What would you do?

[RockNess]

I had a pt with dementia. She has visited our unit before and has always been a handful. Her family is aware of this and because they got rid of the one on one program, they try to have a family member at the bed side as much as possible.

While the family members are there she is a joy to take care of, no hassle, no mess.These family members are very attentive, supportive and helpful....but they left in the middle of my shift. I had thought that people had been exaggerating about how she acts when family is not present, BUT NO MORE.

After several inconveniencing little bothers like her throwing her food at the aide and calling the police to tell them to change her TV channel it was time to take bed time meds. She gets meds ground in applesauce from home, voluntarily took all the applesauce and waited until I leaned over to untangle her call bell and spit the medicated applesauce in my face. My mouth was open.

I WAS REALLY ANGRY. I yelled at her telling her that her behavior was disgusting and unnecessary and left the room as fast as humanly possible.

Looking back I realize it was wrong to yell at her because of her altered mental status but I couldn't keep it inside. I know that I did not handle that professionally and feel very horribly guilty about yelling at her.

Has this ever happened to you? Have any tips on how to keep your cool while dealing with difficult people?

Any advice for the future?

[FancypantsRN]

Who wouldn't be angry? Can the pt help it if they are confused? Probably not, but you are still human. I have said those words to pt's before, usually intoxicated pt's who are verbally abusive or take a wiz on the floor, etc. In my opinion, it's ok to set boundaries and tell your patient if their behavior is inappropriate, maybe next time just say it and avoid yelling.

If my pt's are drunk as a skunk or confused and do anything grossly inappropriate, I just step out of the room for a minute to regroup. Then I go back in and address it. The confused ones don't tend to tick me off as much as the intoxicated ones, but they can still misbehave just as much sometimes.

[eriksoln, BSN, RN]

"What would you do?"

Well, I've seen this too....patients who are angels with family/sitters around but DEMONs when they are gone. I remember, while a new nurse, trying my best to get a sitter (with a supervisor who did not want one) for such a patient so they wouldn't end up in restraints.

Biggest thing you can do is get a feel for the family. Some family members don't want called while at home, they come in and give what time they can but need to regroup/rest while at home. Others resent if you don't call at the first sign of trouble.

Find out which side of the fence her family is on. If they are the later type and are willing to come in, take advantage and have one at the bedside as often as possible. I have called family only an hour or so after they left to inform them their loved one's mentality changed drastically and was becoming unsafe. If you did a good assessment of how open to being called they are, they'll be back and you can administer meds with family present.

This, of course, only works if the family is very involved. But, don't make the mistake of assuming they are not. I've had more than my share of family members upset with me because I did not call them. Those are the ones that really hurt.........knowing you had an out but didn't use it.

[Davey Do]

You know, RockNess, ANYONE could react as you did under those circumstances. Sometimes a real reaction affects these Patients and causes them to adhere to certain boundaries.

Now, I'm not advocating raising your voice at the dop of a hat, but a Patient having to deal with the natural reactions of Others when exhibiting their inappropriate behavior can be therapeutic. This Patient does have the ability to control her actions, as evidenced by her behavior with Family Members.

I sense that you realize your behavior was a loss of control. That concerns you, which it should. But don't be TOO hard on yourself. You are a Human Being with limitations on how much crap you'll put up with.

Of course it's always better to remain in control and deal with any emotionally-stimulating situation on a logical level. But I've gone as far as tell a Patient that her behavior was grounds for me to bring legal action against her, if we were out on the street. She had been relentlessly tormenting Staff for days. We had tried every intervention we could come up with, to no avail. After I informed her of my belief, she backed off. Her reaction took me by surprise. I was sorta venting to the cause of my frustration and it had a therapeutic outcome. The Patient realized her behavior boundaries and ceased and desisted.

If the same thing happens again, may you react more like Atticus Finch when Bob Ewell spit in his face in the movie "To Kill A Mockingbird"- with dignity and resignation.

The best to you, RockNess.

Dave