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Long-term care nurse finds ways to reach challenging clients

Monday February 25, 2013
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I could share numerous stories about the people I cared for during my many years working as a nurse in correctional facilities. Sometimes I almost lost my cool because of their behavior, and other times I went home and cried. I know I should not take my job home, but it happens.

I am going to share two stories. The first is about a man named "Joe," who was a very challenging individual. Joe did not like where he was and kept making demands of the nursing and security staff. First he did not want his vital signs taken or finger stick performed, nor any medication or nursing care, then he demanded that care two hours later. At times he would not eat for days, which dramatically affected his glucose levels.

One day I went to his room and found he had fallen and cut his arm. Because it was time for his finger stick, I told him I would take the sample from his arm. He said, "You cannot do that. You can only do it from my finger." I replied, "Blood is blood, isn’t it?" He started to laugh. "No matter how hard I try, I cannot get mad at you Ms. Mary," he said.

That was the start of a working professional relationship between us. Because he was so dangerous to himself and the staff, he needed four security officers with him at all times, especially during nursing care time. He refused all care from everyone except me. He told me he adopted me as his mother, and depending on his behavior, I would call him my son or stepson or distant cousin. I always made sure he was aware it was a professional relationship.

In this setting, the patients are supposed to have no choices. I always would give patients choices, especially Joe. I asked permission to come into his room. I asked him which finger I should prick for his glucometer reading, if I could take his vital signs, etc. He liked having choices, and I respected his choices, even when the answer was no.

It is important to give patients choices and information that allows them to make informed decisions about their healthcare. In this institution, the nurse was responsible for doing the teaching. Joe eventually moved to another institution. The first night he was gone, everyone admitted they missed him and wondered how he was.

The second person who tugs at my heart was a difficult, demanding elderly lady. Nothing we did satisfied her. The food was too hot or too cold. She said we had not given her pain medicine, when in reality she had received it 15 minutes earlier.

It got to the point that I was losing my cool with her. I prayed to God for an answer about dealing with this difficult individual. Then a light bulb turned on: Why not treat her with kindness? I asked if she would like to take a shower in the morning. She said she could not stand up. I told her I could help give her a bed bath. She agreed.

The security staff sergeant and I gathered all the items we’d need for personal care. I filled a basin of nice, warm water. I asked her if she wanted soap to wash her face, and she said no, she never washed her face with soap. I told her how good her skin looked. She told me the answer is not to use soap, ever.

She did all the washing herself. She also brushed her teeth and brushed her hair. Her hair was down to her waist and full of knots. She worked and worked, and next thing we knew, she had beautiful, free-flowing hair.

The next day the daytime charge nurse told the patient something looked different with her. The patient said Ms. Mary had helped her have a bed bath. The daytime charge nurse complimented her on her appearance, and the patient became much more cooperative and pleasant.

When she was discharged, she left a message for me: "Tell Ms. Mary I love her." •


Mary Clare McNamee, RN, worked as a nurse at correctional facilities in Maryland for 20 years. She is an agency nurse and a weekend RN at two adult day care centers, and is working toward her BSN. Send comments to editor@nurse.com or post comments below.