Insight Dialogues: What Would You Do?

Nurses General Nursing

Published

Let me start off for those of you who don't know me:

I work at a LTC facility that is run by state. This facility cares for individuals with mental and physical disabilities. The population ranges from profound to slight mental-retardation. Behaviors range from PICA to SIB to over violence. (Not all of them have these behaviors of course.)

Recently I was given an in-service, or "Insight Dialogue" asking me what I would o in a particular situation. Now I'm curious as to how you would react in the situation given:

(NOTE: I'm not quoting word for word, I'm just rebuilding a similar scenario.)

It is time for an individual, that you were assigned to, to take his shower. When you approach the individual to tell him this he asks you if it would be okay to smoke a cigarette first. You don't see a problem with this so you go outside to monitor the individual while he smokes his cigarette. Before he lights it, however, you notice that he has urinated himself. You ask him to come back inside to change and wash up before he smokes his cigarette. He insists on smoking his cigarette and this request causes the individual to become agitated. You know he has a history of violence toward staff when he does not get his way. What do you do?

The correct answer may or may not surprise you. It didn't really surprise me... but then again I've been working at this place for about 3 years now... nothing... and I mean nothing phases me anymore lol.

(NOTE: I'm not quoting word for word, I'm just rebuilding a similar scenario.)

It is time for an individual, that you were assigned to, to take his shower. When you approach the individual to tell him this he asks you if it would be okay to smoke a cigarette first. You don't see a problem with this so you go outside to monitor the individual while he smokes his cigarette. Before he lights it, however, you notice that he has urinated himself. You ask him to come back inside to change and wash up before he smokes his cigarette. He insists on smoking his cigarette and this request causes the individual to become agitated. You know he has a history of violence toward staff when he does not get his way. What do you do?

Sit upwind.

hahaha Sharon, you're right. Please I didn't mean any offense. Everyone answered correctly. I was just playing devils advocate. If staff came up and questioned it I would simply tell them what happened.

Sit upwind.

*snort*

I let him have the cigarette. If a supervisor questions the wet pants I say, "Yes, they're wet. He wanted his cigarette. We're going to take care of that as soon as he's done." "Oh, I should insist that he change first? Well, he weighs 230 and he'll try to hit me. Would you care to get him to change?"

That might be one reason I don't hold jobs....

Specializes in IM/Critical Care/Cardiology.
hahaha Sharon, you're right. Please I didn't mean any offense. Everyone answered correctly. I was just playing devils advocate. If staff came up and questioned it I would simply tell them what happened.

I knew you were holding out!;)

*snort*

I let him have the cigarette. If a supervisor questions the wet pants I say, "Yes, they're wet. He wanted his cigarette. We're going to take care of that as soon as he's done." "Oh, I should insist that he change first? Well, he weighs 230 and he'll try to hit me. Would you care to get him to change?"

That might be one reason I don't hold jobs....

That's the right answer. If the supervisor insists on you changing him that minute she would be in the wrong... and anything resulting from that decision would be on her.

I knew you were holding out!;)

:devil:

They do that at my job hardcore though. Even if you get the right answer they try to convince you that you're wrong... they are a little more intimidating about it than I am. Their theory is that they want to make damn well sure you know what your supposed to do in any given situation. our policy and procedures fill up two shelves in every unit. They are insane..... they have everything listed from what color bus do individuals ride if they smoke to what to do if one has a paper cut... to what you should do in the case that an ind. is trying to eat their own... well never mind.

But yeah.... I love my job none-the-less. And the population is great. You really learn how to deal with people... but you become less tolerant of people who don't live there who should "know better". I remember one time my supervisor got in trouble for wearing a shirt that said, "Stupidity is not a crime... you are free to go."

God.... someday I'm going to write a book about that place. There already is one out called "Hard Candy" but it's... kinda sad and depressing. Mine would be about the quirks of working in a developmental center.

Specializes in Med-Surg/Peds/O.R./Legal/cardiology.

I say let him smoke his dad burned ciggy. The pee won't kill him--why start an uproar? As far as the supervisors, etc., if they are directly involved in the pt's. care, they would be cordially invited to review his chart/history.

I say let him smoke his dad burned ciggy. The pee won't kill him--why start an uproar? As far as the supervisors, etc., if they are directly involved in the pt's. care, they would be cordially invited to review his chart/history.

*nods*

Yeah, this situation would definitely have to be documented in his Active Treatment Notes.

I say let him finish smoking, then get him into the shower. You already promised that he could smoke first. If you go back on that, he is going to be agitated and maybe get physical with you. The wet pants aren't really going to hurt him to wear just long enough to smoke.

Leslie

Specializes in Jack of all trades, and still learning.
That's the right answer. If the supervisor insists on you changing him that minute she would be in the wrong... and anything resulting from that decision would be on her.

And if she insists on you doing it, well, just ask her could she demonstrate the most effective way of doing it...

Then she can suffer the ensuing behavioural problem! :idea:

And if she insists on you doing it, well, just ask her could she demonstrate the most effective way of doing it...

Then she can suffer the ensuing behavioural problem! :idea:

That so wouldn't work lol. If anything the supervisor would yell at you because you should know how to do your job hahaha. That's their mentality anyway.

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