Why does this man's personality change instantly

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I am a carer in a residential home, and we have set units what we work on. On this particular unit, there is a gentlemen who is such a pain in the backside! He loves his buzzer, and he loves it when young women come on the unit (hence why I dread it!) Anyway, yesterday, he wasn't too bad at all, he didn't press his buzzer very often and it was all dandy. Me and another carer was getting him onto a stand-aid, and he kept going ''I want to use the hoist'' (goodness knows how that came about!) I explained that he does not have a sling or is not assessed to use the hoist unless in genuine emergencies, and that he is quite capable of using a stand-aid as his wife has tried hard to get him assessed for it, then he went CRAZY! Going ''You have NO idea do you! Seriously if you do not get the hoist, I am going to hit you, and you (pointing to the other carer), we ignored this and just carried on because of this outburst, put him in the bathroom and left him. He only wanted it so that he can take more of mine and the other carers time.

He kept buzzing constantly, and every time we asked if he was finished, he says no. So we turn the buzzer off, and we emptied his bag, then he said he wants it emptying again (the bag was already emptied! Just emptied it there and then) and had ago at the carer, calling us a ******, etc. I said there was no need for him to be like that, and why has he got an appalling attitude. I said to him I am going home in 10 minutes as it was the end of my shift then he immediately said he is finished (he didn't need the toilet - he always does this!), we got him over to the bed, he tried forcefully to pull off his conveen, but I said if he does, I will not be changing it because I do not want to speak or go near him and he can lay in a pool of urine until the night staff come on. He continually buzzed that night before I went home... Literally, the minute I left the door he kept on buzzing. I went in one last time and he apologised (he always apologises! He does this to majority of the people), but I just said "you are always apologising, and you do not mean it. Anyway I am going now because you are a really rude man, and I do not want to be near you", and I just went home.

You must all think I was really rude but he really did annoy me with his horrid attitude and we tried helping him! He continues to buzz throughout the day, knowing you are toileting/showering/feeding people and it is so hard, if you leave it for too long, he will set the emergency off. He has a brain injury, and also vascular dementia. We have reported his violent outburst and continuous episodes of pressing the call bell and taking up our time - so many times but nothing is getting done about it. What else can I do? I am dreading working on that unit again because of his stinking attitude towards me and the other carer.

He was calling me names like thick, I cheated to get into uni, I am dumb, I don't know anything - can't I leave sooner, etc :/ Really sad!!

because of the "brain injury, and also vascular dementia"

he can't help it

Don't take anything he says personally and don't react to his actions.

Talk to your nurse about the best way to deal and talk with this man.

Some pretty harsh responses on this thread.

Water off a duck.

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Some pretty harsh responses on this thread

We're somewhat harsh because we are quite appaled at the treatment of this patient. A patient who is not just being an *******, but is suffering from debilitating, irreversible diseases that are the cause of his behavior.

It's also appaling that a facility would hire "carers", (I'm guessing a minimally educated person who performs/assists with ADL's), to care for the residents in their care but fails to provide them with the education needed to do their job properly and communicate effectively with these patients.

I would raise **** if I ever heard one of my family members being treated the way the OP treated this man.

I think it all boils down to lack of education.

(I apologize for the @$......just trying to make a point)

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Specializes in Med/Surg, Ortho, ASC.

Some pretty harsh responses on this thread.

Water off a duck.

Would it be water off a duck if the patient were your father or grandfather?

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You are internalizing this. Which is not a good thing, especially in brain injured patients. The comments and traits that this patient undergoes is typical in a setting with patients who can not organically think logically.

But you can think logically. And how you chose to interact with this patient is absolutely unacceptable, could be considered abusive, and could land you in hot water quick.

You need to learn how to discuss what you are going to do and how you are going to do it. Someone must have had conversation with this patient about an alternate lift, and this could be something that you could discuss with PT going forward on how you can assist with that. And an inservice regarding how these aids are used, if you should be using them, and the like.

It is never ever appropriate to threaten a patient. You should not personalize to the level in which you are. Demented, brain injured patients are likely to say anything. How to communicate is key, and what you need to learn going forward.

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We're somewhat harsh because we are quite appaled at the treatment of this patient. A patient who is not just being an *******, but is suffering from debilitating, irreversible diseases that are the cause of his behavior.

It's also appaling that a facility would hire "carers", (I'm guessing a minimally educated person who performs/assists with ADL's), to care for the residents in their care but fails to provide them with the education needed to do their job properly and communicate effectively with these patients.

I would raise **** if I ever heard one of my family members being treated the way the OP treated this man.

I think it all boils down to lack of education.

(I apologize for the @$......just trying to make a point)

Thanks Esme12 for the editing.....won't happen again, I promise!

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Specializes in LTC.

I think you answered your own question. This person's personality is being ruled by their TBI and dementia. Due to the disease process of dementia some of the nicest people can become down right nasty. In this situation there is only one persons behavior you can modify and that is yours.

Some ideas and thoughts:

1. He's asking staff to use a lift. Talk to a nurse, can he be evaluated for a lift instead of a stand? There maybe something going on with the stand that he doesn't like or agitates him. Maybe it's painful.

2. Talk to his normal caregivers about approaches. Do the staff that normally work with him have any tricks that work? Is there anything in the care plan that gives ideas for approaches.

3. Update the nurse you are working with with behaviors. Maybe he needs a psych eval. Psych can give the healthcare team an idea if he needs further medication and also gives them an idea of what kind of approaches are appropriate. Maybe there is underlying pain that the nurse can treat. Maybe he needs a better care plan, like male only assist if it's available.

4. As others have said EDUCATE yourself. Find out more about TBIs and dementia and how to deal with these. If you plan on working in healthcare you're not going to get away from this.

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Your treatment of this patient is border on abuse and neglect. You need to understand the disease process that is present here. He has dementia, he cannot remember what you have told him. He has vascular issues which means he is not getting much oxygen to his brain which is already having a disease process. He needs a Psych eval and this should be brought up to the unit manager. We used behavior sheets to document when a pt was having outbursts, are you making the nursing staff aware of these outbursts? A Psych eval would show his dementia stage and what medications may be useful to treat it. If the nursing staff is not paying attention to his well being then you should report it higher, the supervisor or even the DON. The facility can be held liable for with holding proper treatment from this pt.

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Specializes in critical care, ER,ICU, CVSURG, CCU.

if you worked in my facility, and i observed your behavior, YOU WOULD BE TERMINATED,

i would also have to report your abusive behavior to the state regulating body......

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Specializes in Med/Surg, Oncology, Epic CT.

You sound like you are having a difficult time with this patient. As many others have said before, perhaps you are not a right fit for this position and/or you need to educate yourself about these type of patients.

I have a family member who has dementia and she was one of the main reasons why I became a nurse. However, before I was educated as a nurse, I did not understand much about the disease process itself and many of the things my family member did and said were taken personally at times (to the extent of frustration).

As I went through nursing school, especially after Geriatrics, I learned I needed to reassess myself and my approach on the care of my family member with the new knowledge I was given.

Even now, after graduating from nursing school a month ago, I am still reading articles to keep myself up to date about Alzheimer's, dementia, and the care of these type of patients so that I can give the best quality care to not only my family member, but for anyone else's family member that might come into my care. A good resource to start: http://www.alzfdn.org

I STRONGLY SUGGEST you heed the advice of those in this thread and take a look at this situation seriously. You need to either do what I did and educate yourself or go to the necessary people to get transferred to a different unit or find a different position altogether.

Remember, this is not just a PATIENT. This is someone's father, grandfather, brother, uncle...

How would you feel if this was your loved one? Give it some thought.

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"I said if he does, I will not be changing it because I do not want to speak or go near him and he can lay in a pool of urine until the night staff come on. He continually buzzed that night before I went home."

......yeahhh.

No matter the situation, you need to re-read what I've posted and re-evaluate yourself.

Im fairly sure that the above statement is one of assault and neglect.

Example- Assault (IIRC) - "If you don't stop ringing that call bell ill ______"

Im sure someone else can correct me if im wrong. (assault / battery / threat of violence / threat of neglect)

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As someone who is disabled I am appealed that you feel it is ok to talk and treat another person this way, especially one who is helpless and depends on you for care, I have to say it takes a lot for me to report or complain about a Nurse or CNA as I know how hard their job is but I would not hesitate if I was treated like this. Please take time to educate yourself about the population you are working with or leave the profession altogether. To those of you who are compassionate and understanding towards the patients you care for and would report this behavior when witnessed THANK-YOU, your patients are so grateful for people like you.

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Many VA violations here. Threats are inappropriate no matter what and so is neglect.

I work in group homes and have had a couple very irritating clients that had dementia among other things. One needed a staff to pretty much stay on his tail to keep him from hitting everyone. The other also was MR and was constantly seeking attention, throwing fits, and was sexually inappropriate, and the fact he had previous pedophile behavior didn't make him much more likeable.

The second in particular drove all staff a little crazy. We're human and it's okay to admit that. We don't have to like our patients but we DO have to have patience and take care of them anyway. Staff worked together to give each other breaks from him and vented to each other when the chance presented itself to get through the shift. One person lacked the patience and fell to berating him and she transferred out to a different home because she could not stop herself from stooping to his level.

You need to take a good long hard look at yourself and reconsider if you belong in healthcare. There will always be nasty patients but the dementia/tbi ones can't help it. At the very least, let your supervisor know you aren't handling this environment well and need to go to a less challenging area. They are usually understanding. Not everyone is cut out for dementia clients.

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