My Impossible Resident

lovingtheunloved, ASN, RN · Oct 5, 2005

You are definately right about being professional, and I agree that there are all types of people, but being an aide, spending 3/4 of 8 hours a day in that room with someone who is abusing your care one minute, and screaming for you to come to her rescue the next minute, you just can't help but feeling a little more than "professional". Yes, I am a very professional person, but it takes more than going by the book to get through to people-that is, if you really put your heart in what you do. After you lose touch with "what it's really like" to hear a patient crying for long periods of time, or screaming out, or pouring their hearts out to you, all you do is get report that that's what is happening. You don't have to deal with it but us aides do. I know that passing pills and doing paperwork is stressful, but do you think our job is a walk in the park? It's easy to instruct your aides to act in a way, but if they are good, they'll be just a little more than "professional". Thank you for your thoughts.

Oh, PLEASE don't start the nurse's job v. the aide's job. It's been hashed to death already.

Kitkat23 · Oct 5, 2005

kitkat23
I had a patient in LTC that was much like your patient. I was a nursing assistant and had this little lady who no one wanted to give her shower, get her ready for bed or as little as possible for this lady. I was a brand new na/r and was ready to jump into my job and make everyone in LTC better. Any way I started out with this lady and like you it would take me 40 minutes to get her bath in the beginning. You stated that now she gets about 10 minutes for her bath. I know how busy you get but don't you think 10 minutes is a little rushed. It takes that long to get their clothes on and off. Any way I am rattling. It took a lot of doing but I finally made friends with this older lady and learned a great deal about myself in the process. I have only one suggestion I hope it works for you because it did work for me. I began by setting aside at least one bath during the week (she got one every other day) in which we did not rush through the bath. I found out that she liked a certain scent of bath soap and used that on the special bath day. She also got a good rub down after getting out of the bath(legs, feet, back, and arms). Then her favorite pj's and robe. It wasn't long until these special bath days were the days or evenings when we began sharing things about our lives. I learned alot about the difficult old woman that no one else took the time to know. She died on day and I was their with her rubbing her favorite lotion arms and legs. I found myself even spending time with her when it was my day off. I know you are thinking that you do not have time for this. I guarantee you that you do somehow the time just seems to be there once you get started. If you want to know more feel free to pm me.

Hi there. Actually I do her showers in 20 minutes. I guess I was exaggerating. She's a minimal assist. She can get undressed, but needs help with her socks, shoes, and pulling her pants and pullups off. I have to supervise her when she can get into the shower chair. She's not a fancy woman, she only wants a tiny bit soap and shampoo, and she hates lotion. I had offered to give her lotion since her skin is dry but she complains it's sticky and makes her feel unclean. She loves hot water and scrubbing herself till she bleeds. I worry because she's so fragile and caused herself some skin tears. I do what she tells me, but I learned to get her early so I wouldn't go nuts putting in my other patients.

I'm not trying to be mean and rush her, but she's clean enough; she'll tear her skin up. Tuesday night is a busy night for showers and we have only one shower room. I try to start conversations with her and ask her about her family and interests, but she just glares at me or makes bitter remarks. I'm not God and I can't reach out to everyone. She never smiled, but I know how she feels giving up her house for a small room and a hall full of nutty patients and lack of privacy. I agree with Michelle. :cool:

casi, ASN, RN · Oct 5, 2005

I can't even being to fathom the amount of loss these people feel when they enter a nursing home, or even assisted living facility (where I work as an aide). Ofcoorifice some of them are going to miserable, especially if the are still young. Being 47 and being put in the old folks home has to feel very demeaning and frustrating.

There are a couple of things I do when I have a difficult resident: 1. help put them in charge and 2. trying to imagine what it's like being them.

When I first startted my job, just about every aide warnned me about Emily. Emily will eat the new aides alive. The way they talked about Emily was she was the biggest scariest lady you ever met. When you saw she she was the exact opposite. A very strong willed woman who barely weighted 85 and had to depend on people for much of her personal cares. The first thing I did was put her in control. "Emily, I haven't worked with you before, so if I do something wrong, I need to know. I want to try and do this the way you like." Simple as that. She didn't demand anything spectacular, she just wantted me to transfer her slow, or make sure I repositioned her right. I was one of the few new aides that had no problems with her.

Then trying to walk in their shoes. Your resident is trying to lose weight. Of coorifice she is going to think your starving her. Think of what she is use to eating and when you restrict that, she's going to feel hungry, and she's definately going to feel out of control. She's 47 and her parents are now making all of her decisions. I would just try and be encouraging, but not push things on her. Don't offer advice or critique her personality. Just be there.

SierraC · Oct 5, 2005

I can't even being to fathom the amount of loss these people feel when they enter a nursing home, or even assisted living facility (where I work as an aide). Ofcoorifice some of them are going to miserable, especially if the are still young. Being 47 and being put in the old folks home has to feel very demeaning and frustrating.
There are a couple of things I do when I have a difficult resident: 1. help put them in charge and 2. trying to imagine what it's like being them.
When I first startted my job, just about every aide warnned me about Emily. Emily will eat the new aides alive. The way they talked about Emily was she was the biggest scariest lady you ever met. When you saw she she was the exact opposite. A very strong willed woman who barely weighted 85 and had to depend on people for much of her personal cares. The first thing I did was put her in control. "Emily, I haven't worked with you before, so if I do something wrong, I need to know. I want to try and do this the way you like." Simple as that. She didn't demand anything spectacular, she just wantted me to transfer her slow, or make sure I repositioned her right. I was one of the few new aides that had no problems with her.
Then trying to walk in their shoes. Your resident is trying to lose weight. Of coorifice she is going to think your starving her. Think of what she is use to eating and when you restrict that, she's going to feel hungry, and she's definately going to feel out of control. She's 47 and her parents are now making all of her decisions. I would just try and be encouraging, but not push things on her. Don't offer advice or critique her personality. Just be there.

i agree..can you imagine to walk in their shoes? I think the most valuable skill that I learned as a CNA was to just put myself in the place of another. I remember this one pt i had...traumatic brain injury...20 year old..car accident...very combative...I told him it was Mothers Day and his face lit up...called his house...his mom answered and he said "dad happy mothers day..i love you"but it was just so sweet the way he said it ..his mom and I ended up talking and crying on the phone.

Antikigirl, ASN, RN · Oct 7, 2005

You are definately right about being professional, and I agree that there are all types of people, but being an aide, spending 3/4 of 8 hours a day in that room with someone who is abusing your care one minute, and screaming for you to come to her rescue the next minute, you just can't help but feeling a little more than "professional". Yes, I am a very professional person, but it takes more than going by the book to get through to people-that is, if you really put your heart in what you do. After you lose touch with "what it's really like" to hear a patient crying for long periods of time, or screaming out, or pouring their hearts out to you, all you do is get report that that's what is happening. You don't have to deal with it but us aides do. I know that passing pills and doing paperwork is stressful, but do you think our job is a walk in the park? It's easy to instruct your aides to act in a way, but if they are good, they'll be just a little more than "professional". Thank you for your thoughts.

Believe me...I know exactly what you are talking about! I may be an RN by license...but do as much as possible while I am there to help out my patients and my care team! My CNA's are awesome...and I couldn't make it without them, and they couldn't make it without me! We are a team, and I am privilaged to work with such wonderful caring ones who get along with all staff members and patients (very family feel).

But some times I have to remind my fellow health care team members that there is an emotional line you need to be aware of! If not, you take it home and suffer...I know, I have done it far too often! The patients get into your heart and soul...that can't be helped, but there are times when you must be a little forward and say "I am here to help you, if you are having difficulties with my service, I will have you talk to the "nurse" or "administration"."

Oh believe me, I know that only works at most 10% of the time, but if done correctly by having ALL staff come together with a plan like this (or others)...it tends to increase odds!

If not, usually I go in and talk to the resident...a actual sit down for discussion with a representitive of the Administration! I am sympathetic to the resident, but very very proactive for my staff! Without them, the residents or health staff would be in dire trouble!!!

BTW...not only does my CNA/Unlicensed caregivers tend to 15 residents for all care needs/ADL's/Transfers/simple dressing changes/feeding/tolieting/etc...they do all medication administration (except injections). They do all ostomy care as well. I can't believe how wonderful dedicated the staff is...if I was a CNA and heard the list of how many and what I had to do day after day I would have been scared right out of there (as most new hires do).

I have a great team! Love them lots! And so I help out with all their duties, and my own, and counsel/advocate for them as well!

One time I posted a very unique way of dealing with one of my most argumentitive patients...I was down to earth, and very bold with this resident (which was what this particular resident needed)...and I got burned on here for being 'unprofessional' by many a nurse, but the CNA's understood that I wasn't being 'unprofessional' just realistic in patient/staff expectations..they agreed! That felt wonderful, and I keep with that :)...to me it isn't CNA vs RN...it is team helping resident/patient that is the bottom line :).

I find dealing with difficult patients is hard, but if you step back...try to let emotion take a back seat for a moment...think of things realistically and logically...then add the emotional..things actually come out okay (that is if someone actually listens to your ideas..LOL! We all know that one...).

bethin · Oct 8, 2005

I think your resident is very angry. Angry at God for the CHF and diabetes, although her obesity doesn't help the problem and that is something she can control to an extent. When I was first diagnosed with Crohn's I felt like everyone and everything was against me. I would sit at home and pity myself. I definitely think your resident needs a psych eval. She sounds depressed. When I have to deal with an angry pt. I ignore what they're saying and comment on the pretty weather or how nice their hair looks. And sometimes I just walk out of the room (I make sure she's safe and decent--I don't leave them half naked). She says that you are the only one that can take care of her--that means something. She likes you even though she has a strange way of showing it. Even though she may have been nasty when she said it. I think (and I'm no psychiatrist) that way down deep she is frustrated by her condition. She feels that it is such a looong uphill battle to lose weight that she doesn't think it's worth it. You need to show her that it is worth it.

Good Luck! :)

I posted a similar thread in the psychiatric forum but I got 0 replies. After thinking about it, I guess I should have put it in here.
I work in LTC as a CNA. I take pride in my work, and the nurses and "higher ups" are always telling me that I deserve more recognition for the great job that I do. I was employee of the month in August-finally!, after two years of service, and my regular residents are so happy to see me after I come back from my day off.
I have the same assignment every day, and I love knowing my residents well enough to know what they like and dislike. I also love to hear their family members compliment me on my techniques and such. But.....I have one problem. She is a very large woman, not quite 5' (with tape measure), weighing in at about 365 lbs. She cannot walk, or even stand, refuses to get out of bed even for her twice-weekly showers, and she is the meanest 47 year old woman I have ever met in my life. She came to my facility probably about a year ago and I was warned about her, but I was determined that I was going to make friends with her and reach the goal of helping her lose the weight so she could have therapy and learn to walk again. Her parents are her POA, and she treats them just as bad as she does us. She screams and swears every day, and all night. Her only focus in life is food, food, and more food. She says we are trying to starve her because she is on a restricted diet, and also just recently fluid restriction. She still gets plenty, but whatever she can't have, she wants, and she wont stop screaming and throwing tantrums until she gets what she wants. She has hit two of my fellow aides, and has been verbally abusing everyone that walks into her room ever since she first came there. I have tried talking heart to heart with her, but she is just the nastiest thing. Nobody has ever met anyone like her-guaranteed. I just can't explain here what it's like to try to care for her; she is in her right mind but calls us every name in the book if she doesn't get her way. She throws things at us and belittles us. She is always telling others that the only one who knows how to take care of her is me, but then, when I come back, she treats me like sh*t. I don't want to give up on her, but I need to get through to her somehow. Not very often, but once in a great while, she will get sensitive with me, but whenever I try to offer advice, or suggest that she may be treating her caretakers badly, she gets offensive and tells me to get out. She is scared to die, but isn't willing to try to get any better. She thinks that because she is diabetic and has CHF that she just can't get better, but she uses all this as an excuse for not trying. I don't know if you all have any suggestions, but if you do, I will take anything I can get. Tomorrow is shower day!! And I know I will have to fight with her to get up!! And she is getting up. Thanks for giving me a place to vent anyways!!