I Feel Like a Bad Nurse: Alzheimer's/Combative Patients

I feel like a bad nurse.

I feel like I am not doing the best by my patients, those of confused/combative/Alzheimer's/dimentia status.

I don't want to go into any details about my patient care, but I find myself anxious lately about taking care of combative patients. Now some of you are probably thinking "well duh, combative patients suck". However this hasn't always been the case with me.

I have had many families tell me I have the "patience of Job" with their families, but lately it just seems like I can't manage combative patients.

Last night a patient started grabbing me when I was attempting to recheck her BP. I looked at her sternly, like you tell a child, and told her not to grab me. Another patients family member walked by and overheard me reprimand the woman and I felt like I was about two inches tall.

The patient did stop hitting me, for a second, but I just can't shake the feeling I am losing patience.

I try to look at them and think of them as they might have been, I try to be calm, smiley, and agree with whatever tangent they are on, but I seem to lose compassion quickly when someone hits me, or tells me I killed their family (like last week).

Maybe I am just worn out this month since it seems the floor is littered with combative patients.

I am not really looking for support or sympathy.

I just don't know some days if I am beating myself up, or letting go of my compassion...which scares me to no end.

Tait
I think when you start to having feelings like this it is you body and your psych telling you it is time to take care of yourself. It is OK, you are not a bad person or bad nurse just a human being. Have a look at what is going on in your life and see where some changes need to be made. Good luck and God bless, you sound like a great person and a good nurse.

I think taking care of combative patients gets to anyone, at one time or another. It's not how you imagined nursing would be. You want to be kind and you don't want to get hurt. Maybe you need some time off? I know that always recharges me.Maybe the patients need a calming medication? Sometimes I hum a lullaby, both for the patient and for myself, as a calming thing. I move slowly and not ever suddenly. It's likely the patient is feeling fear about something (hallucinations, delusions, anger at loss of independence, etc.) and you are just there for the lash-out. It would be nice if you could figure out what he/she is afraid of. I know that's seldom likely.You have a right to tell a patient not to grab you. Somewhere inside the Alzheimer's, the person is still there, and for a moment you might reach them. Then you can do what you need to do.Don't be hard on yourself. I think they're lucky to have someone who cares as much as you do.

You are not a bad nurse. A bad nurse would give up. I have a few combative patients at my job too. We are not afraid to give them medications to calm them down. Its for the safety of them, us, and the other patients. Don't be afraid to be firm and tell them to stop hitting you. Whispera is right, they may realize what they are doing is wrongExcuse me if this sounds odd but maybe the b/p cuff could be hurting them? Is it one of those digital ones or is it a manual?

I think your body and soul are giving you warning signs. It may be time for a change.I doubt that some time off would do it. I think you should look into exploring other options, another area of nursing. There is a reason that nurses sometimes move into diametrically opposed types of nursing - they burn out on one and need to get the hell out of dodge.I once knew an older nurse, very experienced, who alternated her whole career between neonatal and psych - polar opposites, if you ask me. Just about the time she'd feel herself becoming hardened to the death of a preemie, she'd recognize the need to move on and transfer to psych. Just about the time she started feeling less empathy for the psych residents, she'd return to neonatal.

Tait -You are not alone. I know Exactly how you feel. I work in an alzheimer assisted living and deal with combative behavior on a regular basis. I too am full of compassion and patience. Family members often say im an angel. However, when im kicked in the face or curses out or threatened it does affect me a little and it i too find myself having to use a stern voice to tell a resident to stop or not to hit me or others. We are not bad nurses and they are not bad patients, its the disease. reading your post also made me feel that im not alone. thank you

It sounds like you're just worn out, Tait. The fact that you are aware of this, and feel badly about it, tells me you are just fine. I think maybe you need a bit of a break. Caring for others is extremely draining, physically, mentally, emotionally, spiritually. We have to find ways of renewing/refreshing ourselves, and filling that cup back up. What do you do to refill your cup?

It gets to you after awhile.I do find that kneeling down to eye level helps a lot. I also call them ma'am and sir, and Mr or Mrs. It sort of helps them remember a little bit of dignity.Hugs.

Quote from dajulienessYou are not a bad nurse. A bad nurse would give up. I have a few combative patients at my job too. We are not afraid to give them medications to calm them down. Its for the safety of them, us, and the other patients. Don't be afraid to be firm and tell them to stop hitting you. Whispera is right, they may realize what they are doing is wrongExcuse me if this sounds odd but maybe the b/p cuff could be hurting them? Is it one of those digital ones or is it a manual?

Quote from WhisperaMaybe the patients need a calming medication? Sometimes I hum a lullaby, both for the patient and for myself, as a calming thing. I move slowly and not ever suddenly. It's likely the patient is feeling fear about something (hallucinations, delusions, anger at loss of independence, etc.) and you are just there for the lash-out. It would be nice if you could figure out what he/she is afraid of. I know that's seldom likely.You have a right to tell a patient not to grab you. Somewhere inside the Alzheimer's, the person is still there, and for a moment you might reach them. Then you can do what you need to do.

Quote from leslie :-Di agree about remaining low-key and gentle.what also works with me, is explaining/warning them (the bp cuff is going to get tight around your arm) re potential adverse effects.of course the most helpful, is when the pt knows and trusts you.but that takes time.until then, it's time to replenish your soul, however you can do that.wishing you peace.leslie

Hi Tait,Don't be too hard on yourself. I own a home care agency in San Francisco that specializes in taking care of Alzheimer's patients at home. I want to share a document that we give to hospital nurses in the Bay Area that seems to help them. You can download it from this link--Hospital Nurse's Guide to Alzheimer's Care.You may already know this, but here are a few basic tips (the booklet has a lot more information):Aggressive behavior is the patient's way of communicating.The patient is likely confused, scared, in pain, or all three.Always approach from the front.Call the patient's name and identify yourself every time (even if it's only been 10 minutes since you introduced yourself--the patient doesn't remember you).Tell the patient what you are going to do in short, simple sentences.Use a relaxed, calm voice, smile, and try not to appear rushed.The patient may not be able to understand language very well, but he or she can read body language extremely well.Good luck on recharging your batteries; you have a tough job, but as the son of an Alzheimer's patient, I appreciate everything you do for our loved ones while they are in the hospital.Thanks,Jim

I have to thank you... I have been dealing with a couple combative residents at the nursing home I currently work at. Today one of my residents fell, and hit her head. Part of our protocol when someone falls and hits their head is to do neuro checks. Well part of that is getting vitals q15 min x4, then q30 minx4, etc... well this resident had been refusing to have her vitals checked. She had been reproached numerous times and kept refusing. I decided that this time I would have an aide take her BP and I would talk her through it, and distract her. This resident immediately got combative, I tried asking her questions about her family, her past, and just about her. She kept saying that it was none of my business asking these questions and to stop. She was hitting, and kicking, me. We did end up getting her BP, and when I was getting her sweater back on her she reached up and slapped me. I grabbed her wrist and sternly told her NO, that it is not ok to hit. She then head butted me. I reached up and moved her head away from mine to prevent her from doing it again. At this point another nurse suggested that I walk away. I was done with her anyway so I did. I then also went on my lunch break. Well apparently the other nurse only saw me reach up and move her head back because when I came back from lunch, I had a call from my DON telling me I was suspended pending investigation of abuse. I have been very upset about this because I would NEVER hit anyone. I feel that I was acting out of self defense, considering that she had head butted me and had been hitting and kicking me.I have had residents, hit, and scratch me to a point that I had blood dripping down my wrist, and I didn't hit back. I have been slapped across the face and called abusive names and I haven't retaliated. I am almost always calm and collected, and when I get frustrated I walk away and go cry in a storage room. I never take it out on the resident. The posts on this thread have helped me realize that I'm not the only one dealing with a situation like this, and I now have new ideas and tools on how to deal with the combative residents I have. ThanksLaura