nurseprnRN, BSN, RN]

Every time I've seen a psych MD consult, they mess with the meds and the meds can't do their job during an inpatient stay. As for a psych nurse consult, I've never heard of such a thing in acute care. FWIW, these patients didn't split staff. They just bit my head off each time I entered the room! Those patients were also rotated among staff so that a nurse never had them two days in a row in order to save our sanity.Please keep suggestions coming. We all need more tools in the toolbox for difficult patients!

OK, so let's look at it from the patient's perspective. He's scared, he has no social skills to speak of or has, as many people under stress do, regressed to the level of a snotty adolescent. He never sees the same person long enough to develop any sort of trust, so he's always calling for help. He knows the staff can't stand him, so he is even more scared because what if something happens and he calls and no one comes? Can he trust anything anyone says when he knows that nobody really cares?

If this is you, what do you want? You want to feel less scared. You want to know what's going to happen to you, both here and when you leave. You want to know that you matter and that your needs will be met. One person telling you is not going to be enough to reassure you; one person looking like she's trying to help you understand is not enough.

Consistency is, in fact, the key. Someone needs to become this person's primary nurse on each shift, not just one someone who is working two shifts in seven days. Those nurses need to remember what they learned about therapeutic communication, authenticity, and empathy when they took psych nursing, or study up on it a bit; they need to consult with one another and communicate well as a group. Everyone needs to know what the nursing plan of care for this behavior is going to be, same as if it were some unusual surgical drain or uncommon infection. And everyone has to work with the patient to help him, not just treat him as an annoyance to be "managed" and avoided. This is nursing. Be nurses.

[loriangel14, RN]

But most of us don't work seven days a week.How could one person be there consistently 7 days a week?

[itsnowornever, BSN, RN]

But most of us don't work seven days a week.How could one person be there consistently 7 days a week?

The same nurses need to be his nurses consistently. If you are there Monday Tuesday and Wednesday, the Susie is his nurse Thursday Friday and Saturday and Mary is his nurse Sunday. He knows who is coming when and that decreases anxiety as well as gives him a routine.

[loriangel14, RN]

Our patients couldn't remember from one day to the next who they had.

We make a point of rotating these patients so no one has to deal with them more than 1 or 2 days in a row.

[dudette10, MSN, RN]

GrnTea, thanks for the suggestion. It IS important to build trust with patients that have psych disorders that are exacerbated by being hospitalized for other medical conditions. However, it takes time to build trust with them, and while the idea of the same nurse each shift is great--if it can be done with the buy-in of all the nurses or at least a charge nurse who insists upon it.

We shouldn't make promises that we can't keep with these patients, but the very nature of acute care means that we can't always be in that room the very second the mood strikes the patient. I have put on the white board the time at which I will be back--a trick I learned from a nurse who works on another floor that has a lot of patients with prescribed med addictions d/t histories of post-operative pain management gone awry. But if you miss that time even ONCE, the trust-building has to start all over again. Plus, for each shift, the patients violated the rounding agreement we had with the white board times, and the trust was lost before it even began. This is compounded by needing to build trust within a relatively short LOS for the medical condition that got them hospitalized in the first place. Can enough trust really be established in a non-psych acute care environment that can make a difference?