Diplomatic Persuasions

[Vikki 0]

We have a resident who becomes very combative when it is time to go on the Joy Ride outing. She is in a wheelchair and is also on oxygen. She isn't able to hold herself up with a walker, so when we go on the bus she is in one of the wheelchair spaces in the back.

 

Lately, she has become really combative once we start putting her on the bus because she wants to ride in one of the other seats "like all the normal people". For one, it is sort of distressing to the other lady who sits beside her in the other wheelchair and it also fouls the mood for all of the other residents on the bus because she is so boistrous about her displeasure and complains loudly during the ride with comments such as, "I don't see why I have to sit back here in this prison, it's not right to treat people like this."

 

I don't have a problem doing a transfer to a seat, but she has the huge, bulky oxygen tank strapped to the back of the chair and she has to have the oxygen. So I don't know how to resolve the thing about the oxygen so she can sit in a regular seat. We've talked about trying to get one of those carts we can put the tank in and wheel it to her seat, but someone would have to hold it for her while she rides because she is rather frail. So the only way I can think to do it is to get her up on the lift, somehow do a transfer up to a seat, put her oxygen tank in the portable cart and then bring that up to the seat, have someone hold it and then take the wheelchair off the bus so someone else can use the wheelchair spot.

 

I'd hate for her not to ride at all, but it is really starting to be a problem for the whole group because it has created such a fuss recently and she is becoming so combative.

 

Then my other concern is if we figure out a way to do a transfer for her, everyone else who is in a wheelchair will be wanting to do the same thing and then it will take over an hour just to get people on the bus to get ready to go instead of the 20 minutes it usually takes us to load the bus. The other residents who walk onto the bus already complain about how long it takes to load and get everyone buckled and secured.

 

There has got to be some kind of diplomatic compromise to resolve this, but I'm sort of at a loss right now.

[Guest Lo]

Not sure how big this O2 Tank is, but ours are not that bulky. (They are the size of two 1/2 Gal. plastic milk bottles on top of each other) We have had people with walkers or WC transfers, when seated keep the tanks between their feet on the van. Maybe you could use a plastic "milk cart" to contain the tank on the floor. PS. Did you check with Nursing about the O2 tank? Many of the Residents on O2 can be off them for a limited amt. of time with no consequences

[KateAA 0]

First, I would actually get in a wheelchair and look to see what the resident see's on the bus ride....On some buses, the wheelchairs face the lift and they actually can't see anything. And if the resident has glasses she might need a new perscription. I had a resident who "wanted to go out" and everytime we put her on the bus she was miserable until we got to where we were going. It turned out that she would get car sick becasue she couldn't see that well.

The second thing would be to schedule another type of trip where you can transfer her and take some residents that may want to go out, but haven't had the chance. OR assertively request that a CNA or Nurse go out with you and hold the O2 bottle. There are smaller tanks that one can use that are more portable. Discuss and care plan this as there could be other members of the team that might have a good idea.

Hope that this helps

[BartMan 0]

Yes , i agree with the smaller O2 tank. There are so many O2 tanks out there now that would benefit this Resident , then you could look into transferring her to a bus seat and letting a Nurse or Aide/Tech ride beside her............ Let us know how it works out !!!! Your Fellow AD , BartMan

[Vikki 0]

Thanks for all of the great input! I talked to her personal care assistant about the tank and we're trying to get a smaller one. The assistant can hold it for her, as she is too frail to do so. The assistant is concerned, however, about her frailty and hip problems. I am going to try to find a solution with one of the nurses about if there is a safe way to transfer her without causing injury since it's a tight fit along the aisle. In the mean time, I have been trying to make the window space available to her, but she has become even more combative. After talking with one of the other department managers I learned about the oxygen deficiency problem she has that requires her to be on oxygen and how that affects her mood a lot of the time. Which explains a lot about other behavior I have noticed when not doing outings.

 

When doing games, discussion groups or other programs I ask if she wants to join us and bring her over to the group, but really she wanted to argue with me about why she has to wear her oxygen. She wants to take it off a lot, but her personal care assistant explained that she pretty much has to have it on all the time because of her condition. I can only imagine how frustrating that must be for her. She often talks about wanting to "get out of this prison" and "why can't I be treated like a normal person". Since it is in her best interest to have her oxygen on, the only thing I can do for her is voice my empathy for her situation and try to show understanding for her frustration. A few times I have been able to get her mind off things during an activity, but often she will be vocal and loud about her predicament and many of the other residents become upset about it. I just try to redirect her back to the activity or politely change the subject by pointing out how nice her flower arrangement is coming along, etc. She's smart, though. She has this really mischevious gleam in her eye and she'll grin at me and go, "oh, I know what you're trying to do." It seems to be working much of the time, however, so I've decided I'm not above trickery. Hahah.

[Pennie 26]

Hi

I think that the oxgen problem has been resolved for you in all of the helpful replies that you have gotten from the others.

But what about the ladies attitude? You have discovered some of the underlying cause for it. But my question is how unfair she is making the outing as well as your activities fo rthe other res. They have voiced a concern about the lenght of time it takes to load/unload the bus. You said it effects the mood of everyone. This problem seems to me that it is a concern of the other res rights to have an enjoyable outing & activity. Maybe this lady should speak to Social Services about learning how to deal with her health issuses &/or speaking to her about her her negative comments is effecting others. She should be made aware of this (I am sure she already knows this) and how this needs to be resolved or addressed. Is this part of your question? A problem that you are asking for advise as well? Just a thought that went through my head as I read your posting & the replies. I personnel have a hard time, as I am sure most of do, with behavioral problem res. Let know how it is going what is working & not working. Maybe other AD's have been here before & can share the experinces with us.

[BartMan 0]

Hey Pennie ! How are ya ? Hey, funny thing ya mentioned what you did . I just had to remove a Resident from Bingo because of disruptive behavior. And then he wondered why I did what I did. After I explained it to him and he finally calmed down he was willing to give it another try. Now this Res. is fully alert and after all was done he was able to realize what happened. This is very difficult to do with a Resident that has cognitive difficulties.Know what I mean JellyBean? How is the Coginitive level with the Resident on the Bus ? BartMan