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.
Maybe if the facility's logistics allowed it, and assuming it meets all the fire codes etc., there could be a dining room table or something similar set aside specifically for the residents? Maybe with a laundry basket full of old (clean, of course) washcloths or something for the resident to do? That way the resident can feel comfortable (her right) and the other nurse can get her stuff done, and everybody wins.
It does sound like this nurse was way out of line in talking to that resident, though.
I will admit, LTC & Alzheimers are not my specialties. Just suggesting.
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.
I have to disagree with you here, on several points. It is abuse to treat a resident this way. Calling someone "mean", etc, is verbal abuse. This is there home, and even if she didn't have dementia, she should have the right not to be spoken to in this manner.
Second, your comments about the resident hitting the nurse (it being abuse) bothers me. It really is a part of the disease process when these Pt's are aggressive. They cannot help it. If you really feel this way, do you believe there should be some sort of punishment for the Pt's actions? I just don't get what you are trying to say there.
The nurse, at the very least, needs some education. It might be frustrating not to have a private space to work in, but that is managements problem, not the residents.
As for "personality conflicts", well, nurses aren't allowed to have them with demented elderly that they are there to take care of. I did LTC for a long time, and there were residents that were hard to deal with, but you can't treat them this way. It sounds to me that this resident had a POC that specified what actions to take in this situation,and the nurse did directly the opposite of what the POC was. If she changed Dept's, there is sure to be another resident that she has a conflict with.
I have to disagree with you here, on several points. It is abuse to treat a resident this way. Calling someone "mean", etc, is verbal abuse. This is there home, and even if she didn't have dementia, she should have the right not to be spoken to in this manner.
Second, your comments about the resident hitting the nurse (it being abuse) bothers me. It really is a part of the disease process when these Pt's are aggressive. They cannot help it. If you really feel this way, do you believe there should be some sort of punishment for the Pt's actions? I just don't get what you are trying to say there.
The nurse, at the very least, needs some education. It might be frustrating not to have a private space to work in, but that is managements problem, not the residents.
As for "personality conflicts", well, nurses aren't allowed to have them with demented elderly that they are there to take care of. I did LTC for a long time, and there were residents that were hard to deal with, but you can't treat them this way. It sounds to me that this resident had a POC that specified what actions to take in this situation,and the nurse did directly the opposite of what the POC was. If she changed Dept's, there is sure to be another resident that she has a conflict with.
No, the patient should not be punished at all. Disciplining an Alzheimer's patient will get you what? More trouble. When someone's mind is gone where will reasoning get you? Nowhere. But life is what it is. We are supposed to be all smiley and pat people on the hand and understand. It is not their home but it is where they have to live, so in a sense, yes it is "their" home but by the same token they are not able to care for themselves and function independently and this is why they are in a nursing home. Yes, we are supposed to understand, but when a nurse makes a gesture in frustration (and it sounds like a frustrating situation) everyone wants to pull out the pink slips and discipline the nurse. Mother Theresa had boundaries, I'm sure. Of course, we are there for the patient, we are paid to take care of them and treat them with a reasonable amount of respect, but I have heard so many nurses and aides (and myself) that have said something out of frustration that
if I wanted to run and yell abuse I'd be spending all of my time in the office. I'll bet this woman with Alzheimer's had no recollection of what happened a day later (or maybe a few hours or even minutes). Yes, we are there for them but it is a very hard and trying job to work with A/D patients and if it was so easy everyone would want to do it.
Some A/D patients can be an absolute joy to take care of, and some can be real stinkers.
I've worked private duty nursing with an Alzheimer's patient, and when the sun went down it was hell. The patient would hit and slap the nurse all the while messing all over the floor when the nurse would try to transfer her back and forth from the bed to the chair. She would call names, threaten to sue. First of all, this patient had no business being anywhere but in a facility where many people could take care of her. But the family was adamant that mama wasn't going to no nursin'home (even though they didn't want to lift a finger to help take care of her)
and they were able to find some doctor to write her orders for Medicaid to pay for 24hr private duty care. Actually, I handled it pretty good, because she didn't really try to hit me but one time. You are taught in nursing school not to feed into their delusions and confusion, but this is about the worst advice you can give when it comes to taking care of an Alzheimer's patient. So, rather than get into a big argument which would only make matters worse, I agreed that yes, Pearly went to town and will be back later. This not only satisfied the patient but she forgot about it almost as soon as we started talking about something else.
The problem with trying to give advice on an internet forum is that there is no possible way to truly get the picture of what really went on and the context in which it took place. It may look cut and dry on here, but there are too many variables to make a judgement on a few paragraphs. Yes, it was a innapropriate thing to say any way you look at it, but there are so many other things to take into account. We aren't perfect and frustration can bring out things in all of us we don't normally show the public.
Elvish, BSN, DNP, RN, NP
4 Articles; 5,259 Posts
Maybe if the facility's logistics allowed it, and assuming it meets all the fire codes etc., there could be a dining room table or something similar set aside specifically for the residents? Maybe with a laundry basket full of old (clean, of course) washcloths or something for the resident to do? That way the resident can feel comfortable (her right) and the other nurse can get her stuff done, and everybody wins.
It does sound like this nurse was way out of line in talking to that resident, though.
I will admit, LTC & Alzheimers are not my specialties. Just suggesting.