C.N.A tips for Working with Combative Residents

 

As a C.N.A. you will, from time to time, have to work with a combative resident.

If your resident is combative look for a pattern to the behavior. Your observations will help the nurse or doctor to manage your resident's behavior.

For example do your residence usually become aggressive:

1. When they are hungry
2. After meals
3. When they're cold
4. At a particular time of day
5. When they are hot
6. After taking medications
7. When they're with a group of people
8. When they're left alone
9. After getting some exercise
10. Only with you
11. With anyone dressed in white

As a C.N.A. you need to pay attention to the things your resident enjoys doing. Then, if you see a violent behavior coming, try to distract your resident with a favorite activity.

If you encounter a resident who is combative or violent, try to:

1. Speak slowly and calmly.
2. Listen to what they are saying. Don't tease or ignore them.
3. Don't crowd around them. Give them space to breathe.
4. Don't let them crowd you or back you into a corner.
5. Do not touch angry residents unless you know from past experience that touching them is safe.
6. Sometimes, a C.N.A. can get the attention of a hostile, upset person by calling out his or her name loudly and clearly. But never yell at a resident or continue to call out their name.

Try to get a hostile, combative person to sit down, if possible. Most people are less aggressive when they are sitting. But, if the person refuses to sit, you should remain standing, also.

If a resident becomes violent around other residents, do your best to protect the other residents and yourself from them.

Keep in mind that all residents have the right to refuse treatment. For example, if a resident becomes aggressive when you try to give them a bath, let your supervisor know that the resident has refused your care.

Be a good role model. If a C.N.A. becomes angry or aggressive because of a residence's violence, it will only make the situation worse.

Remember that all episodes of combative or violent behavior should be reported to a physician. There may be a way to treat the aggressive behavior.

When people are being difficult, it's usually because they:

• Want the C.N.A.'s attention.
• Are afraid.
• Feel insecure.
• Lack confidence.
• Feel like their lives are out of control.

Be sure to praise people when they behave in a positive manner. Reward the behavior you want to see them repeat.

It's a good idea not to make promises that you cannot keep, especially with a difficult person. If you tell them you are going to do something, then do it. If you have to break your promise for some reason, be sure to apologize. Residents depend on C.NA.'s for most of their daily care; they need to know that they can count on your word.

When you're working with adult residents, be sure to treat them like adults. If you treat them like children, they may behave that way.

Watch your body language. If you tell people that you were listening to them, but you're standing with your hands on your hips, tapping your foot and staring out the window, the resident knows you are not really listening.

Most of us have certain pet peeves, which developed during our childhood. For example, one of your siblings always teased you about your glasses. One day, a resident says to you, "Your glasses are really funny looking" she didn't say it in a mean way, but it sets you off because you're sensitive to it. It's important to think about little things that tend to bother you to try not to overreact when a resident or coworker does them. Pick your battles. Making mountains out of molehills is very exhausting. Your energy is precious, use it in the most productive way for yourself and your residence.

Don't waste your energy trying to change people who behave in a different manner. Instead, work on changing the way you react to their behavior. As we grow older we learn that changing others is virtually impossible. Changing ourselves and our response to the world around us is much easier and more rewarding.

SAFETY IN THE WORK PLACE

As a C.N.A. keeping yourself and your residents safe is one of your top priorities.

Ask your supervisor if any of your residence have a history of being physically or verbally abusive. Knowing your residence's history will help you to prepare to handle violent situations.

Take threats seriously. In a Colorado hospital, the patient was recovering from surgery. During the night, he told the nurse that he would kill the next person who came to get him out of bed. The night nurse didn't tell anybody what the patient had said. The next morning, the patient stabbed a C.N.A. with a pen.

Remember it is better to report a threat and have it turn out to be nothing than to ignore a threat and wind up with someone getting hurt.

Be sure to share your observations about your resident with other staff members. For example, tell your coworkers if Mr. Smith is getting agitated or hostile every time someone mentions his son

Consider using a buddy system when caring for residents who have a history of being aggressive. You are not ganging up on the resident, but remaining safe as you perform resident care.

If you work in a hospital, assisted-living facility or nursing home, there may be a special alarm or telephone code used when an employee is in trouble. Be sure to know your workplace procedure.

As a C.N.A. you know that the needs and rights of your residents come first. However, you have rights, too. That includes the right to a safe in a healthy work environment.

OSHA has developed a zero-tolerance policy for any violence or threats of violence against employees. Employees cannot be punished for reporting incidents whether they involve a resident or a coworker.

CONDITIONS THAT MAY CAUSE COMBATIVE BEHAVIOR

1. COPD. This lung disease may prevent the brain from getting enough oxygen. This can make people anxious and agitated.
2. Stroke. After a stroke, there may be some damage to the brain that causes a change in your residence personality.
3. Urinary tract infection. An infection in or near the bladder can cause confusion and agitation.
4. Pain. When residents are in a lot of pain, they may become frustrated very easily and may lash out at those around them.
5. Dementia and Alzheimer's disease. While violence is not a frequent symptom, if it does develop, it is usually in the middle stages of the disease.
6. Brain tumor. When there is an abnormal growth in the brain it can cause personality changes.
7. Substance abuse. If the resident is under the influence of drugs or alcohol, they may be combative or violent.
8. Depression. When people are depressed, they may not be thinking straight and may get frustrated easily.

If any of your coworkers have experienced workplace violence be supportive. Any violent incident can be very frightening and can leave lasting emotional effects on someone. Some C.NA.'s have even quit working in the healthcare field due to stress caused by workplace violence.

HOW A C.N.A. CAN HANDLE DIFFICULT PEOPLE

Since you spend so much time with your residence, their negative behavior is often directed at you. Try not to take their comments or behavior personally.

It is only your opinion that someone at work is difficult. A person who seems difficult to you may get along fine with another C.N.A.. You may get along great with a resident that no one else wants to work with. It's our differences that make us unique. We all need to celebrate the differences and different people in our world.

Try not to overreact when dealing with a difficult person. Ask yourself, "is the situation really worth making a fuss over?"

When you work with people who have given you trouble in the past, try starting fresh every day. Forget about what happened yesterday, last week or last month. Harboring anger and resentment about the past only makes your present day more frustrating.

Tell your resident what you are going to do before you do it. This lowers the chances that they will react negatively.

If a resident is yelling crying or complaining loudly, try standing still, looked directly at the resident and wait. This gives the resident a chance to get all their anger out. Next try saying, "You seem very upset Mrs. Smith, let's go somewhere private and talk about it".

Usually at this point Mrs. Smith will calm down, knowing that someone is going to listen to her.

Be patient with other C.N.A.'s, too. It's human nature to think that if your coworker is in a bad mood then it must be something that you did. But, chances are, it has nothing to do with you. Don't take everything personally. Most of us spend the day thinking more about ourselves then others. So more likely than not, if your coworker doesn't say hi to you in the hallway it's probably because they have something on their mind concerning themselves. Not saying hi had nothing whatsoever to do with you.

Remember counting to ten? That really does work. The next time you feel angry or upset with the resident or coworker, take a deep breath and count to ten before you speak. You will feel much better about how you handle the situation.

Don't allow other people to control your moods. If you do, you're giving them tremendous power over you. So, if you're in a good mood, don't let someone else's anger bring you down. We are each responsible for our own joy. How we feel is our choice. No one can make us feel one way or another.

A FINAL WORD

Working with people can be a very demanding job. Working with people can also be the most rewarding job. Any job is more about what you bring to it then the job itself. You are the deciding factor on whether or not a job is joy or sorrow. You are often the deciding factor on whether those around you are feeling positive or negative. Bring your best self to any job and you will find that everything and everybody around you will be much better. Thank you for being a C.N.A. we love you.