I have had a resident admitted to my unit that is causing anger and anxiety for my other residents. Many will not come to our dining room because of her behavior. This resident has the DX of Organic Brain Syndrome and Chronic Schizophrenia. She yells constantly with a voice comparable to a Drill Sarg. She is very loud, day and night, causing my other residents not to be able to sleep and they are staying in their rooms, rather than gathering to socialize with each other, because she is so noisy they cannot talk to each other. Many have made threats to hit her and of course, we take her from the area to protect her. We cannot take her to her room, because if this was done every time the behavior was displayed, she would never leave her room. Also, we cannot leave her alone for long because she ties to walk alone and has fallen 3 times in less than a week, in spite of the Nurse Alert alarm and the chair alarm. We have tried various tactics to distract her, such as TV, headphones with a varity of music selections, magazines, stuffed animals to hold, even put her with another resident who has similar behavior and they actually talked for a long while but then she started yelling once she became bored with the conversation and scared the other resident so we will not attempt that again. The other residents will not have anything to do with her because of her constant disruptions to their routine. The MD's are trying different meds but so far no results, we also have a Pysch. consult scheduled next week. The part that really puzzles me is that if you are with her, one on one, she is completely able to converse appropriately, and all of her details are correct. She seems to be totally oriented during one on one converstaions and can go into great detail about her life, both past and present. Nothing we have tried has held her attention for more than a few minutes. I think she will eventually be moved to our Alzheimer's Unit, simply because of her constant disruptive outbursts. I fully admit I am not a Pysch. Nurse, so I am calling upon any of you that can give me some insight and ideas to try as diversions or medications that you have seen used in the past to assist in contolling such behavior. I have never had a resident that I couldn't at least help a little bit and it makes me feel like I am missing something and that I am letting her down. Your input would be greatly appreciated.
First of all, I want to thank each one of you that responded. You are all great folks and I appreciate every idea that was given. I don't want to write a book but would like to make some further comments, regarding the posts. I really liked the idea of one on one, so I spoke to my DON and she flat out said no. I understand that it would take some rearranging of our staffing but if she could have someone 1:1 during waking hours, allowing time for naps and meals, I think it would be productive. I think the reason the idea was nixed was that to do this would be giving her special attention that others don't get so it's like rewarding her for the negative behavior. I understand the reason she said no, but I cannot say I like it. I think it could have had some promise. We tried her on Ativan QID and it did nothing for the behavior. The docs are trying Risperdol now but so far no changes are noticed. I have tried multiple times of sitting with her and just asking her questions, like one post suggested. At times she will deny yelling and at other times she will say she is sorry and within a few minutes, she's yelling again. I really feel she does comprehend to a certain extent. The other night, after several complaints about not being able to sllep from other residents, I went in and pretty much laid it on the line. I told her that the other residents were getting very upset with her and wanted her moved from the unit. I told her I didn't want this but what I wanted wouldn't matter if she kept upsetting everyone. She actually calmed down for over an hour but then started again. When I went in the next time I told her she needed to stop yelling because everyone was trying to sleep and for the remainder of my shift I listened to her yelling, " Make me be quiet, they're trying to sleep. I have to be quiet, they're trying to sleep." I have to tell you all, I'm getting very discouraged. I am coming home with horrible headaches, partly from her behavior and also the other residents reaction to her. I want to badly to make a difference but I know there are times that nothing you do will matter and I'm starting to think this is one of them. I have recommended that she be moved to the Alzheimer's Unit, not because I don't want her on my unit but like many of you said, it's the right thing to do, for all the residents. I have an incident report several pages long every shift on her behavior. I'm not sure when they will move her as the special unit is currently full. I fell like by moving her I am not making a difference, I'm just putting the problem on someone elses shoulder. I appreciate the website that was recommended by "cargal" and it may not help with this lady but could benefit someone else. This is one of the "down sides" to being a nurse, sometimes you wnat so badly to make a difference, but you just can't, no matter how hard you try. Thank you all again for your input and ideas, I really appreciate them all. By the way, HAPPY EASTER!!!!!!
Duckie, that was a very difficult decision to make and after reading your last post I agree that you made the right choice. While this resident appears to have moments of insight and remorse towards her behaviour, she also appears to lack overall insight and I am not convinced that any psychotherapy will have a lasting effect. She requires an environment more conducive to calm behaviour, with attention from a team of nurses who have the special training and resources to deal with this, which your unit cannot offer.
I hope that your recommendation is taken seriously and that this resident is promptly transfered to a more suitable unit. Hope you've had a happy Easter!
Specializes in LTC,Hospice/palliative care,acute care.
Originally posted by Doc:
Duckie, that was a very difficult decision to make and after reading your last post I agree that you made the right choice. While this resident appears to have moments of insight and remorse towards her behaviour, she also appears to lack overall insight and I am not convinced that any psychotherapy will have a lasting effect. She requires an environment more conducive to calm behaviour, with attention from a team of nurses who have the special training and resources to deal with this, which your unit cannot offer.
I hope that your recommendation is taken seriously and that this resident is promptly transfered to a more suitable unit. Hope you've had a happy Easter!
Doc
And won't she wreak havoc in the Alzheimer's unit also? How about a trip to a geriatric psych unit? I am charge nurse on a 22 bed dementia unit and just transferring her to a unit like that(populated by residents whom may be unable to verbalize complaints regarding another resident) is not fair to her or the other residents there.It sounds like meds will be the answer along with an appropriate atmosphere-how often are dementia units calm and quiet?Also-it sounds as though our facility should re-examine their admission procedure-who assessed her in the field and what criteria was used that deemed her appropriate for your unit?We have had a similar problem recently and tried to find other placement for our resident-next to impossible.We have a social worker who frequently goes into the field-unfortunately dementia and psych are not her strong points-she also believes the often rosy pictures families paint for her regarding their "pleasantly confused "loved ones.I am sure that they don't mean to be purposefully misleading-they are just afraid that admission will be denied if they tell the truth about the person's behaviors-but it does not benefit the resident in the long run when they are admitted into an inappropriate unit.Good Luck...
[This message has been edited by ktwlpn (edited April 16, 2001).]
My DON approached her MD about sending her to a psych. unit to see if they could get her behavior under control. He wouldn't order it. Stated she'd only had the med change a few days and we needed to "ride it out" to see if it had any effect on her.
Easy for him to say, he's not the one dealing with the situation. I got a little mouthy with my DON when she told me this and I told her to tell him if he thinks this is so non-important, then he should bring his butt in here and explain to all the other residents why their life is being totally turned upside down. I know she cannot help it but her quality of life has greatly decreased and someone needs to figure out something to help her. I agree with the previous post that sometimes the people assessing potential residents tend to "fudge the report" a little to get beds filled and this doesn't do anyone justice. On the other hand, in this case, I think this resident would have most likely spoken to her as she often does to me and you'd swear there was nothing wrong with her. This one would have been a tough call to make because she can come across as being quite normal in in complete control. Every idea that has been given to me I have tried to act on, maybe the answer will come soon. For her sake, I pray it does.
Not a psych nurse, but just wanted to tell Duckie that I think you're doing a great job by being so proactive. Wow. Uh, can I just say I'm SOOOOOOOOOOOOOOOOOOOOOO happy I don't do psych? Yikes!! Hope it gets better for you Duckie. Chin up. You're doing a good job and TRYING to do the right thing, even if no one else is.
Well it seems that persistance has won out, thank the Lord, and we finally obtained the order to admit her to a psych. unit for total evaluation. The point I kept repeating was that sending her to the Alzheimers unit would only remove the problem from our unit but it would not change the quality of her life any. I was off the weekend and the float nurse that worked my unit continued the ball I had started rolling and took it upon herself to speak with this womans's son when he visited, even allowing him to read documentation of her behavior. ( he is her POA, so no breach of confidence committed) He was very receptive to anything that would help his Mom and within a couple I days I think they will transport her. I wish it was ASAP but we all know how slow the wheels can turn. I feel very blessed that the float nurse worked with me in this mission, that's the true meaning of TEAMWORK. I do not know how successful this will be but I personally feel she will be in better hands of those trained to deal with her DX, and so now I can sleep peacefully, knowing I really did do all I could do for her. She started doing something different today. I worked 9 hours and she yelled the entire time but this time, she kept yelling at "Jane". That is her name. I asked her why she was yelling at Jane, because there was no one but her around that had that name and she said, "Because I want her to hear me." I'm not sure exactly what she meant by this but I swear at times it seemed like two different people talking. A couple of my CNA's said the same thing. I've never dealt with anyone with multiple personalities but I'm starting to wonder if this could be possible. Maybe I'm all wet on this one and it could just be the other DX she has. Anyhow....I want to thank all of you for your ideas, words of support and encouragement. I have been getting pretty down over this and just couldn't stop worrying about her. The things you all posted kept me going and I think it helped me to be a little more aggressive in my determination. Maybe being a pain in the butt has it's advantages if used properly! LOL This may not be a miracle cure, but I do believe in miracles so you just never know. I will say one thing though, those of you that do work Psych, my hat is off to you for you truly are special. This little lady challenged me and my staff but hopefully once in the hands of those who are specifically trained to deal with this, her quality of life will improve. Thanks again and God Bless.
There are lots of good suggestions here. What I don't see is any mention of her baseline personality. Does she have any family that you can talk to about what she was like before she decompensated? Maybe she has some personality traits that are magnified by her dementia. I will be interested to see the results of the Risperdal. In my experience, it's not very effective. A visit to the geriatric psych unit sounds like the next best step. You've done a good job.
Yikes!! Hope it gets better for you Duckie. Chin up. You're doing a good job and TRYING to do the right thing, even if no one else is.
duckie
365 Posts
First of all, I want to thank each one of you that responded. You are all great folks and I appreciate every idea that was given. I don't want to write a book but would like to make some further comments, regarding the posts. I really liked the idea of one on one, so I spoke to my DON and she flat out said no. I understand that it would take some rearranging of our staffing but if she could have someone 1:1 during waking hours, allowing time for naps and meals, I think it would be productive. I think the reason the idea was nixed was that to do this would be giving her special attention that others don't get so it's like rewarding her for the negative behavior. I understand the reason she said no, but I cannot say I like it. I think it could have had some promise. We tried her on Ativan QID and it did nothing for the behavior. The docs are trying Risperdol now but so far no changes are noticed. I have tried multiple times of sitting with her and just asking her questions, like one post suggested. At times she will deny yelling and at other times she will say she is sorry and within a few minutes, she's yelling again. I really feel she does comprehend to a certain extent. The other night, after several complaints about not being able to sllep from other residents, I went in and pretty much laid it on the line. I told her that the other residents were getting very upset with her and wanted her moved from the unit. I told her I didn't want this but what I wanted wouldn't matter if she kept upsetting everyone. She actually calmed down for over an hour but then started again. When I went in the next time I told her she needed to stop yelling because everyone was trying to sleep and for the remainder of my shift I listened to her yelling, " Make me be quiet, they're trying to sleep. I have to be quiet, they're trying to sleep." I have to tell you all, I'm getting very discouraged. I am coming home with horrible headaches, partly from her behavior and also the other residents reaction to her. I want to badly to make a difference but I know there are times that nothing you do will matter and I'm starting to think this is one of them. I have recommended that she be moved to the Alzheimer's Unit, not because I don't want her on my unit but like many of you said, it's the right thing to do, for all the residents. I have an incident report several pages long every shift on her behavior. I'm not sure when they will move her as the special unit is currently full. I fell like by moving her I am not making a difference, I'm just putting the problem on someone elses shoulder. I appreciate the website that was recommended by "cargal" and it may not help with this lady but could benefit someone else. This is one of the "down sides" to being a nurse, sometimes you wnat so badly to make a difference, but you just can't, no matter how hard you try. Thank you all again for your input and ideas, I really appreciate them all. By the way, HAPPY EASTER!!!!!!