One fact of working as a certified nurse assistant is that we will come into contact with residents that are combative or abusive. Some are suffering from dementia, while there are a few here and there that are actually enjoying the freedom (or perceived freedom) to be mean. Not everyone will be honest about that – but there are people on the planet that are mean and even they grow old.
People that have any sort of dementia are liable to forget who you are and what you are doing. Even when you are in the middle of an activity that you have done many times with the same resident, if they have an episode where they have forgotten where they are and who you are, it can become a combative situation fast.
If a resident becomes combative or abusive during care, the best course of action is to make sure the resident is in a safe place and then walk away. Combative episodes are made worse when you try to restrain the resident in order to finish any type of care. Give the resident time to calm down, go perform care for another resident, then come back. If the resident is still having issues understanding that you are there to help them, you may need to speak with your unit nurse for help.
With residents that enjoy causing trouble for other residents and aides, there are a few things you can do. The most important is to try to always have another aide with you when you are giving personal care to the resident in question. This gives you a witness in the event that the resident accuses you of improper or unprofessional behavior. If another aide is unavailable, speak with your supervising nurse. Keep a pocket notebook handy to jot down any comments the resident makes towards you, any incidents that happen, and anything else that may be important during the time you are giving care to a resident that is known for causing problems among staff.
If all else fails with a resident that you seem to have conflict with, you can request to be moved to another unit or you can trade assignments with your hall partner. It may not always be possible to avoid residents that you have conflict with, so try to always maintain your composure and walk away when needed.