I need to ven't about my job!

Virgo_RN, BSN, RN · Oct 17, 2008

You are going to encounter this for the entirety of your nursing career. Best way to deal with this is first, don't take it personally. It is not about you. Often these behaviors are rooted in the person's disease process and/or their sense of vulnerability and helplessness and lack of control. Also understand that many elderly people with dementia react poorly to even the slightest changes in their environment or their routine.

For example, the resident that you were helping back to bed could have gotten used to transferring in a certain way, and then you come along and do it differently than what she is used to. This change can produce stress that will manifest in her behavior. The best way to handle this is to remain calm, involve the resident in the process by asking her how she's used to doing it, do it her way (providing it is safe), and move on.

In the second example, I'd say "kill her with kindness". This person sounds like she feels threatened by her lack of control, and will attempt to control anything that she can. With this kind of person, you give them control over as much as possible. Give them choices and options (within reason), do your best to learn their routines and their preferences, and ask them how they want things done, then do them that way and don't argue or try to do things your way. Don't get into a power struggle.

You are not going to fix these people or change them. They are set in their ways and their routines, and you are the outsider. They do not have to adapt to you, but you to them. Once you have earned their trust and developed a relationship with them, you may see small adaptations and accomodations to you, because you have become a part of their environment. But keep in mind that the turnover can be so high in these places, that the residents don't develop attachments to their caregivers, because they know they are temporary.

I remember one resident I cared for when I worked in LTC. The CNA that trained me warned me "he hits". I watched her with him, and helped her change his briefs and get him tucked into bed. The way she approached him was blunt, she was rough with him, and it was clear that she didn't like him. When I was on my own and was assigned to him, I behaved differently. First, when I entered the room, I plastered a big smile on my face, and I addressed him as "Mr. X", rather than by his first name. I made a little small talk with him as I stood next to his bed, then I told him that I was going to check his blankets and make sure they were dry. I *never* said I was going to change his diapers. If his brief was wet, I'd calmly get a dry one, and tell him we needed to put some dry "pants" on. I was very careful to never make any sudden moves, and to make my movements calm and deliberate, giving him verbal cues about what I would be doing next. He would cooperate and roll side to side for me, and never, ever even once tried to hit me. This man was an old Navy man, and had his pride. He did not like being addressed by his first name, being told his "diapers" needed to be changed, or being rolled around like a rag doll. So, he would try and hit the CNA that treated him that way. When I treated him with respect and courtesy, and protected his pride, he was cooperative, and even began to smile back when I entered the room.

Remember, you are in *their* world. You need to learn about each of their individual preferences and adapt your behavior for each one.

nursing_student84 · Oct 17, 2008

You are going to encounter this for the entirety of your nursing career. Best way to deal with this is first, don't take it personally. It is not about you. Often these behaviors are rooted in the person's disease process and/or their sense of vulnerability and helplessness and lack of control. Also understand that many elderly people with dementia react poorly to even the slightest changes in their environment or their routine.
For example, the resident that you were helping back to bed could have gotten used to transferring in a certain way, and then you come along and do it differently than what she is used to. This change can produce stress that will manifest in her behavior. The best way to handle this is to remain calm, involve the resident in the process by asking her how she's used to doing it, do it her way (providing it is safe), and move on.
In the second example, I'd say "kill her with kindness". This person sounds like she feels threatened by her lack of control, and will attempt to control anything that she can. With this kind of person, you give them control over as much as possible. Give them choices and options (within reason), do your best to learn their routines and their preferences, and ask them how they want things done, then do them that way and don't argue or try to do things your way. Don't get into a power struggle.
You are not going to fix these people or change them. They are set in their ways and their routines, and you are the outsider. They do not have to adapt to you, but you to them. Once you have earned their trust and developed a relationship with them, you may see small adaptations and accomodations to you, because you have become a part of their environment. But keep in mind that the turnover can be so high in these places, that the residents don't develop attachments to their caregivers, because they know they are temporary.
I remember one resident I cared for when I worked in LTC. The CNA that trained me warned me "he hits". I watched her with him, and helped her change his briefs and get him tucked into bed. The way she approached him was blunt, she was rough with him, and it was clear that she didn't like him. When I was on my own and was assigned to him, I behaved differently. First, when I entered the room, I plastered a big smile on my face, and I addressed him as "Mr. X", rather than by his first name. I made a little small talk with him as I stood next to his bed, then I told him that I was going to check his blankets and make sure they were dry. I *never* said I was going to change his diapers. If his brief was wet, I'd calmly get a dry one, and tell him we needed to put some dry "pants" on. I was very careful to never make any sudden moves, and to make my movements calm and deliberate, giving him verbal cues about what I would be doing next. He would cooperate and roll side to side for me, and never, ever even once tried to hit me. This man was an old Navy man, and had his pride. He did not like being addressed by his first name, being told his "diapers" needed to be changed, or being rolled around like a rag doll. So, he would try and hit the CNA that treated him that way. When I treated him with respect and courtesy, and protected his pride, he was cooperative, and even began to smile back when I entered the room.
Remember, you are in *their* world. You need to learn about each of their individual preferences and adapt your behavior for each one.

After reading your post it made me feel better. I will try the helpful tips that you have mentioned above. It's just frustrating when these residents get in thier moods. Thanks!:wink2:

chevyv, BSN, RN · Oct 17, 2008

I have to add my :twocents: , it's not just residents, but many people are just plain rude! I have two children who I've taught good manners, such as holding the door open for older people or if they go first, hold it for the people behind you and especially if a mom with little ones in tow is coming. I've also taught them to give up their seat for an older person or pregnant lady. They have always been so good at doing this, I'm so proud. But so many people will walk through the door and not even say thank you. I've see an older woman yell at my child to move out of her way at a shoe store. I was appalled! Yet I continue to encourage them to be kind and treat others the way they would want to be treated. When somebody doesn't acknowledge them at the door, I always thank them for being kind loud enough so the person will hear. I'm so tired of people saying the younger generation isn't respectful. Ugh!!!

Sometimes I wonder if people feel like they can treat others like dirt because they lived long enough to do just that! An older man dropped some change at the museum and my son ran over to help pick it up and the man thought he was going to steal his quarter! My son tried to explain that he just wanted to help and finally the man saw me eyeballing him and said thank you. Not all kids want your quarters!!!

It's easier for me when they're my pts. Many of them are scared, frustrated, or have had CVA's or TIA's and that affect them. I can understand that.

Other times, some are just rude and I call them on it. They usually get it and change their tune quick. I do have a grandma who was in the hospital where I worked and I'm so embarassed, but the cna's were trading her for 2 pt's because she was so demanding. It was horrible and miserable for my coworkers. Funny thing, I was thrilled I was on maternity leave while she was there so I didn't have to take care of her nasty holier than thou attitude. :imbar

Bortaz, MSN, RN · Oct 18, 2008

They are old, and near death. I know it's hard to take, but I believe they should be given a little leeway. It can't be easy to know you're that close to the end. And to be stacked up in some nursing home makes it worse.

180Chick · Oct 18, 2008

You are going to encounter this for the entirety of your nursing career. Best way to deal with this is first, don't take it personally. It is not about you. Often these behaviors are rooted in the person's disease process and/or their sense of vulnerability and helplessness and lack of control. Also understand that many elderly people with dementia react poorly to even the slightest changes in their environment or their routine.
For example, the resident that you were helping back to bed could have gotten used to transferring in a certain way, and then you come along and do it differently than what she is used to. This change can produce stress that will manifest in her behavior. The best way to handle this is to remain calm, involve the resident in the process by asking her how she's used to doing it, do it her way (providing it is safe), and move on.
In the second example, I'd say "kill her with kindness". This person sounds like she feels threatened by her lack of control, and will attempt to control anything that she can. With this kind of person, you give them control over as much as possible. Give them choices and options (within reason), do your best to learn their routines and their preferences, and ask them how they want things done, then do them that way and don't argue or try to do things your way. Don't get into a power struggle.
You are not going to fix these people or change them. They are set in their ways and their routines, and you are the outsider. They do not have to adapt to you, but you to them. Once you have earned their trust and developed a relationship with them, you may see small adaptations and accomodations to you, because you have become a part of their environment. But keep in mind that the turnover can be so high in these places, that the residents don't develop attachments to their caregivers, because they know they are temporary.
I remember one resident I cared for when I worked in LTC. The CNA that trained me warned me "he hits". I watched her with him, and helped her change his briefs and get him tucked into bed. The way she approached him was blunt, she was rough with him, and it was clear that she didn't like him. When I was on my own and was assigned to him, I behaved differently. First, when I entered the room, I plastered a big smile on my face, and I addressed him as "Mr. X", rather than by his first name. I made a little small talk with him as I stood next to his bed, then I told him that I was going to check his blankets and make sure they were dry. I *never* said I was going to change his diapers. If his brief was wet, I'd calmly get a dry one, and tell him we needed to put some dry "pants" on. I was very careful to never make any sudden moves, and to make my movements calm and deliberate, giving him verbal cues about what I would be doing next. He would cooperate and roll side to side for me, and never, ever even once tried to hit me. This man was an old Navy man, and had his pride. He did not like being addressed by his first name, being told his "diapers" needed to be changed, or being rolled around like a rag doll. So, he would try and hit the CNA that treated him that way. When I treated him with respect and courtesy, and protected his pride, he was cooperative, and even began to smile back when I entered the room.
Remember, you are in *their* world. You need to learn about each of their individual preferences and adapt your behavior for each one.

Wow! This is some really helpful advice! I'm in my very first semester as a nursing student, so of course, I'm all doe-eyed and excited about this stuff, haha. My first week of clinicals comes this Wednesday, and I am assigned to perform mine in the nursing home. I was kind of dreading it, because I am a person who wants to most likely work with Peds or NICU. Your story about the Navy man has made me think of it entirely differently now. I know that I will probably not become a permanent presence to them or someone they even become accustomed to, because I will only be there for 5 weeks, but this has still changed my attitude. Thanks! :)

Blueorchid, ASN, RN · Oct 18, 2008

Amen to that NancyNurse08! Having worked in a nursing home, hearing your story makes me smile and remember some of my own. You'd be surprised how much you find out from residents when you really listen to them.

I had a lady once doing basic motor skills with a Connect Four board in the therapy gym that was clearly distressed. You know the yellow plastic with slots you fit the black and red pieces in? She was shouting at all the therapists and being completely disagreeable, demanding to go back to her room (she was also quite along with dementia). After trying to get her to put the pieces into the slots several times the therapists were ready to give up and went to get me.

But when I started to push her wheelchair out of the room she seemed desperate to get back to the board and kept putting her fingers through the holes. When I tried figuring out what was wrong she told me she was trying to contact her daughter because she was worried something had happened. Apparently the residents in the ward had been watching television and the staff had flipped over footage of a car accident. She thought the Connect Four board was a telephone switchboard and was getting angry because she couldn't get through to her daughter. After explaining what was going on...she was not only relieved but quite agreeable and easy to work with.

While I know this is really specific (and I just kind of felt nostalgic...sorry!) the point that appears to have been made is people act the way they do for a reason. Whether its a loss of independence and control or a physical ailment, figuring out the reason for a resident's rudeness often leads to a common ground and makes things much much easier :)

Good luck!