Patient who is on his call light every 3-5 minutes ALL night long

[hollyberry678]

This is a chronic patient, lives at a group home, came into hospital with vague complaints. Complaining about the "lazy ED nurses" and all other staff in general. on his call light ALL night long, wanting to be repositioned every 5 minutes, have the water on bedside table dumped, just anything. Told another staff person he was "dumb" when the staff person who didn't hear his request asked "Can you say that again?".

What is the best way to handle this patient?

Patient did receive pain meds for c/o discomfort.

[MomRN0913]

I usually tell such a patient that I will not be returning for another half hour unless there is an extreme emergency, so if there is anything else you need, tell me now.

[CompleteUnknown]

Patients like this are very challenging to care for, to say the least. If he lives in a group home there has to be some sort of mental or physical disability so you can't expect him to be as 'reasonable' as the average patient and often these patients have very poor memories. Sometimes they're scared or lonely as well. Not a great combination!

I've had the most success by spending as much time as I possibly can with the patient near the beginning of the shift making sure that every detail I can think of is taken care of, and using this time to talk to the patient and try to get to know him as much as I can. Then, I say I'll be back to check on you in 30 minutes or whatever time I'm fairly sure I can get back. Then I go back when I say I would (barring emergencies and the like of course). I say 'just checking that everything is okay, do you need anything?' Spend a few minutes with the patient doing whatever or just talking. Say again I'll come back in 40 minutes and make sure I do, or before if at all possible. Rinse and repeat all shift.

I also go to the room as often as I can when the patient hasn't called and say 'just thought I'd see how you're doing' or something like that. The idea is to stop the patient thinking he only gets attention when he calls, it's so tempting to stay away if he hasn't called for a while but I find this to be counterproductive. If the patient calls to have his tissue box moved, I'll say from the doorway 'yes I'll do that soon, remember I said I'd be back in 30 minutes?' and then make sure I go back and move the tissues.

I find that this approach works often enough to make it worthwhile and if the patient realises he can believe what you say he'll hopefully relax enough to stop calling constantly and maybe even go to sleep. No, I don't have enough time to spend 20 or 30 minutes with the patient at the beginning of the shift but I certainly don't have enough time to be running to the room every 5 minutes all night either.

[Poi Dog]

Where I work we have a perfect solution for these patients. They get plunked in a geri chair/wheelchair and parked at the nurses station, sometimes in behind the station. You want to be up all night and have constant attention? You got it.They whine about wanting to go to bed they get told to stop ringing the bell and GO TO SLEEP.

I love the way you worded your post

[Florencebyondthepale]

Where I work we have a perfect solution for these patients. They get plunked in a geri chair/wheelchair and parked at the nurses station, sometimes in behind the station. You want to be up all night and have constant attention? You got it.They whine about wanting to go to bed they get told to stop ringing the bell and GO TO SLEEP.

You do this with alert and oriented patients? How do you initiate it with them? I have only done it with disoriented patients who are screaming out or constantly trying to get out of bed.

[loriangel14, RN]

Oh yes. Alert and oriented is the best. They know darn well why they are out there.

[mskate]

- Anticipate their issues as much as possible. When I walk into a room for the first time I have a pitcher of ice, a pitcher of water, a juice, a few cups, a few straws, a fresh warm blanket, etc... so they have fresh water and ice chips. If they drop a cup, theres another, if they lose a straw, theres another.

- Before I leave the room I say "I am going into see MY OTHER PATIENTS now. Is there anything else that you will need in the next hour before I go into their rooms and take care of them? its important to me that all of my patients get the help that they need so I am not going to be able to come in here again for an hour. (unless there is a huge emergency.) I will come in and check on you at 9pm. (Specify the time). So what can I get you NOW that you will be settled until THEN?"

- When they inevitably push the button 5 minutes after you walked out having the above speech, I usually will have another nurse co-hort go in and say "I know your nurse JUST LEFT THE ROOM and she told me she made a point to get you everything you needed. She isn't going to be back in here until 9. Whats wrong that she wasn't able to do 5 minutes ago?" or something to that effect. It reminds him, again, that you are busy - and its not YOU that comes back when you said you wouldn't and reinforces the limit setting.

- I have no problem telling people that I have other patients too. Their concerns matter to me and I will take care of them, but that they need to group their needs together because I have to be able to help other people as well.

- Document it all. All of it.

- Let a supervisor know about the problem and if you work charge, try to make sure the same nurse doesn't have that room 2 nights in a row.

[crb613, BSN, RN]

Unplug it??

[KareBear0609]

Hide the light.... I mean......

[loriangel14, RN]

Hide the light.... I mean......

Tempting but unethical.

[chevyv, BSN, RN]

Apart from hiding the light, I usually have a candid discussion with that type of pt. No matter what you do, it's never going to be right or enough. I then talk with my coworkers and ask them to help out. Most are okay with it. That is the pt that is very difficult to like for long. It's a good thing we get to go home eventually. That's when they usually sleep for the day like they're waiting to see you again when you come in, lol.

[joanna73, BSN, RN]

Even though you may feel like taking their bell away, we cannot do that. If something were to happen, we are at fault. They can't be told not to ring, either. I have a pt who rings constantly sometimes. We walk back and forth. I usually say to her, "if you can't sleep, perhaps you might want to get up for a snack?" She nicely gets the point and this approach sometimes works. Other times...I get lots of exercise :)

[Ev1987]

If it were me, especially if he was being nasty and calling staff members by derogatory names I would call him on his crap, but nicely of course!

Here's what I would say:

"Mr. So-and-So, As for calling staff members names, it will not be tolerated. It is rude and disrespectful and I will not stand for it. Don't let it happen again!"

Please remember that I would never just say these things to be mean to a pt, but if a pt is calling me or another staff member names or swearing at us, I don't let it go. It's ridiculous.

Awesome! I wish my assigned nurses would stand up for me like that when the residents are calling me every name in the book. :redbeathe:heartbeat