Commentary

Evelyn is newly resisting care that she usually accepts. Assess the change for delirium and possible illness, rather than only recording her behaviour. She also has immediate reasons to be distressed: she does not hear the explanation, movement hurts and several staff approaching together frighten her.

Staff stop and assess these problems before resuming necessary care. The nurse checks hearing, explains the next action and seeks clinical assessment of the new change and pain. Staff time care according to the revised pain relief plan and ask Evelyn to do fewer things at once. These actions follow the distress guidance in T01 and recommendations to address causes and communicate effectively [G01].

Evelyn still has delirium after she accepts help with washing. That improvement does not establish that her thinking has recovered or that hearing loss explained all her difficulties. Future attempts at care may still be difficult. Continue the approach that helped and report symptoms that return or worsen.

Before repeating an unsuccessful attempt at care, assess what has changed and what the person may be experiencing. The accompanying sources describe related clinical situations. They do not describe Evelyn’s life or the exact sequence in this example [S05, S30].