Need advice please

[u/Pure_Concern_4184]

How do yall deal with a patient who is just so hateful and mean? All I do (well, pretty much everyone) is walk by the room and she’s cussing at us calling us names and throwing stuff at us. She has no where else to go. Our social worker has been trying to place her somewhere for months. She’s just a boarder patient in our ER right now. No one can give her meds, change her, check her sugars, etc. Even bringing her a lunch tray results in violence against us. Management has spoke to her, we’ve given her IM drugs to calm her. Nothing is working. They have been putting me over there daily and I feel horrible. Does anyone have any tips to make her realize we aren’t the enemy? I feel like I’m neglecting her by allowing her to sit in her filth. I’ve tried being stern, being kind, acting like it doesn’t bother me, etc. I document everything. She’s starting to get skin breakdown. We have to literally hold her down when she poops so it doesn’t get worse. She has a UTI from her purewick being covered in shit and refusing to be changed. I hate feeling like I’m being neglectful. I hate feeling like there’s something else I can do that I haven’t tried yet.

[u/hxwkmoth]

All you can do is what you're already doing. Yes it feels terrible. But patients like this who refuse all cares and pose a dangerous risk for your safety have a right to experience the consequences. Don't let her abuse you, keep trying, and document everything because this is the type of thing that can show up in a courtroom someday. Protect yourself and just do whatever you can. At this point it's on the care manager and social worker to get a handle on. What's crazy to me is how long it's taking for them to establish a transition of care for her.

[u/Goth_Duck666]

One lady I had would hate being cleaned and would lie about pooping… mama we can smell. I learned if I told her I have 10 minutes with her and I would sit there for 6 and then tell her ok I have for 4 minutes to get you clean and she would let me. She knew I had limited time and would hustle. She would just say “fine get it over with”

[u/purpleelephant77]

Boarding her in the ER for months is kinda crazy, I’m on a med surg unit and we have people stuck with us waiting for placement forever sometimes (one dude was there for a little over a year, a couple of years ago there we had guy that they eventually started transferring every 2-3 weeks so staff didn’t lose it/quit). The ER is like the worst possible place for her and I’m sure it’s really hard for you guys too since this isn’t what you’re set up or trained to do and it sucks that you’re all kind of just being set up for failure.

My 2 biggest tips are greyrock and try to get to know her habits/patterns. Gray rocking can help because odds are she’s looking for a reaction from you and if you don’t give her one you’re not reinforcing the behavior by giving her what she wants and a lot of people will give up or at least tone it down when they realize there is no way to get you to play their games. In terms of knowing her patterns, pay attention to what she’s like/what’s going on the times she does cooperate; is she better at certain times of the day or after you give her a snack, is she more accepting if you give her choices (at 11 tell her x needs to be done by 1 then after 1 it’s not your choice anymore, let her pick what she wants to do first but be clear it’s all happening) or if you just come in like “alright girly we’re doing this” type stuff.

Also cluster care cluster care cluster care — touch base with the nurse about when they are going to try and do things and go with them, when we have a difficult patient we’ll try to always go together because a.) power in numbers and b.) if we catch them at a good time the nurse can give the oral meds, hang the antibiotic and do a quick assessment while I get vitals and a blood sugar then we get out of there and leave them alone until they call/we have more stuff we need to do.

It can also help to let her say no to some stuff to give her that sense of control and so you have the energy to maintain firm boundaries about what absolutely has to happen. Figure out what your top priorities need to be and don’t push back on stuff that doesn’t ultimately matter (talk to the nurses, they can also reach out to the doctors like “hey she hasn’t had an abnormal vital in weeks can we make her Q12 instead of Q4” etc) so you’re not engaging in power struggles over stuff that isn’t essential.