Residents up all night!!

dekatn · Oct 10, 2006

If she is awake anyway, have you tried getting her up and giving her some type of activity to keep her busy enough that she won't think about the bathroom as often. She may have been a night shift worker and just be used to staying awake at noc. We have a little lady like that, she is a nurse, worked night shift in the hospital for 30 yrs. Now, she spends her nights with us. We have given her paper and let her "chart" on pts. Her cognitive status is diminished, but she can still tell us a lot about her "days" as a nurse. Just a thought. You might try it.

ktwlpn, LPN · Oct 10, 2006

This is becoming a bigger and bigger problem, and I'm not sure what to do about it.
First, I had the 'wanderer' who would get up as soon as nite shift came on - days swore she wasn't sleeping during the day, but I've seen and heard differently.
Now I have a LOL who is up all noc - on the lite to go to the BR. Last nite she was up 10x - we finally started to keep track. She's too fragile to let go by herself, so she needs assist. She told the aide last nite that she doesn't sleep, so when she's laying there awake, she can't remember if she's gone or not. Her roommate told us that she sits in her chair and sleeps all day.
We also have two others who get up at different times, and when they're all up at once, it's wild.
The problem is, there are only two of us, myself and 1 aide for up to 40 patients at night, and some nights we can't get anything done, because we're busy just trying to deal with call lites and these gals. Then we're into OT trying to do paperwork.
Is this the way other places do it? Aren't they supposed to be getting them involved in activities?

In a perfect world they would be busy during the day.Sadly we can't drag them to activities and our activity staff seem to spend more time doing paperwork then they do actually on the units with the residents.As the population in LTC gets younger it's more of a challenge to find activities that appeal to all-you can only play so much bingo,you know? As for your wanderer-it is not uncommon for those with Alzheimer's and other related dementias to get their days and nights turned around.In my experience there is not much that can be done and this is often the last straw prior to these people being admitted to LTC.The best you can do is make sure they get adequate nourishment and hydration when they are awake because waking them up for meals during the day often brings another set of problems.She really belongs on a secure unit with others like her..Your "10 x's a night tinkler" may have a UTI-I'd rule that out and also obtain a uro consult.It may be something easily remedied with a little detrol or ted hose and lasix .Continue to make sure she gets up to empty her ballder and does not use a bedpan.I would consider a bowel and bladder program also-explain the rationale to her and start with q 1 hr and work from there...Also-if she is not going back to sleep give her a drink and a snack and keep her up for a bit.Maybe that will tire her out...Don't you love the staffing on NOCs? Some people really believe that the residents actually sleep.. (had a fella that peed 10 drops seemingly q 10mins through the night-he had dependent edema and it had to go somewhere when he got in bed-HCTZ and ted hose did the trick and none too soon-I think the staff and his roomate where ready to hold a pillow over his head-he is blind and wanted the urinal emptied after every squirt because he did not want to spill it in the bed)

lovingtheunloved, ASN, RN · Oct 10, 2006

If they're night owls, let them stay up. Feed them, find them something to entertain them. Just because we think "it's night time, they need to sleep" doesn't mean they should.

marjoriemac, LPN · Oct 11, 2006

We had a lady who used to buzz all night for the toilet too, she always said she 'thought she needed to go to the toilet'. Never actually went though and never had the same problems during the day. I think she was awake at night and lonely and this was the only excuse she could think of to bring staff to her room. Its pointless to keep somebody in bed who is awake and mobile, continuously getting out of bed will just increase the risks of falls. If they cannot be more active during the day, try allowing them to participate in meaningful activity at night - they may just want to do one thing before going to sleep. I have had night nurses complain to me before about allowing residents to sleep too much during the day - what do they want me to do pull their eyes open!

Oh, we did have a lady once who wanted company at bedtime. The only way we could get her to sleep was to sit with her and pretend we were asleep, creeping out after she fell asleep. Took time but all in all it was better than having her wander in and out of other peoples rooms all night! :idea:

adrienurse, LPN · Oct 11, 2006

sounds familiar. Has this LOL been tested for uti's? Just checking. We have "Bed exits" here, which are sensors that tell us when the people who are "not with the program" get out of bed at night. Sometimes these are a blessing and yes sometimes these are a curse for the ones with tiny bladders who need to pee every 30 minutes. But what are you going to do? Maybe giving her a commode at the bedside could let her transfer herself safely and have a little independance at the same time.

adrienurse, LPN · Oct 11, 2006

I have had night nurses complain to me before about allowing residents to sleep too much during the day - what do they want me to do pull their eyes open!

Yeah, gotta love that. Do they want us to sit next to them and give them a poke every 5 minutes to keep them awake? :trout:

Sadly the name of the game with the confused has to be individualized care. That means if Hazle and Esther need to say up all night, that's what they have to do.

banditrn · Oct 11, 2006

Yeah, gotta love that. Do they want us to sit next to them and give them a poke every 5 minutes to keep them awake? :trout:
Sadly the name of the game with the confused has to be individualized care. That means if Hazle and Esther need to say up all night, that's what they have to do.

Unfortunately, at nite, we don't have the staff that they have on days - it's one thing to not be able to keep them awake, but they just put them in a chair and let them sleep, it seems like.

Yes, I should have mentioned that UTI has been ruled out. And we take her to the BR to go.

It would be great to be able to have time to involve these people in meaningful activities at noc, but we're too busy trying to keep all of them turned and dry - and with me, it's all the paperwork I do at noc. So, I guess, yeah, wake them up when you see them snoring during the day.

CapeCodMermaid, RN · Oct 11, 2006

If she is awake anyway, have you tried getting her up and giving her some type of activity to keep her busy enough that she won't think about the bathroom as often. She may have been a night shift worker and just be used to staying awake at noc. We have a little lady like that, she is a nurse, worked night shift in the hospital for 30 yrs. Now, she spends her nights with us. We have given her paper and let her "chart" on pts. Her cognitive status is diminished, but she can still tell us a lot about her "days" as a nurse. Just a thought. You might try it.

Excellent advice. We had a woman who was a nurse for years...NEVER slept at night at home or at the facility. Sleeping meds made her a huge risk for a fall so we gave her some fluids, a snack, and head phones for the TV. She eventually went back home, and was thrilled that we were didn't try to make her fit our schedule. She wasn't demented (well, not TOO demented!) but....

banditrn · Oct 11, 2006

Excellent advice. We had a woman who was a nurse for years...NEVER slept at night at home or at the facility. Sleeping meds made her a huge risk for a fall so we gave her some fluids, a snack, and head phones for the TV. She eventually went back home, and was thrilled that we were didn't try to make her fit our schedule. She wasn't demented (well, not TOO demented!) but....

Capecod, this worked somewhat when we only had two or three doing it - now we have 5 (no. 6 recently passed away). With only two staff. Plus 33 other residents to care for.

We give them a snack when they get up, and try to give them something to do, but it's having someone keep an eye on them!! The other nite I almost had heart failure when 'the wanderer' took another demented LOL for a 'walk' - the other LOL is very unsteady and needs assist to ambulate - I found them both on the other side of the facility. When I reported this the next morning, all I got was a snicker!

The DON is young, won't even consider hiring another helper at nite, yet refuses to come in at nite to see for herself what is happening - just says "Handle it." Well, I'm not sure if this is a reportable offense or not, but obviously they aren't involving them in activities during the day.

CapeCodMermaid, RN · Oct 11, 2006

I don't see what is reportable...no eloping out of the building...just wandering which is not reportable and if no one got harmed....I'm certainly not saying it's a wonderful thing, but really nothing to report.

Does your activities department realize not providing the optimal psycho-social environment can result in a G tag? It is a whole new way of looking at activities and we are all responsible for helping provide some diversional time....surely not you tho with all those residents...

could the residents be kept up one hour later each day for a week to see if that makes a difference? Can your DON change people's shifts so there is more help on that shift when it apparently is needed?

lovingtheunloved, ASN, RN · Oct 11, 2006

Well, I'm not sure if this is a reportable offense or not, but obviously they aren't involving them in activities during the day.

Be careful assuming that they aren't being involved during the day. You're not there, you don't know that for sure, and assuming it and reporting it to whoever can at very least, cause some unecessarily hurt feelings.