Isolating Demented Residents

[SuesquatchRN, BSN, RN]

I've seen this time and again. My last place we had a woman who perseverated and stayed on the call light. I managed to calm her down, we got her Seroquel restarted, and the day before I was fired she wheeled up to me and said, "I feel safe when you're here." Of course, the aides and evening nurses started removing her call bell again (illegally) and this resulted in falls and fright for her, but hey - they didn't have to reassure her, or bring her to the common area to keep her from being lonely.

The new place, which is very good, has a resident who calls out, "Help me! Help meeeeee!" in a piercing, hog-calling voice. She's in a private room and is never brought out. Well, she CAN communicate a bit, although I have to lead her with questions and ystdy she had an actual complaint of a stomach ache. As soon as I left the room to check her standing orders she started yelling again. I returned to the room and reassured her that I was looking at her chart, which was in my hands. I then went out to pour the Maalox-equivalent and she started yelling again. I came back with the meds and smiled and told her we needed a little time. I gave her the Maalox and she immediately calmed and stopped yelling.

When I've tried to get her brought out from her room I've been told that her yelling upsets the other patients. Well, when we're right there we can reassure her and it stops - for a bit - instead of going on for two hours.

How do I get her reincorporated among the living without thoroughly pissing off my coworkers, including the charge?

Suggestions?

[leslie :-D]

talk about exacerbating one's anxieties!!

sometimes i do agree that one should be BRIEFLY isolated if they are overstimulated.

nothing like a little quiet time to restore one's soul.

but the majority of the time, i believe these residents need more 1:1/reassurance, which could be rectified by placing them near the nurse's station, only if someone is there of course, and will respond sensitively to the perseverating.

sometimes, i would bring a needy soul along with me on my med pass.

yes, it took a little longer but my resident felt safe.

i would place them in an area of the hall where they could see me at all times.

sometimes just the sound of my voice would be enough to quiet someone down.

these residents do know who look out for their well being.

someone needs to advocate for them.

good for you sue.

you'll find a way to handle this, i'm sure.

leslie

[squeakykitty]

Isolating them could be abuse. However, I've seen a few residents who could move in wheelchairs/merry walkers take themselves to an isolated part of the hallway or empty room for some peace and quiet.

If people are taking the call bells away illegaly, shouldn't that be reported before some resident has a heart attack/falls/chokes and can't call for help?

[SuesquatchRN, BSN, RN]

If people are taking the call bells away illegaly, shouldn't that be reported before some resident has a heart attack/falls/chokes and can't call for help?

It was, and I got, eventually, fired for rocking the boat.

This resident is hemiplegic, obese, CHF, COPD, vascular dementia 2 CVA, oriented x1, Hoyer hoist.

[CapeCodMermaid, RN]

You got fired because you told someone that the others were taking the call lights away??? Clearly removing a call bell is neglect and should be reported to the DPH as such. I tried to fire someone because clearly he was incompetent...faxed labs to MDs in the middle of the night, didn't call a family member with a change in condition and the patient died before her husband knew, and gave insulin without a doctor's order. I was told by the regional nurse that I didn't have "enough on him' to fire him and she was afraid he'd 'pull the race card'....yikes...I guess it all depends who is in charge of the place.

Sometimes you have to 'piss off your co-workers' to do what is right for the patients. But, not everyone will benefit from being out where the action is.

[SuesquatchRN, BSN, RN]

Mermaid, I was ultimately fired for the death of a patient - not on my shift. But there is no question that my advocating for the residents was what got me terminated. I was told that I was "perceived as pushing pain meds" - for a resident dying with a subdural hematoma, another with an inoperable broken hip for which she was being given tylenol who died within the week, another who would awaken at night crying for God to take her because her legs hurt so badly - and that I was too "direct" with the aides, as in, "Hey, she's been needing to pee for twenty minutes! Someone wanna give me a hand with her?" That was "barking." And I reported aides repeatedly for removing bells. None of them were fired. I was.

[CapeCodMermaid, RN]

Sorry for what you've gone through. Seems that facility's loss is your new facility's gain. Barking? I guess you knew who was running that facility. I was accused of 'yelling' at someone because I asked them to do something they didn't want to do. That's part of the reason I left my job...no support to try to make things better and I didn't want to be a part of it or beat my head against the wall. At the end of days, what you and I have done will count for something even though now it doesn't seem like it mattered at all.

[SuesquatchRN, BSN, RN]

I've been reading your thread, CGM. I just don't know what to say. LTC is such a hard gig. Everyone wants their folks to have primo care, and everyone wants someone else to pay for it. And the state reimburses us less than the cost of a hotel room per day.

*sigh*

Yes, we matter. And thanks for saying it.

:)

[travel soon]

you know all in all it really doesn't matter which way you go your going to piss someone off. If you do your job you surely do and if your one of those like myself who decide to just do what I can and let everyone else do their own thing(as long as it isn't abusive) then everyone treats you like your a know it all or a snob. But if someone took a call bell away from a patient for your own benifit you should notify state but I would also cover my butt by charting what the worker did, who you notified about the incident, and chart, chart, chart. That way when they start on you they have to be very careful. But that being said when you start pissing people off you run the risk of being set up. I have been there and it took my a year to prove my innocence. isn't that sick? They tried to ruin my career over drugs that it turned out were never missing. Just be very careful and trust your gut and don't trust anyone that has worked at a facility for any length of time, just do your job and go home. Good luck to all of you.

[squeakykitty]

It was, and I got, eventually, fired for rocking the boat.

This resident is hemiplegic, obese, CHF, COPD, vascular dementia 2 CVA, oriented x1, Hoyer hoist.

Who did you report it to? Is it still happening? It sounds like the resident has problems, and needs a way to call for help. I truly wish the state would do undercover inspections (disguised as a resident or new employee), and don't tell the facility when they're coming. I heard they do that in AZ.

[CapeCodMermaid, RN]

In Massachusetts, we NEVER are told when state is coming....

When my daughter was 3, they had a Halloween party at her school so we both dressed up. She was a fairy princess(of course...now she's 19 and still thinks she's a princess!) and I went as an old man. Everyone there really believed that her great grandfather had come to the party.

What an idea for a new career. Dress up like an old person and get admitted to different facilities to see how they treat their residents!

[marjoriemac, LPN]

I think many dementia residents shout or use the call bell persistently because they want to tell us something and/or they want the company. I believe therefore that continual isolation is abuse in this instance. I do think sometimes people need time on their own but as nurses we should get to know our residents and see what works best in what situation. There is an ethical issue is saying someone is isolated as they upset others - if you isolate the minority to please the majority you are simply prioritising the needs of the majority. It is important to teach all residents that they have equity in the home, no one person has the right to make decisions.