The Resident Crying After a Phone Call
Mrs. Grant is 80 and usually cheerful. This afternoon she took a phone call from her son and afterward stayed in her room crying. When you check on her she says, "He's not coming for Thanksgiving. Nobody comes anymore." She has not eaten lunch and does not want to go to the group activity. She says she is fine and asks you to leave. She denies any thoughts of hurting herself. Her daughter lives out of state, and her son visits about once a month. This is the third time this week she has skipped a meal.
1. How do you respond in the moment, and what do you avoid saying?
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I would sit down at her level, give her time, and listen without rushing to fix it. I might say, "That sounds really hard. You were looking forward to seeing him." I would avoid saying "Don't cry," "Cheer up," or "At least your daughter calls," because those dismiss her feelings. I would not promise that her son will come or make excuses for him. I would ask what would help right now and offer a choice, such as bringing a tray to her room or sitting with her for a few minutes. I would respect her request to be alone for a bit but would not just walk away without checking back. I would also notice that she has missed meals three times this week, which is a pattern worth reporting.
2. She denies self-harm. What still needs to be reported, and to whom?
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Even without thoughts of self-harm, this needs to go to the nurse: crying, missed meals three times this week, staying in her room, and refusing activities. Changes in eating, mood, and withdrawal can signal depression or a medical problem, and the nurse and social worker need to know. I would report what I saw and heard objectively, without diagnosing her. I would also tell the nurse that she denied self-harm, since that is important information. If she ever expressed a wish to die or to hurt herself, I would stay with her and get the nurse immediately, because that is urgent. I would follow facility policy on documentation and on involving the social worker or chaplain if she agrees.
3. How would you support her independence and connection over the next few days without being pushy?
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I would make small, low-pressure offers rather than demands. I could ask if she would like to eat in the dining room or in her room, and bring a tray either way. I could invite her to one activity she used to enjoy rather than the whole schedule, and offer to go with her. I would find out whether she can call her daughter or whether a video call could be set up, with her permission. I would keep checking in briefly and consistently so she knows someone notices her. I would share what works with the team so the approach is consistent. The goal is to respect her choice to be alone while making connection easy and showing that she matters.