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Author Topic: Angry, acting out patients  (Read 11827 times)
renalsw
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« on: March 19, 2007, 12:40:28 PM »

As a social worker, I would like your input, as patients, regarding angry, disrespectful patients. 
I have a patient who is very angry and none of the staff has been able to pinpoint the problem.  She will curse at the nurses and even at the other patients.  She requires some assistance with psychosocial needs but when the staff tried to help, she rants and won't listen.  When staff is trying to explain that many programs have guidelines, and in order to help her we need certain info, she explodes and starts cursing. 

As a patient, how does this make you feel?  Do you have any suggestions on how I, as a Social worker, can best approach this patient?  I know there must be some underlying hurt or concern that makes her respond like this.  However, she pushes away that people who are trying to help.
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jbeany
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« Reply #1 on: March 19, 2007, 01:45:33 PM »

I think the anger is pretty normal.  Taking it out on the staff is not acceptable, though.  That she acts that way toward other patients has no excuse whatsoever.  Going in for a treatment is bad enough.  Having a fellow patient screaming obsenities at me would be intolerable.  My center has a form we were required to sign that stated that any screaming, swearing, or abusive behavior would not be tolerated, and that we understood that any such behavior would result in our dismissal from the center.  Does your center have a similar policy?  Can you work at implementing one?  Put it in black and white, and make sure she understands that there are consequences for her behavior.

I have, at times, been frustrated with the staff at my center.  I have bitten back a few sharp remarks.  Sometimes, I have snapped at people.  No one is perfect, and when I'm feeling sick, it's hard to keep in perspective that the staff are only human as well.  But my illness is not an excuse for a total lack of civilized behavior.  No illness is.
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BigSky
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« Reply #2 on: March 19, 2007, 03:29:05 PM »

We had a guy here come early and then bitch and moan about not getting put on early.  He was getting other patients riled up and some of the nurses riled up.  Head nurse told him the "facts of life" and he if he kept it up he would be finding a new place for dialysis.  :thumbup; He is a mellow fellow now.
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lambs
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« Reply #3 on: March 20, 2007, 12:07:50 AM »

Absolutely the person needs to get a grip...and no medical personnel should have to listen to the raving and have people being disrespectful...Also, if I was a patient and has to listen to it I would be upset that the current management of the facility would allow it go on.  I may seek services elsewhere if possible.
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KICKSTART
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« Reply #4 on: March 20, 2007, 02:34:05 AM »

Maybe you should sit down with her and have a one to one, ask her what exactly is bothering her. Unless she has some sort of mental disorder she should find it hard to rant and rave when being given the chance to say what the problems are.
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Zach
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« Reply #5 on: March 20, 2007, 05:17:53 AM »

Shoot 'em!
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Meinuk
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« Reply #6 on: March 20, 2007, 05:34:42 AM »

You also need to look at her outbursts medically.  Anger and depression are pretty common side effects of ESRD, we all handle it differently.  Some cry, others withdraw, some rant, some obsess on IHD...

I remember when my grandfather was dying.  He had been the sweetest old man, but in his final days, he had bouts of psychosis.  His caregivers saw a screaming abusive patient.  But I knew him to be a caring gentle man.  The staff still had to deal with a psychotic patient, but they knew that it was a symptom of his illness.   

As for the disruptive patient, Do you have a complete psych history?  Have you talked to caregivers/family members/referring physician?  Has she always been a problem?  Or is she manifesting a chemical imbalance?

We all are separate and unique individuals with one thing in common.  Disruptive patients do use more time, and I know that in this medical climate you are spread thin.  A little xanax may help (for her!)  :)

From a patient's perspective, I've noticed that because I spend so much time each week on dialysis, I neglect my overall health.  Our kidneys take precedence, but we need to be diligent in addressing overall health issues.  (which reminds me, I need to schedule an appointment to get my teeth cleaned!) 

Dialysis and ESRD can be overwhelming for all involved. That is why IHD helps so many - she obviously isn't a member - if only you could get her to channel her yelling in to a good ole online RANT!

That's it.  My  :twocents;.

Happy Tuesday!
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Ken Shelmerdine
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« Reply #7 on: March 20, 2007, 05:44:04 AM »

Shoot 'em!

 :rofl; :rofl; :rofl; :rofl; :rofl; :rofl; :rofl;
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Ken
renalsw
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« Reply #8 on: March 20, 2007, 12:58:11 PM »

Maybe you should sit down with her and have a one to one, ask her what exactly is bothering her. Unless she has some sort of mental disorder she should find it hard to rant and rave when being given the chance to say what the problems are.
This has been attempted.  She says she does not want to talk and often tells me or the other staff to get out of her face. As her social worker I would like to be able to help her deal with whatever makes her miserable.  It is difficult to know how to dela with someone who gives the appearance of not wanting to be helped.
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kitkatz
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« Reply #9 on: March 20, 2007, 01:48:31 PM »

Ummm. Excuse me.... dialysis is making her miserable.  You go sit in a chair for four hours and have big huge needles poked into you, then have your blood cleaneed and then told to go have a normal life.   Yeah right!  Her life is not normal and you want her to act normal.  Find her an outlet to do while she is there in clinic to get her anger out.  Draw how she feels, write how she feels, you just listen to her.  Give her a tape player and have her record what is going on.  Maybe develop a job in clinic for her to do to help out.  One patient we used to have in our clinic folded and taped up needle packets for the techs to use. 
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« Reply #10 on: March 20, 2007, 02:25:44 PM »

two words: medicinal marijuana
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kitkatz
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« Reply #11 on: March 20, 2007, 02:26:37 PM »

Please!!!
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lifenotonthelist.com

Ivanova: "Old Egyptian blessing: May God stand between you and harm in all the empty places you must walk." Babylon 5

Remember your present situation is not your final destination.

Take it one day, one hour, one minute, one second at a time.

"If we don't find a way out of this soon, I'm gonna lose it. Lose it... It means go crazy, nuts, insane, bonzo, no longer in possession of ones faculties, three fries short of a Happy Meal, wacko!" Jack O'Neill - SG-1
Meinuk
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« Reply #12 on: March 20, 2007, 02:56:29 PM »

Quote
two words: medicinal marijuana

 :beer1;

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52 with PKD
deceased donor transplant 11/2/08
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list: 6/05
a/v fistula: 5/05
NxStage training diary post (10/07):  http://ihatedialysis.com/forum/index.php?topic=5229.0
Newspaper article: Me dialyzing alone:  http://ihatedialysis.com/forum/index.php?topic=7332.0
Transplant post 11/08):  http://ihatedialysis.com/forum/index.php?topic=10893.msg187492#msg187492
Fistula removal post (7/10): http://ihatedialysis.com/forum/index.php?topic=18735.msg324217#msg324217
Post Transplant Skin Cancer (2/14): http://ihatedialysis.com/forum/index.php?topic=30659.msg476547#msg476547

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KICKSTART
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« Reply #13 on: March 20, 2007, 03:43:56 PM »

You say she tells you to get out of her face ..then maybe thats what you should do ? She may be a really private person , i know i am and hate sometimes being treated like i am a 5yr old by some of the staff ( i am in my 40s). Maybe she just cant come to terms with it all ,so doesnt know what else to do except get angry? I know when i go to clinic , i get fed up with all the mundane questions. Maybe if you just ignore her when she starts ranting (seeing you cant get through to her anyway ) she might just stop if she realises she hasnt got an audience ? Its really difficult what to say having never met the person , we all re-act differently.. one day i can go to the appointment a saint and the next time i just snap at all the staff.
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goofynina
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« Reply #14 on: March 20, 2007, 03:50:00 PM »

two words: medicinal marijuana


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Sluff
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« Reply #15 on: March 20, 2007, 04:15:22 PM »

Absolutely the person needs to get a grip...and no medical personnel should have to listen to the raving and have people being disrespectful...Also, if I was a patient and has to listen to it I would be upset that the current management of the facility would allow it go on.  I may seek services elsewhere if possible.

Welcome Lambs,

Please go back to the Introduction and read the site rules here: http://ihatedialysis.com/forum/index.php?board=34.0 and when you are done go to the Introduce yourself Thread and post an introduction here: http://ihatedialysis.com/forum/index.php?board=14.0 so we can get to know you better.

Thanks

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George Jung
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« Reply #16 on: March 21, 2007, 09:44:25 AM »

How long has the person been acting that way?  You can't help someone who doesn't want it so just continue to show compassion and hopefully time will will make things better.  Try to avoid situations that provoke that type of behavior.  No, you nor other patients should be barked at but this person is obviously having a difficult time so be patient.  Wanting to shoot em mentality does more harm than good so I would not recommend taking on that attitude.  Compassion and patience :)
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renalsw
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« Reply #17 on: March 21, 2007, 12:40:03 PM »

How long has the person been acting that way?  You can't help someone who doesn't want it so just continue to show compassion and hopefully time will will make things better.  Try to avoid situations that provoke that type of behavior.  No, you nor other patients should be barked at but this person is obviously having a difficult time so be patient.  Wanting to shoot em mentality does more harm than good so I would not recommend taking on that attitude.  Compassion and patience :)
From what I can gather from staff that has been around longer than me, she has had run ins with staff for years.  The situaiton has escalated because now she has started the cursing and what appears to be blatant disregard for the other patients.  Several of the patients have suggested that she be sent to another unit.  I have dealt with many angry, frustrated patients over the years but this is the first I have had who uses such foul language.  As far as provoking the behavior, it appears that just trying to do what is needed to help wiht her treatment provokes.
Don't worry, I have not resorted to the shoot em attitude.  That's not my style.  Staff and patients are surprised when I get flustered because I am usually so together.
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jedimaster
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« Reply #18 on: March 21, 2007, 01:09:58 PM »

It is sad to hear this kind of stories. As it has been said here it is already hard to deal with dialysis and people reacts in so many different ways. Obviously this person does not know how to focus anger. In my opinion, this person needs professional help...it is out of your hands. I would recommend a referral to a phsyquiatrist.
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Meinuk
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« Reply #19 on: March 22, 2007, 02:03:52 PM »

Quote
From what I can gather from staff that has been around longer than me, she has had run ins with staff for years.  The situation has escalated because now she has started the cursing and what appears to be blatant disregard for the other patients.  Several of the patients have suggested that she be sent to another unit.

Does your unit have an isolation room?  Can she be dialyzed in there?
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Research Dialysis Units:  http://projects.propublica.org/dialysis/

52 with PKD
deceased donor transplant 11/2/08
nxstage 10/07 - 11/08;  30LS/S; 20LT/W/R  @450
temp. permcath:  inserted 5/07 - removed 7/19/07
in-center hemo:  m/w/f 1/12/07
list: 6/05
a/v fistula: 5/05
NxStage training diary post (10/07):  http://ihatedialysis.com/forum/index.php?topic=5229.0
Newspaper article: Me dialyzing alone:  http://ihatedialysis.com/forum/index.php?topic=7332.0
Transplant post 11/08):  http://ihatedialysis.com/forum/index.php?topic=10893.msg187492#msg187492
Fistula removal post (7/10): http://ihatedialysis.com/forum/index.php?topic=18735.msg324217#msg324217
Post Transplant Skin Cancer (2/14): http://ihatedialysis.com/forum/index.php?topic=30659.msg476547#msg476547

“To doubt everything or to believe everything are two equally convenient solutions; both dispense with the necessity of thought.” - Henri Poincare
renalsw
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« Reply #20 on: March 23, 2007, 10:41:06 AM »

Quote
From what I can gather from staff that has been around longer than me, she has had run ins with staff for years.  The situation has escalated because now she has started the cursing and what appears to be blatant disregard for the other patients.  Several of the patients have suggested that she be sent to another unit.

Does your unit have an isolation room?  Can she be dialyzed in there?
Yes, we have one.  The problem it is strictly for those who are Hep B positive. 
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Duane
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« Reply #21 on: April 21, 2007, 03:42:17 AM »

Grace and Peace :grouphug;

A SW asking professional advise concerning patients from patients on what makes an angry patient act like a lunatic. emmmm interesting. This is good logic.

Lunatic = suffering from lunacy, wildly or giddily foolish, crazy, moon.
Lunacy = mental derangement associated with certain phases of the moon, insanity, foolish and irresponsible conduct.

Or you have a person's environment, influences and such.

Now a SW is trained and ceritified as a licensed SW so i would think so, which would require refresher courses over the years and when a SW is faced with a problem beyond the scope of what the SW already knows that's when referral experience comes in. I would recommend a psyc or something.

When i'm clear minded like now, i see things 2 ways, 1 natural (earthly) 1 spiritual (heavenly).

For when i see in the natural which is most of the time, it's earthly and full of things down below and there is a huge list of things and attitudes.

But when i see in the spriitual i see Love, truth, good, pleasant things not things that hurt me.

I told one guy at the center one time, he was cursing and moving around very loud, etc..i said; sir, if you knew who you really were and how you sound, you would'nt be acting like that.

He said; I don't give a d..... etc.. i said ok, well my Father and I do care and we love you and want the best for you and i asked if he would like me to pray with and for him right now. he said yes and the rest is history.

I'm not ashamed of giving the "good news" to someone about eternal life as it was given to me.

See i know for a fact that in the near future i will be taking off this old body of mine that's dying every day and will be given a new body everlasting that means, no break downs or malfunctions for ever and ever.

My Father and his Son is preparing a place for me and my Family members and i have family all over this world who believe the same. There's room for everyone.

Real Love is the answer.

We all have dreadful stories to tell on a daily basis, we are in so much pain inside, it affects our entire being. We come from all walks of life, abused, used, sheltered, you name it, the dialysis center is going to meet that person.

I come there with my baggage, whether being good or bad, you come with yours, and then there is everyone else including staff, that's a lot for an employee to handle.

Let's pray for all staff at all the dialysis centers everywhere, they have there hands full. :clap;
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