So I had this older lady who was hospitalized for pneumonia. All evening she was very pleasant and even offered chocolate each time I went in to see her. It was mentioned to me at the beginning of the shift that the night before she had gotten out of hand and I thought this lady is so sweet I wonder what they are talking about. Well at 6am I found out. She was screaming down the hall that if someone doesn't get her water right now there is going to be a dead patient. I go in the room and her eyes are red and puffy and she starts screaming at me saying I am a horrible nurse and I neglect her and this is a horrible hospital. When I asked her why she was so upset and what she needed she started screaming how she hasn't had a bowel movement in 2 days and I don't care because I'm not calling the doctor. (The night before I did give her something)
I wanted to tell her the reason she isn't going as frequently is bc she won't get her butt out of bed! She refuses to get up to a commode or a chair. But I wasn't going to fight. She yelled for us to get her fixed up in bed so we pulled her up in bed and I laid the blanket on her and she said "this is how you're gonna leave me, you aren't even gonna make it nice." Omg! I wanted to just tell that lady to cut the crap bc she was just out of control but I know we are supposed to be cordial with the patients.
Has anyone ever told a patient to just cut the crap and stop being nasty?
Yes- I once told a pt to cut the crap & behave himself. Thing is, it was my Dad & I wasn't his nurse.
Similar situation though. I had stressed repeatedly to the nurses to make sure he got his hs clonazepam- that it would more pleasant for everyone concerned- because when he's in the hospital he sundowned pretty badly. Well, they didn't watch him take his meds & I found it in his bed the next morning. But only after he became a demon around 0500! Chasing a nurse with his cane, throwing things being paranoid, etc because he hadn't slept all night & the dementia was on turbo by then.
I didn't see where OP said if her pt slept or not, but that would certainly have an effect. All the other suggestions- starting with O2 sat (esp for a LOL w/PN) fsbs, uti, urine retention, all excellent suggestions.
It took quite a bit of Ativan to finally knock my Dad out & afterwards had no memory of any of it... Not even telling me to hush because I was interrupting his Masonic lodge meeting he thought he was at...
And it's easy for us to imagine the oh so compassionate way we think we would act/react when reading about these situations from the relative quiet of our homes when you have time to think about the pros/cons of different actions.
It's a whole different thing when you're reacting in the moment to a sweet LOL calling you horrible names & tossing things at your head!
I know I constantly have a stream of things I think- but don't say- running through my head! Thinking it doesn't make you a bad nurse- it means you're human!!
Absolutely! Especially in light of the fact that this woman had such a drastic personality change. Something is wrong. The ow sounds like she needs a refresher course in assessment.
I recently had a patient with Expressive Aphagia who told me to "Get my GD fat f'n ass outta here *****!" Didn't think he had Expressive Aphagia then. He had been yelling so I asked what was wrong. It went from bad to worse from there. I switched patients with another nurse. He wasn't cooperative with her but he was nicer. He told her "you and I had a thing, but you didn't want me. So I don't want nothin' from you." He wouldn't take his meds. When the techs went in to change and clean him up you'd have thought they were stripping in there, "Ooooh you so good." "That feels sooo good." We couldn't help but laugh outside the room. I've been called bad names before but that particular string of words was just nasty. I would love to say that, but the best I've said is "I do not have to put up with you calling names and I won't." They don't care the H out there stands for Hilton and I'm nothing more than someone to order around. I did tell one patient who demanded an ice cream with a BS of 375 that I don't reward bad behavior and not with a 375 BS. He pouted all night then reported me. SMH
Yep, I've called out patients for their bad behavior before. One memorable occasion was a middle-aged man who continually verbally abused the nursing staff, being very manipulative and rude, and rating his pain a consistent 10/10 - even though he was laughing, talking on the phone, and ordering pizza as he said it. I finally had enough and said, "Dude. I have your pain meds right here. I've been in here with your pain meds every three hours on the nose. You're getting your meds no matter what number you tell me, so just give me an honest number and life will be more pleasant for both of us." "I'm still getting my meds?" he asked. "No matter what?" I told him yes, I got it, he was post op and pain was a real thing, I just wanted him to be honest. "Fine. It's a three." "Thank you!" I said, just a little exasperated. He got his full dose every three hours, he stopped being a manipulative little $#!t, and miraculously, as soon as he was reassured that his needs would be met, his attitude improved and his angry demands for pain meds subsided. We got him down to q4hrs and provided him with a strategy for weaning off the narcs when he got home, and for dealing with the side effects. He was never the ideal patient, but he was far more pleasant after I got him to shut up and listen. Some people just need a firm hand to cut through the fog. (Note, I said "some people." It's a strategy that should ONLY be employed if you're very certain it will work.Using a firm hand on certain other personalities will get you reprimanded.)
Specializes in Gerontology, Med surg, Home Health.
I am not an LOL either. My MD refuses to prescribe Ambien because of the myriad of side effects. Plus it's on the BEERS list. Trazodone is a much better choice.
A few posts mentioned that we shouldn't be diagnosing. I think what many of us were suggesting doing was thinking of possible reasons for the change in behavior and was suggesting assessing. You know, what we are suppose to be doing all the time.
Seems like you're focusing on yourself, your emotions, and not the patient. Nurses are supposed to use therapeutic communication, although, this technique doesn't always work. When all else fails, sincere compassion and desire to help usually does the trick. Patients usually act out because of fear or confusion. Try to imagine how you want to be treated before reacting negatively!
Seems like you're focusing on yourself, your emotions, and not the patient. Nurses are supposed to use therapeutic communication
....yadda frickin yadda.
It's because we are human too and the very reason we have a place like this to come and vent to instead of reacting in the moment with patients. I'm pretty tired of the nurses should be better than everyone and the angels of the world crap. And that's coming from me, one of the most empathetic people you'd ever meet.
Hopefully your facility does not allow this behavior either. When all other causes have been ruled out, call security. They will set the patient straight on what is and is NOT appropriate communication.
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Yes- I once told a pt to cut the crap & behave himself. Thing is, it was my Dad & I wasn't his nurse.
Similar situation though. I had stressed repeatedly to the nurses to make sure he got his hs clonazepam- that it would more pleasant for everyone concerned- because when he's in the hospital he sundowned pretty badly. Well, they didn't watch him take his meds & I found it in his bed the next morning. But only after he became a demon around 0500! Chasing a nurse with his cane, throwing things being paranoid, etc because he hadn't slept all night & the dementia was on turbo by then.
I didn't see where OP said if her pt slept or not, but that would certainly have an effect. All the other suggestions- starting with O2 sat (esp for a LOL w/PN) fsbs, uti, urine retention, all excellent suggestions.
It took quite a bit of Ativan to finally knock my Dad out & afterwards had no memory of any of it... Not even telling me to hush because I was interrupting his Masonic lodge meeting he thought he was at...
And it's easy for us to imagine the oh so compassionate way we think we would act/react when reading about these situations from the relative quiet of our homes when you have time to think about the pros/cons of different actions.
It's a whole different thing when you're reacting in the moment to a sweet LOL calling you horrible names & tossing things at your head!
I know I constantly have a stream of things I think- but don't say- running through my head! Thinking it doesn't make you a bad nurse- it means you're human!!