The Resident from Hell!

DusktilDawn · Aug 20, 2008

I would hope that with a dozen people injured in relation to providing care to this client that it has been documented. If that's the case, I'm surprised that management hasn't stepped in to review this situation. Suggesting PT evaluate this patient and the safety of transferring may be an option. One person should never assist this patient with transfer, if he has to wait for 2-3 people to be available, so be it. Give him the option: wait for adequate assistance or use the bedpan.

Definately document for you supervisors any instances of sexual aggression and rude/inappropriate behavior, be sure to keep your own copy.

You may not like this, but I can't tell you how often I have seen the lack of proper body mechanics used not only by CNAs, but by nurses as well when it comes to transfers, lifts, boosts, etc. I don't know if that is something that may need to be addressed in this situation or not. It just seems to me that that use of proper body mechanics when providing care to patients is woefully neglected either through training programs or by whomever is ensures safety protocols. This is another area that could be looked at and not just because of this resident.

txredheadnurse, BSN, RN · Aug 20, 2008

I am in total sympathy with your frustration.....and your aching back and arms. You might want to ask the nurse for this patient if he has been evaluated for any bladder or bowel problems. It seems odd that he would need to use the bedside commode so many times in a day unless there is a physical problem involved. Perhaps, if he does have a problem with either or both bladder and bowel, there might be a medical approach to help reduce the number of times he wants out of bed for toileting purposes.

AprilW3 · Aug 20, 2008

Check to see if your facility has a "no lift" policy. The facility I work at does. It means that anyone who needs as much help transferring as your resident does HAS to use a mechanical lift or a bedpan. Nursing staff in my facility would be in trouble if we tried to transfer this resident ourselves. It's not safe, neither for you nor the resident.

PBAJS · Aug 20, 2008

if he was in my facility and had some use of his legs, we would be using a sit stand lift to transfer to the bathroom. the only residents where i work that would use a bedside commode are those that might have cdiff, mrsa, etc.

"the lift that we have is a full hoyer and isn't practical for this type of transfer."

(we have been told not to use the would 'hoyer" as the lifts we have are not manufactured by hoyer. the correct wording now is mechanical lifts.)

i did a search - this will give you a idea of the type of sling that we use -

http://www.phc-online.com/patient_lift_sling_p/drive-13221x.htm

:typing

Crystal2dish · Aug 20, 2008

Well this is probably going to sound like a broken record but here it goes. At my facility we have a male resident who rings approximately 20 or more times a shift to get up and down on his bedside commode. The problem with this is transferring him back and forth from bed to commode and so forth. Many times due to his weak legs we have asked him if using a bedpan would be okay? The lift that we have is a full hoyer and isn't practical for this type of transfer. The Licensed staff demand that we transfer him back and forth as many times as he requests. Over a dozen girls have been injured in one way or another by this resident as he weighs over 200 pounds. He is sexually aggressive and rude and yells nurse! nurse! in between using his call lite. He has three different alarms on his bed because of non-compliance with using his lite to ask for assistance. He will not wait one minute for anything. The other residents do not like this guy because of the time he takes away from them. We have approached our nursing staff with the problems we have with his care and they say that we must continue to obey his requests. I feel that these nurses need to try their hand at this resident for a day and see if they can go home without a sore back and sprained arms. What can be done with this situation before this resident gets seriously hurt or we CNA's do? Our LVN is fed up too, she has went in the room and politely informed the resident that he needs to use his bedpan if he is to weak to bear weight on his legs because he is hurting the girls and he says "Who cares" I pay their wages"
Any ideas out there???
Thanks Pumpkin92356

Always safety first. Proper body mechanics. Protect yourself by refusing to participate in unsafe situations. If you or the resident become injured, it is not helpful or positive to say the least.

The resident's behavior is inappropriate and the expectation that he be assisted to the commode anytime he asks is unrealistic at best. Unless, of course, he is the only resident in the LTC facility. The standard for toileting is every 2 hours, which would allow for a max of four times/shift. Behavioral issues aside, does the resident have regular bowel movements? What does his stool look like? Does he use the urinal? Does he produce regular urine in adequate amounts? Is there pain or discomfort with elimination? If all physical systems are clear and functional, maybe caregivers could be restricted to males only. You do not have to regularly tolerate sexually inappropriate behaviors from anyone, including residents.

The ideal scenario would be a team effort and nursing care plan to realistically revise the residents care plan. If your immediate supervisor is helpless to make changes, continue up the ladder of responsibility until you start to be heard. State the facts: Record dates, times, pertinent comments, actions, staff involved, etc. Do not include OMG statements or speculations. Don't fluff the pillow as the facts alone are enough meat on this bone to evoke change. Coordinate same efforts with your coworkers (writing/documenting just the base facts) and put forth a concerned, respectful but coordinated front to your superiors. Don't be alarmist, but work pro actively. If change doesn't happen and you all continue to be ignored, perhaps you may consider changing employers.

Good luck! :nurse:

SFRN · Aug 20, 2008

What about a condom catheter if he needs to urinate frequently---until, like another poster mentioned, the medical reasons of why he needs to get up to the commode so frequently is explored.

Vito Andolini · Aug 20, 2008

has anyone looked at his medical history to see if he might have a reason for feeling like he needs to have a bm so often? something like irritable bowel? mucous colitis? spastic colon? some other type of colitis? he might need a dietician consult to see if he is getting enough fiber - like from whole grain breads and cereals, leafy green vegetables, and fruits. maybe something as simple as adding some stewed prunes and raisins could help him have good strong movements and he would not feel the frequent need to try to bm. typical nursing home menus are pretty challenging.

he might also need some caffeine to stimulate his bowel. maybe some lactulose, benefiber, or metamucil would help. how about a good cleansing enema every few days - and who cares if he' becomes dependent upon enemas? yes, i know, vagus n. stimulation, cardiac issues - but it might be the answer on occasion. some dulcolax or other laxative?

he might need a gi consult. stool culture. other tests. some imaging, perhaps, or a colonoscopy.

keep a food and fluid diary for about 3 days to see what he actually eating. his dietary intake might be really poor.

also, what happens when he's on the toilet? is he actually putting out urine and/or stool? is it hard and painful? does he have trismus (rectal area pain after bm), does he have hemorrhoids, which can make it feel like he needs to bm, or maybe an infection? might he have a rectal fistula or some other pathology? involve the doctor. 20 times a day is just not normal and he needs a good evaluation by the parties i've mentioned.

i know how hard it is to have to lift him so much but please remember that he is in a horrible position - dependent, out of his home, and he knows, i'd bet, that people resent him and dislike having to help him so much. i hope you are using gait belts. and please don't expect him to use a bedpan. they are sometimes necessary, i know, but they are really hard to use. why is the hoyer not practical?

he might also need a psych consult. why is he in your facility, if you can say without violating privacy? just state something general - stroke, senility, other? does he have family who keep interested?

of course, it goes without saying that he needs to be treated with dignity and respect. he will, i hope, respond positively to calm, quiet speech on your part. let him know you are interested in his welfare and desire to truly help him with this problem that he must find terribly distressing. i know it's hard but he needs to know you all care about him and are his allies, you are on his side. i guarantee you he is lonely, angry, frustrated, and very afraid.

i hope these ideas help.

noc4senuf · Aug 20, 2008

Yes to the low lift program and getting his medical history looked at.

But, I hate to be the one to put a damper on things. IF someone called the ombudsman, they would side with him. It is his "right" to use th toilet as many times as he wishes and adequate staff is not "his" problem but the facilities.

Vito Andolini · Aug 20, 2008

the resident's behavior is inappropriate and the expectation that he be assisted to the commode anytime he asks is unrealistic at best.

yes, how wrong to hope to be able to use a bathroom when you need to. shame on all of us who share this greedy hope. :devil:

p.s. i do know where you're coming from and you probably didn't really mean to say that a person should not expect to be able to pee or boop when needed. right? :bluecry1:

Lovely_RN, MSN · Aug 21, 2008

The only thing you can do since the resident has the right to go as often as he needs to is round up an adequate amount of staff and take him. If it takes two then get two if it requires four etc. If it takes everyone on the floor to get this man on his bedside commode then so be it.

If your co-workers refuse to help then go directly to your charge nurse and tell her/him that you need to toilet your resident and the others are refusing to help you.

If it's impossible to provide this resident with the care that he needs while providing care for the rest of the resident's on your assignment then let the nursing staff grapple with that issue.

pumpkin92356 · Aug 21, 2008

Thanks for all the input, I appreciate the help , I will try some of the suggestions I have read. I agree that the resident should be able to use the commode when he wants as I myself would not want to sit and wait for to relieve my self. But he has been evaluated and has no physical problems that the doctors can see that would make him need to go so frequently also the majority of the time he doesnt do anything. He is very mean and demanding. We don't have a standing lift at my job as of yet.

Thanks again everyone!

Pumpkin92356