“You’re bleeding, Mr. Ramsey! Go upstairs with your aide!” The nurse’s well-meaning directive was falling upon deaf ears.
“I ain’t goin’ nowhere until I get my money!” Mr. Ramsey clutched a tissue to his bloody lip with one hand and waved his other hand around in a fist.
The aide took hold of the handle bars of his wheelchair. “Come on, Mr. Ramsey. Come with me.”
Mr. Ramsey swung his fist around in an attempt to hit the aide.
“Mr. Ramsey! Stop it! Calm down! You’ve got a bloody lip! You’ve got to get cleaned up!” The nurse turned to the aide. “I’m going to page Security.”
It was clear to me the staff had escalated the resident to the point of aggressive behavior. It was equally clear they had no idea they’d done so. I debated the pros and cons of intervening and perhaps undermining staff authority versus a showdown between Mr. Ramsey and the security guard.
“The social worker will be back in just a minute with your money, Mr. Ramsey. Just let him get his money and then he can go upstairs calmly.” They looked at me like I was speaking a foreign language.
Luckily, the social worker, who’d realized Mr. Ramsey was adamant in his position, rushed back from the business office with his funds. Immediately mollified, Mr. Ramsey went upstairs without further incident.
Psychologists spend years examining the nuances of human interactions and are trained to deescalate situations like this, which happen every day, in the nursing home and out. While many nursing homes have psychologist consultants who work with the residents and provide an occasional hour-long staff training on communication skills, very few have psychologists on staff. A psychologist on staff at least part-time could provide intensive interpersonal training to reduce resident/staff conflict, increase resident, family, and staff satisfaction with the nursing home, reduce time spent on incidents, and increase the quality of care.
i like this post very much. this issue was clearly something that could have been avoided if the other staff members involved in this issue had the right training to deal with this sort of issue.
perhaps there could be further training from the psychologist…
I agree, Jill, with the proper training countless similar interactions could be avoided. Many nursing homes have occasional inservice training sessions from their consulting psychologists. The format of the standard inservice, though, doesn't allow enough time or individual attention for the staff to learn and practice interpersonal techniques. Full-day training sessions are much better for absorbing this type of information, which requires rethinking one's interpersonal approach.
Dr. El,
I agree, Psychologists should be on staff in nursing homes. It amazes me how, with little effort, situations like this could be avoided altogether. In many instances a therapeutic intervention can do wonders, however, sometimes just treating residents with respect and speaking to them in the manner they deserve is all it takes. That is, it is the residents that we are working to serve; they are not our husbands, wives, mothers, fathers or children who we sometimes get irritated with. Perhaps, rather than inservice, staff members could receive psychotherapy?
I recently came accross your blog and have been reading along. I thought I would leave my first comment. I dont know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.
Lucy
http://maternitymotherhood.net
To be honest Nursing job is not easy…As to look after different patient and interactions with them..
Sue, I'd like to see an on-staff psychologist with open office hours for brief consultations with staff regarding any issues they might have. They could discuss their interactions with residents, families, or other staff members, and if they have personal problems, they could be referred for off-site counseling.
Also, the psychologist could be on a floor/unit/neighborhood for several months at a time, working with each team to facilitate communication skills with the residents and improve the process among the team itself.
Mabel/Lucy, welcome to the blog and thanks for letting me know you're reading it.
Satish, I agree, nursing home work is difficult on many levels. I see the psychologist as an underutilized resource in most nursing homes. The other jobs would be much easier if more focus were put on resident/staff communication, team-building, and mental health issues in addition to addressing physical problems.