Advancing patient-centered care in hopes of improving the quality of life for residents with comorbidities. The COE-NF advocates for an empathetic approach to resident resistance.
Case Description: The COE-NF regional behavioral specialist (RBS) was contacted by a facility requesting assistance for a resident with a dual diagnosis of schizophrenia and bipolar disorder and a history of trauma. The resident was exhibiting aggressive behavior towards other residents and staff. The resident’s current medications were not effectively managing her hallucinations/delusions, and her symptoms had worsened since admission. Additionally, she was resistant to any proposed medication changes.
Unique Challenges: The resident’s unmanaged symptoms may have been contributing to her aggressive behavior. However, she was hesitant to change her medication or meet with a mental health practitioner. The resident had ongoing conflicts with neighboring residents, leading to verbal and physical aggressive outbursts.
CO-NF Solution: After the initial assessment was complete, the RBS recommended the following:
- Psychiatric medication evaluation for symptom stabilization (outpatient or inpatient if needed).
- Involving people with whom the resident has a relationship to discuss the benefits of medication and counseling support.
- Counseling/therapy services.
- Discussing the resident’s long-term goals.
- Relocating the resident to a location where they won’t be unintentionally disrupted by other residents.
Outcome/Benefits: Of the five recommendations, the facility point of contact reported:
“Thank you for following up. Your resources/recommendations are appreciated. A lot has happened in the last 24 hours! I was able to get a hold of one of [Resident]’s sisters last night, who gave me some insight into why she is so fearful of taking medications or medication changes. She was also able to speak with [Resident] and convince her that it would be in her best interest to consider some medication adjustments for her comfort. [Resident] met with the Psychiatric Nurse Practitioner today, and she agreed to have her current medication increased. I also visited with [Resident] this afternoon about counseling, and she opened up to me about why she doesn’t feel it would be helpful. I was able to talk with her about her concerns but also point out some benefits, and she was agreeable to at least meet the counselor to see if this would be someone she felt she could talk to. The appointment is next week.”
The RBS provided the facility with comprehensive educational materials, including the COE-NF’s De-escalation Toolkit, Ten Ways You Can Support a Resident with a Schizophrenia Diagnosis Flyer, and the Comfort Menu. These valuable resources will be integrated into the facility’s training program to ensure that permanent and agency staff receive the necessary education and support.
