Difficult Patients

Not everyone is difficult to work with, but for some certified nursing assistants, a few patients can be a real drag on their shift. Thankfully, there are a number of positive options for them to work with needy residents, or to help people feel more empowered. Both are easy to take care of if you take advantage of some good advice.

Dr. Barbera, at My Better Nursing Home, has a great way of helping patients who may feel useless or just less independent than they want. If you need to move things around in a common room, or just take advantage of a quiet space, feel free to ask for help from nearby residents. Simply asking them to hold onto something or if you can use some of their space.

Things like this can help patients, who aren’t particularly taxing on you, and can improve outcomes. As Barbera notes, it can reduce the likelihood of depression and that helps you out, too. So, if something can be done, it benefits you just as much as them.

On a slightly more frustrating note, it’s rare in a hospital or in a nursing home that patients are told how many times they should realistically ring a bell over the course of a shift. Some do it rarely, some can do it many times over the course of a single hour.

If it truly is an emergency, obviously you can understand why they called. But you can also help them out by always responding to a bell call. Instead of actually changing the TV channel or something else, tell them when you’ll be available to do it. You can also let them know when you come on shift and make sure they are aware of where you are and where you’ll be.

Both of these are not uncommon ideas, but they do require a little bit of creativity to make sure that you are addressing concerns, as well as ensuring that patients feel like they’re getting the right level of support. As we’ve mentioned in other articles, it’s managing the psychology of residents and their families that can be the most difficult part, and the most rewarding, too, of being a certified nursing assistant.

When Residents Wander

Nursing home residents are almost always there because they have difficulty caring for themselves. Some require little supervision, while others need to be watched most of the time. Though security at most nursing home facilities is pretty strict, it can happen that residents will wander. As soon as an employee’s back is turned, some residents will take off resulting in a frantic search through the facility.

Wandering in nursing homes is separated into two different categories, actual wandering, and elopement. While a wandering resident will usually be located inside the facility, an eloping resident can manage to get out of the building and even off the grounds.

Should you find one of your residents missing, the first thing you should do is to notify other staff so you can begin a coordinated search for the missing person. Unfortunately for the staff, these people can hide virtually anywhere, but a good search of the building will usually find them.

Also, keep an accurate count of the people under your supervision often. If you take a head count every few minutes or so, it reduces the possibility for one to go missing. Likewise, if a resident has wandered from another area and you find them in yours, returning him to his correct floor, wing or room will help the employees of that area. You will find them faster if you are keeping count of your people’s whereabouts at all times.

Also, be aware of residents who are cognitively impaired and who have a tendency to wander. If your facility doesn’t have safeguards, you may need to be acutely aware of what these people are doing at all times to prevent them from wandering. If you share a wing or floor with other staff, work out a schedule so that someone is checking on these residents every few minutes. Clients with extreme mental disabilities may only require a few seconds to disappear, depending on their physical conditions.

If your search of your facility, grounds and surrounding area hasn’t turned up your missing person, your administrator or the nurse in charge may need to contact the authorities and possibly the family. A resident who has gotten off the grounds can be in danger, especially if they have certain medical conditions or if the weather is severe. Make sure you give an accurate statement to your supervisor or the authorities, even if you feel you have been negligent. The resident’s life may depend on it.

Living in a nursing home can be a pleasant experience for residents, but occasionally their loved ones unknowingly, or even knowingly, cause trouble for the employees. Sometimes the relatives are entirely too demanding, occasionally they get into the habit of treating employees as if they work for them and not the resident and sometimes these people are just downright rude. What should you do if your resident’s loved ones have become a problem?

Dealing With Combative and Abusive Residents

One fact of working as a certified nurse assistant is that we will come into contact with residents that are combative or abusive.  Some are suffering from dementia, while there are a few here and there that are actually enjoying the freedom (or perceived freedom) to be mean.  Not everyone will be honest about that – but there are people on the planet that are mean and even they grow old.

People that have any sort of dementia are liable to forget who you are and what you are doing.  Even when you are in the middle of an activity that you have done many times with the same resident, if they have an episode where they have forgotten where they are and who you are, it can become a combative situation fast.

If a resident becomes combative or abusive during care, the best course of action is to make sure the resident is in a safe place and then walk away.  Combative episodes are made worse when you try to restrain the resident in order to finish any type of care.  Give the resident time to calm down, go perform care for another resident, then come back.  If the resident is still having issues understanding that you are there to help them, you may need to speak with your unit nurse for help.

With residents that enjoy causing trouble for other residents and aides, there are a few things you can do.  The most important is to try to always have another aide with you when you are giving personal care to the resident in question.  This gives you a witness in the event that the resident accuses you of improper or unprofessional behavior.  If another aide is unavailable, speak with your supervising nurse.  Keep a pocket notebook handy to jot down any comments the resident makes towards you, any incidents that happen, and anything else that may be important during the time you are giving care to a resident that is known for causing problems among staff.

If all else fails with a resident that you seem to have conflict with, you can request to be moved to another unit or you can trade assignments with your hall partner.  It may not always be possible to avoid residents that you have conflict with, so try to always maintain your composure and walk away when needed.

Dealing with Overly-Demanding Family

Many nursing home staff can tell stories of overly-demanding family and friends of the residents who live in their facilities. Most nursing homes are notoriously short-staffed and family members may not understand that staff will have to prioritize when attending to the residents.

A client who is having a serious issue will take precedence over someone who just wants the channel on their television changed. This is unfortunate, but when a family member has decided that their loved one isn’t getting the care that they should be, they can often make your work experience very difficult. The family needs to be aware that the care level ration to patients in nursing homes is not one to one. You will have several other people whose needs are your responsibility.

It is also your responsibility, however, not to rise to their bait and become rude to counter their attitude. Remember that you are at work, treat all visitors with respect, but kindly make them aware of the situation and let them know that you will be attending their loved one as soon as you possibly can.

If they do not calm down or become hostile, you may need to have a talk with your supervisor. Do not, ever, confront a rude or hostile guest in the facility. Not only could you lose your job, but you could cause legal problems for the facility. Your supervisor or the administrator will handle it to the best of their ability. If you still continue to have problems with a specific visitor, try to arrange to have a break when they are visiting.

It is unfortunate when caregivers and family members cannot get along. The important thing to remember, though, is to keep the resident your focus. A family member may be rude and demanding, but the resident has to live in the facility where you work. Do everything you can to not let your disagreement with the visitor affect your job in any way.

Steps You Can Take

Step 1: Recognize & empathize

Often, when a person is upset about something, they are looking for a simple acknowledgment from someone else. If an individual unloads their bad experience with you, listen and let them know you can empathize with their situation.

For example, if a patient tells you they’ve been waiting for a long time, acknowledge the wait and show empathy by saying, “I know it’s taking longer than you expected and I know how frustrating that can be. Let’s see how much longer the wait may be.” You might be surprised to see how the simple acknowledgment will defuse the situation instantly.

Step 2: Apologize

Rather than pretend there isn’t a problem, allow the other person to vent some frustration or anger. A patient may say, “I’m really frustrated about this!” and no amount of reasoning from you will change their initial feeling. Telling them, “You shouldn’t be upset” or “It’s not that bad” will only frustrate them further. Simply say, “I understand you’re frustrated (or angry or disappointed, etc.) and I’m sorry you feel that way. Let’s see what we can do to turn this around.”

Step 3: Actualize results

If you’ve determined a patient is asking you to resolve a problem, move as quickly as possible. Simply acknowledging or apologizing for a problem stops short of the necessary last step.

Think about the last time you were upset. When anyone is in this state, we typically want someone to listen and understand, be honest about the reality of the situation and quickly work to fix the situation (if at all possible). Anything less just isn’t enough.