I can understand why you would be uncomfortable. We each have a distance that we like to stand away from others-kind of a "safety zone". If someone gets too close, our instinct is to back away. To answer your question,first I'd like to give you some background information.
The amount of personal space we each need is different for each of us, and it's different depending on the situation or relationship we have with the other person. Also, some cultures like more or less space. It's good that you know how much space you're comfortable with.
There are several different levels of comfortable personal space. Public space is the farthest, and would be like when you're boss is holding a meeting-there is a large space between them and the group. Social space would be when we're with friends or co-workers. Depending on how well we know (and like)the other person, we might stand little closer-or further away. Personal space is when we're with close friends and family- we're comfortable being closer. Intimate space is usually reserved for the people we're closest to and we're comfortable with touching, hugging, etc.
Now think about your relationship with your residents. How close do you stand? Even though we're not family or loved ones, as caregivers, a lot of the time our answer is "Intimate space! To provide care, me must enter the resident's "Intimate space" This can create a lot of problems, especially if the resident has even just a mild cognitive impairment; it's more of problem if the person has dementia. A person with a history of mental illness, "neurosis" or personality disorders can also have "intimate space" difficulties. Have you ever had a patient with dementia become "combative" while you're trying to give them a bath or change their Attends? How about a patient who refused to bathe? We all have. One of the most common causes is that we invaded (or tried to invade) their intimate space!
It seems that with this patient, they're having the opposite reaction. You know that your relationship is a professional one, but they don't. In their mind, you have an intimate relationship, after all you've already seem them undressed, help them in the bathroom, and have possibly touched their private parts. They don't understand why you're "rejecting" them now!
Now that you have some background information about the types of comfortable space & how caregiving crosses into intimate space, what can you do about it?
First, any time there is a behavior problem on a nursing unit you must bring it to the attention of your charge nurse. A behavior plan needs to be developed and shared with all the staff and family members. If it's not, and each caregiver-or each shift-does things differently, the confusion and mixed signals can make the problem worse!
Then, you'll need to figure the "ABC's" of the behavior:
Antecedent (What was happening before the behavior?)
Behavior (What is actually happening?)
Consequence (What happened afterward?)
Some things you'll want to notice:
Does it only happen on the evening or night shifts when the unit's quieting down and there are less people around?
On the weekends?
Right after a family visit-or if they haven't received a visit?
Does the behavior only happen with certain staff? Does that staff person remind the patient of someone significant in their life? Have they treated the patient especially kindly-or "special"? Sometimes we do that without realizing it, which can send the wrong signal.
Something important to remember: Humans are made to have intimate relationships. Could your patient be feeling lonely or craving intimacy? While it is not our role to fulfill a patient's need for an intimate relationship, the need is something to remember; it doesn't go away when a person reaches a certain age or goes into a facility.
After giving the behavior more thought, and have some ideas why it might be happening-what can you do? Your approachl depends on what you've come up with!
First, it's usually easier to prevent the problem than to stop it. For example, if you know that every night, about 9pm, Mr Jones comes down to the nurses station and tries to rub your back. Well, tonight, as you see him coming, you position yourself so he can't get behind you. Maybe stand behind the desk or linen cart. When he's about 10 feet away, greet him and offer your hand. Ask how he's doing and have a little small talk. then tell him how you'd love to talk more, but you must get your work done. Offer him a cup of juice, and help him back to bed, always keeping yourself at arms length and avoid entering "intimate space" if possible. If he tries to touch you, take his hand and step away a little so you're in control of the distance. Gently and professionally, say "Good night, Mr Jones. I'll see you tomorrow evening." If he objects or acts/voices hurt or rejection, acknowledge the feeling with kindness but honesty, "I'm sorry you feel that way, Mr Jones. I didn't mean to hurt your feelings. I enjoy my work as a CNA and enjoy helping you and the other residents. I'll see you tomorrow." Saying this reminds the patient what your relationship is-a professional, helping relationship.
This approach might work-or not. You might need to go back to the drawing board.
All behavior problems should be documented according to "The ABC's": Antecedant (What happens before) Behavior (Who, What Where, When) and Consequence (What happens afterward)
The problem you're having didn't happen overnight-or did it? Any time there's a sudden behavior change it must be addressed immediately-it could be a sign of an urgent medical illness!
but more likely, the behavior you've described has been gradually getting worse over a period of time, so you might need to try a few different things to find something that works. Have patience, be creative and don't be afraid to think outside the box! Remember to never act alone! After listening to all staff members involved, and consulting with the doctor or psychiatrist if needed, your Charge Nurse will develop a plan for everyone to follow. Make sure you document what happened when your followed the plan so it can be reworked if needed. Also, the plan might need to be adjusted at any time along the way. Hope this helps. Pat, RN
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