The Line Up... In The Hallway?

[Flynurse]

here's an ongoing problem at our facility, and needs to be fixed for the dignity of our residents (and because i don't like stepping in poo that has rolled downhill ).

after evening meal our residents tend to get lined up in the hallway along the wall across from the nurse's station. a majority of these residents are there for safety reasons. some of them are there because they don't want to be alone in their rooms. recently someone from admin. was at the facility during these evening hours and was in dismay about the difference from literally night and day...or evening in this case and then reported this to the don. my concern is not with her because, quite frankly, i agree with her. hallways are littered with residents in their w/c's. some of them who constantly try to stand without help or bend over nearly falling out of the chair, others who scream at the top of their lungs, some who plain are just left there. then there are those who roam the halls doing all three behaviors!

the question is: why are all of these behaviors occurring on the evening shift when they so plainly do not happen on the day shift?

quite simply, my answer is this: there is less staff after 6pm. yes, even on the weekend. i include all departments in this simple answer.

there is no social services staff, no admin staff, no restorative or pt/ot/st to stop and say hello or occupy their time. there is not one life enrichment/activities staff member there after 6pm to do an activity or sit and visit. no volunteers come in to chat or play cards or simply sit and hold a hand. these are not solely my excuses but i think it would be a quite obvious reason for the loudness and the line up!!!

so what do we do? well, firstly, those who can be in their rooms, who want to just lay down, who would like to sit in their recliners after meal should be escorted first to their rooms. while other cna's pass out snacks, give them something to do, etc. as a nurse i realize this requires the direction and teamwork of nurses and cna's. but....

here's the "situation" when we have meet the immediate needs of these residents (i.e. toileting) and tried many interventions including pain management, but the yelling and other behaviors what are we to do when these residents are so obviously just plain aggitated or sundowners? some of the nurses have administered prn antianxiety meds but then the next thing they know they are being pulled into "the office" for doing so when it was not appropriate.

give me your input...please!

[twentytenRN]

I don't really have a lot of experience in geriatrics but I'd hedge a bet that several of these patients have sundowners and thus they are more active and restless on the evening shift. They constantly require redirection because of their disorientation.

[RNMLIS]

One of the activities people who of course only works the day shift

Flatly denies that SUNDOWNERS exists

HA!

[stelarRN]

it's also important to note that a lot of patients who we do make a priority and make them comfortable in their rooms after dinner, often get agitated, and we have to bring them back out for safety reasons. sometimes there is just no way around it. sundowners DOES exist and it's not something to be taken lightly.

[morte, LPN, LVN]

WHAT is inappropriate about an anxiolytic for an anxious patient??!!!

how about trying naps after lunch?

how about recruiting volunteers? (easier said then done)

good luck

[Flynurse]

I am absolutely certian sundowners exsists. Maybe this admin. person doesn't know what it is? As it was said, most of the residents we make comfy in their rooms and they come right back out to the hall because they are too restless. Our residents lie down after they return from lunch and most don't get back up until 3 or 4pm (depending on activity at 3pm). I have even done 1:1 time with some of these residents despite my busy sched. However, we have been told to "fix it!"

Documentation might have been the reason these nurses got in trouble when giving the antianxiety meds. As nurses, we'll just have to make sure all avenues of interventions for these behaviors are tried before we give the med. Then, be thorough in documenting the behaviors and interventions.

I really don't think there is a solution that will make everyone happy. I'll just keep brainstorming!

[One Flew Over]

I once cared for an end stage dementia resident who used a hoyer lift and was confined to a geri chair. She wasn't jumping out of her chair, yet they stuck her out in the hallway every night. All she would do was scream and swear yet they said she was sundowning, thus couldn't be left in her room alone. Funny thing is, when I would come and check on her while I was visiting my grandmother, I would wheel her back into her room, put on her music and give her something to look at and miraculously the behaviors stopped!

I took care of her for 4 years on dayshift and she rarely exhibited those behaviors because I used the same methods

So my point is.. Instead of lining them all up into the hallways with absolutely nothing to do except scream, sleep and be miserable. Why don't you set them all up in a TV room or common area, with music or quiet television playing, some books and magazines and generally simple activities? CNA's take turns watching the room and monitoring them for safety if it's of high concern. But it's those safety risk residents especially who need the stimulation, to get their mind off of whatever it is that is agitating them or causing them to yoyo out of their chairs. And those who are sleeping in the hallways can actually do something that may keep them awake so they're not up all night disrupting everyone's sleep

[SuesquatchRN, BSN, RN]

Document the behaviors before and after the anxiolytics.

[Schmoo1022]

We have a very small dining room/main room. I have noticed that even people who are normally content and quiet will become noisy and agitated around other loud residents. Some people just can't take the extra stimulation. We also have some people that we keep near the station for safety, they are ones the aren't constantly trying to get up, but they are the ones who would try to stand if we left them alone in their room. It is a tough sitiuation.