If you work in the health care field taking care of patients suffering from dementia, chances are good that you may have experienced combative behavior from one of the residents of the long-term care facility where you are employed. Dealing with these behaviors is challenging, as the Department of Health and Human Services (HHS) discovered that approximately 6 percent of the million or so residents receiving care in nursing homes act physically aggressive toward staff and others at least once a week.
Some residents have longstanding psychiatric diagnoses that complicate their management and treatment in nursing homes. Others only began to display these aggressive tendencies after they were diagnosed with Alzheimer’s or other conditions that affect their cognitive abilities. Either way, a nurse or aid could be walking into a lion’s den of danger when entering a combative resident’s room to provide care.
Minimize risk of injuries
To protect vulnerable caregivers and other residents, the facility must have strict protocols in place to assess and evaluate patients who may be at risk of becoming combative. Educating and training caregivers in identifying signs that a combative episode is about to take place can reduce risk of injuries to them and others. There are often both extrinsic and intrinsic factors and specific triggers that can escalate aggressive behaviors. Being able to head these off at the pass is an important skill for caregivers to cultivate.
It’s important to understand that combativeness is often a result of a patient’s frustration with their inability to communicate their wants, needs and desires. As most dementia-related conditions are progressive, a resident who was docile and pleasant during the early phases of the disease can become unruly and lash out as the disease progresses and robs them of their ability to communicate effectively.
Prevention and de-escalation techniques
Staff should maintain their composure when a resident begins to act out. Try to calm the resident by using low tones and smiling. Never approach a combative resident from behind. Listen attentively and offer support by paraphrasing what you believe they are trying to express. Be aware of defensive posturing, e.g., crossed arms, as they can convey nonverbal negativity.
If a resident is agitated, stand out of arm’s reach of them as you continue to assess and monitor their actions. Redirection is useful but must be done before the incident escalates too far to be effective.
Pain can bring on aggression
Make sure that the resident is physically comfortable and not in pain. An undiagnosed urinary tract infection (UTI) can cause a patient to act out aggressively to caregivers. Untreated bedsores, dressing a resident too warmly for their comfort or dressing them in clothing that is too tight or restrictive can all spark a violent confrontation with staff.
What can an injured caregiver do?
If you were injured on the job by a combative patient, you have the right to file for workers’ compensation benefits to assist you in your recovery. You should be eligible for both medical and financial benefits and must file a timely claim in order to take full advantage of the recourse available to you under the law.