Need help, is this verbal abuse?

ann945n, RN · Mar 14, 2007

I work in an Alzheimer's unit; I'm a CNA. We have a resident that has to be approached just so, or she gets angry. An example of a typical good approach is: "Hi X, how are you today? Would you like to come for a walk with me? I really enjoy your company." After that, she is usually 95% compliant. However, if you demand of her, scold her, etc, she will get angry and very non-compliant. We had an inservice on her yesterday regarding this.
We have a nurse who doesn't like this resident at the nursing station (on our floor, it's just a dining room table with chairs). However, X, who was always a homemaker, per her chart, is really comfortable there. She doesn't mess with anything, other than maybe to try to wipe the table. I was coming out of another resident's room, and saw X heading to the nurse's station. I tried to get to her first to intervene, because this nurse does have a habit of approaching X wrong. This is how the conversation went:
nurse: X don't touch that!
X: I just want to sit down.
Nurse: NO! This is my place and my things, go away!
Ok, so I'm literally between these 2, trying to verbally seperate them. At this point, the res tries to pull out the chair to sit in it. The nurse yanks the chair away from her, the res reaches out and slaps the nurse. THE nurse then scolds her on why hitting is wrong and how she is a mean lady. Now, this patient has Alzheimer's, so maybe doesn't really know better, and, imo, she was provoked. The nurse then told another nurse how mean X was (this nurse had just walked on the floor), as I was walking X down the hall, having finally calmed her down and removed her from the situation.
I was up all night crying over this; I'm sick. I suppose I know it's verbal abuse, but I feel I need support.

I worked in a alzheimers unit for about 2 years as a CNA before heading to school. We had a few residents as well that had to be talked to and approached in just the right way. We would train the new cna how to deal with them and tricks to get them to do what we needed and not get into arguments. I dont think its unreasonable for your nurse to do the same with this resident. I think its part of the disease at least it was common for me. We had one resident if not talked to in just the right way he would try to hit you, if you just calmly steped back and said why would you hurt me? he would get all teary eyed and appologize with a hug. I would go to your nurses suprivisor privately and say that there has been some issues with resident X having problems with some of the staff and you havent been able to resolve it with your nurses (if that is the case) I would do your best to keep the nurse and resident x apart as much as you can and if you find them fighting again try to redirect resident x to another activity, something like i need helping setting up the dinner table or something else she likes to do. If your nurse isnt open to sugestions i would go hirer up. maybe say something to the nurse, "next time resident x comes into your space will you just come and get me and not confront her? when she gets worked up its really hard for the staff to calm her down so if i can get her out of your hair before you both get upset it would be easier on me!" hope that helps

fultzymom · Mar 14, 2007

I think it was most certainly verbal abuse. If you know that resident has certain behaviors, you try to redirect them, not provoke them et then yell at them for it. That is just part of managing Alzheimer's. We have a nurse who will say (after being asked for the 50th time by an Alzheimer's patient) "I just told you the answer to that! Why are you asking AGAIN?" I think that is verbal abuse. She is berating them for something that they can not control. Of course they are going to ask something 50 times! They do not remember. It sounds like your nurse needs an inservice on Alzheimer's et dealing with the behaviors or maybe she needs to work another unit.

Leslie

jamato8 · Mar 14, 2007

I agree with the statement above. No, it was not right to treat the resident that way and it is a type of abuse. I could not work in the type of unit you are in though I get many pts like you describe do to our aging society. It is part of my job to help them, provide them with a safe invironment and treat them with respect. If I can't do that then I better get a different postion or job.

stamidg · Mar 14, 2007

Thanks everyone. I go to work at 2, and I will stop by the DON's office and report this. I am really struggling with my emotions right now. I am SICK over this, and, well, a little scared.

jill48, ASN, RN · Mar 14, 2007

YES IT IT VERBAL ABUSE AND IT SHOULD NOT BE TOLERATED! I don't know if that other nurse is burned out, or if she is just an evil witch, but this is not acceptable. I know you are hurting over this because you cried all night. But deep down I think you know you have been put in a bad position because YOU are going to have to do something about this. Just keep in mind these two things: 1. Did we become nurses to take care of other nurses and protect their backs, or did we become nurses to take care of people who cannot take care of themselves. 2. Would she speak to the patient like that in front of the patients family? Then she is not doing the right thing. But I know you can. It's going to be hard, but when it's over, you will feel alot better because you did right by your patient. Good luck.

suespets · Nov 29, 2007

remember to document, document,document if possible before going to d.o.n. et al. hopefully,you won't both be working together after this,but you know what you have to do,if you know this is a personality thing w/ nurse & res. Iagree w/ trying to keep them apart,or telling nurse you can help w/ the problem,but your not always there working,right? let me know how it goes,ok?

Liberty Bellpn · Nov 29, 2007

Yes it is.

And "scolding" is not only unacceptable, it's futile; dementia patients don't respond to reasoning or "reality orientation"-- I do think they respond to tone and that tone is demeaning.

Verbal abuse can be as innocent as saying "no, no" to a resident. It's undignified and improper, yet I hear it all the time. Glad you ran interference in that situation.

The only thing I do agree with is not having the resident behind the nurses station. I see that all the time too, but there are other ways of managing close supervision.

Jo Dirt · Nov 29, 2007

nurse: X don't touch that!
X: I just want to sit down.
Nurse: NO! This is my place and my things, go away!
Ok, so I'm literally between these 2, trying to verbally seperate them. At this point, the res tries to pull out the chair to sit in it. The nurse yanks the chair away from her, the res reaches out and slaps the nurse. THE nurse then scolds her on why hitting is wrong and how she is a mean lady. Now, this patient has Alzheimer's, so maybe doesn't really know better, and, imo, she was provoked. The nurse then told another nurse how mean X was (this nurse had just walked on the floor), as I was walking X down the hall, having finally calmed her down and removed her from the situation.
I was up all night crying over this; I'm sick. I suppose I know it's verbal abuse, but I feel I need support.

Why were you up crying all night over this???

No, the nurse should not be reprimanded (unless she was setting up a scene where she could provoke the patient and cause a ruckus). The woman may have Alzheimer's but in this situation you can't protect her rights without trampling the rights of others. Slapping the nurse is abusive, I don't care how out of their mind a person is, it is still abuse. But you know what? Abuse is a part of life. Anytime a situation arises that makes someone uncomfortable people start yelling abuse. To me, this catch-all term minimizes what real abuse is. Like the 87 y/o bedridden woman beaten to death by a nurse aide (yes! it's true!) with brass knuckles.

One thing I cant understand, if the nurse really does not like this patient personally, why can she not switch departments?

If this is all there was to the exchange that took place there was no abuse. It just seems like a personality conflict between the patient and the nurse which could be remedied by moving one or the other somewhere else.

Altra, BSN, RN · Nov 29, 2007

I realize this is an old thread ...

I agree that the nurse described in the OP is not acting in a professional manner or one that reflects knowledge of the care of dementia patients.

However, I also sense that nurse's frustration. Care of people who are unable to respect physical boundaries is difficult. The physical environment of the unit also sounds problematic, if the only place to work is a table in an area easily accessible to all. I can picture myself being on edge if I did not have a place to place papers & a drink without interference.

IMO, the nurse needs a sit-down with her supervisor for some frank talk about better ways to interact with residents, evaluation of whether or not any improvements can be made to the physical layout of the unit to make a better work environment for the employees, and possibly discussion about whether she is suited to this particular position.

barefootlady, ADN, RN · Nov 29, 2007

This is a sad situation for all involved. I agree this is verbal abuse, but I do think the nurse needs a better area in which to do chart work. A meeting with the DON and Administrator is needed and soon.

defeatedcreek · Nov 29, 2007

I realize this is an old thread ...
I agree that the nurse described in the OP is not acting in a professional manner or one that reflects knowledge of the care of dementia patients.
However, I also sense that nurse's frustration. Care of people who are unable to respect physical boundaries is difficult. The physical environment of the unit also sounds problematic, if the only place to work is a table in an area easily accessible to all. I can picture myself being on edge if I did not have a place to place papers & a drink without interference.
IMO, the nurse needs a sit-down with her supervisor for some frank talk about better ways to interact with residents, evaluation of whether or not any improvements can be made to the physical layout of the unit to make a better work environment for the employees, and possibly discussion about whether she is suited to this particular position.

I sense her frustration, too. But it's also verbal abuse and entirely unjustifiable.