>> Well, I can certainly appreciate your concerns and why you tried the rotation idea.
But I'm wondering whether the frequent staff rotations might, in fact,
be part of the problem, adding to the residents' confusion.
Let's shift gears a bit here.
Can you share some details about any patterns that might explain what's happening?
For example, the daily routine can be especially important for elderly patients.
At what time of day do most incidents occur and are they mostly in his room
or in other places such as the common area or dining room?
>> Now that you mention it, it's almost always early evening before dinner that Mr. Otis doesn't want to get out of bed.
And isn't that when Mrs. Ellis is also the most abusive?
>> That's right.
At times, they both resent having to eat in the dining room all the time.
And also if I've been off or working in a different unit, Mr. Otis will ask where have you been?
Who are all these people that I don't know coming in here to disturb me?
>> I agree with the importance of some structure in residents' daily routines and not just letting frail people stay in bed
or perhaps miss dinner, but I would like to suggest you consider how hard and fast those routines have to be
or what residents may experience as inflexible or controlling.
So let's try this.
For the next month, why don't each of you -- Maria and Louis -- keep a brief daily log of each abusive incident.
Make note of the time of day, what nursing activity was involved, the nature of the conservation.
Write down the length of time for each interaction and a description for the incident.
Was it verbal, hitting, yelling?
Then let's see if we notice a pattern.
In fact, to get a fuller picture, do the same thing for all of your interactions with Mr. Otis even if they're not abusive.
So how does that sound?
>> That sounds good.
>> Excellent.
>> Good.
>> Great.
>> Yeah?
>> Yeah.
>> Okay. Well let's get together in a month and see what we find.