【The Reality of Nursing Care】How to Deal with Dependent Complaints? Lessons Learned from Daily Life with a 92-Year-Old Resident

In the field of nursing care, there are moments when a mindset of "how to face the person" is required more than knowledge or skills.

One day, I received a consultation from my colleague, Mr. T (a 67-year-old certified care worker).
Mr. T is in charge of a 92-year-old female resident at a newly opened elderly health facility.
She has moderate dementia and very specific preferences, and Mr. T and her family are exhausted from their daily interactions with her.

Listening to Mr. T's story, I realized thatdeep anxiety and confusion, rather than mere "selfishness," lie behind her behavior.
So, based on the concepts of Cognitive Behavioral Therapy (CBT), I helped him organize a way to handle the situation.

First, I will introduce the consultation text sent by Mr. T.

What I felt from Mr. T's consultation was that
this resident's behavior might bean expression of anxiety or loneliness in her heart, rather than just "selfishness" or being a "difficult person".

And there are many structures in nursing care settings where staff who are sincerely trying to help, like Mr. T,continue to worry about "how they should respond".

Therefore, from the perspective of Cognitive Behavioral Therapy (CBT), I organized the response with Mr. T and summarized it into the following four chapters.

📘Structure: Understand it in 4 chapters! Tips for on-site responses

Chapter 1: "Understanding the 'Cognition' Behind Behavior"

→ Why does the resident repeat her complaints? We focus on her "way of thinking (cognition)" rather than her "surface behavior."

Chapter 2: "Support and Organizing Cognition in Relationships with Family"

→ Families are also unknowingly caught in a vortex of stress. I will explain how to devise ways to interact with families.

Chapter 3: "Concrete Behavioral Intervention and Habit Building for 'Dependent Complaints'"

→ I will introduce many "concrete examples of responses" and "ways to create peace of mind" that can be practiced on-site.

Chapter 4: "Staff Self-Care and Team Collaboration"

→ The most overlooked aspect: "Self-care for those who provide support." It is also important to devise ways to protect the staff's hearts.

Now, let's look at them in order, starting from Chapter 1😊🌱
From here on, based on the perspective of Cognitive Behavioral Therapy (CBT), I will carefully delve into concrete response methods while focusing on the "way of thinking behind the behavior (cognition)" in our interactions with Ms. A🌿✨

🌟Chapter 1: "Understanding the 'Cognition' Behind Behavior"

🧠 Why does Resident A 'repeat complaints'?

When moderate dementia progresses, as in the case of Resident A, feelings of "anxiety" and "confusion" intensify, and to fill the void of loss of control, "behavior that involves those around them" increases.

In Resident A's case, the following **thought patterns (automatic thoughts)** may be at work.

$$
\begin{array}{|l|l|l|} \hline
\text{Behavior} & \text{Underlying Thought (Cognition)} & \text{Emotion} \\ \hline
\text{Change the doctor!} & \text{The current doctor doesn't understand me} & \text{Anxiety/Fear} \\ \hline
\text{Calling out loudly} & \text{No one cares about me} & \text{Loneliness/Anger} \\ \hline
\text{Refusing to eat} & \text{My complaints are being ignored} & \text{Helplessness/Anger} \\ \hline
\text{Complaining to family every time} & \text{Family should be on my side} & \text{Desire for reassurance} \\ \hline
\end{array}
$$

🧩 Steps for Utilizing Cognitive Behavioral Therapy (CBT)

In cases like Resident A's, it is effective to focus on the cognition → emotion → behavior cycle, carefully interpret the "cognition (way of thinking)" that leads to the behavior, and interact in a way that fosters a flexible perspective.🌷

🌼1. Shifting the staff's perspective from "anger" to "understanding"

It is natural to feel exhausted by Resident A's words and actions. However, for Resident A, "complaining" may be their only means of SOS.

💡Reframing examples:

• "They're being selfish again..." → "Resident A is feeling very anxious right now."

• "Are they trying to cause trouble on purpose?" → "They might be trying to confirm their own existence."

🌼2. Creating a system to "anticipate anxiety and provide reassurance"

"Anxiety" grows from a lack of predictability. → By providing Resident A with a "predictable environment" where they know "this will happen next, so it's okay," their anxiety may decrease and their complaints may settle down.

✅Practical examples:

• 📅 [Resident A's Mini Schedule]: "The doctor's visit is tomorrow," "Bath time is in the afternoon," etc.

• 📖 [Request Log Notebook]: "I will tell the doctor. I'll write it down here."

• 🔔 [Routine Check-ins]: Make it a habit for one staff member to confirm "How is your pain or physical condition?" every morning, noon, and night.

→ The reassurance that "I am being heard even without shouting" will reduce the frequency of complaints.

🌼3. Let them accumulate "small successful experiences"

When feelings of helplessness such as "nothing I do matters" or "no one will help me" intensify within Resident A, aggressive or avoidant behaviors become more likely to appear.

💡As a countermeasure:

• 🌸Give them a "role" (e.g., towel folding duty, helping to create seasonal decorations)

• 🍵Consciously create "moments to be appreciated" (e.g., "We are so happy when you are doing well, Resident A!")

→If their self-efficacy—the feeling that "I can still be useful to someone"—is restored, their dissatisfaction and aggression will also soften.

🌼4. Examples of reframing Resident A's "automatic thoughts"

$$
\begin{array}{|l|l|} \hline
\text{Resident A's words} & \text{Staff response (CBT-based approach)} \\ \hline
\text{"I can't trust the doctor here!"} & \text{"He is a doctor who has taken care of you for a long time, isn't he? But the current doctor also examines you very carefully."} \\ \hline
\text{"No one cares about me!"} & \text{"We care about you, Resident A, which is why we check in on you every day like this."} \\ \hline
\text{"It hurts! Take me to the hospital quickly!"} & \text{"It makes you anxious when it hurts, doesn't it? I have already told the doctor. They will see you right away."} \\ \hline
\end{array}
$$

→The key is "acceptance" of emotions + "providing reassuring information"😊

This concludes the content of Chapter 1: [Understanding the "cognition" behind behavior]🌱
Next, I would like to proceed to [Chapter 2: "Support and cognitive organization in relationships with family"]✨

🌟Chapter 2: "Support and cognitive organization in relationships with family"

🧩 Families are also parties to "invisible stress"

Family members who continue to listen to complaints during daily visits, like those of Resident A, may be feeling a psychological burden where they feel "I am not providing care, but I am just as tired as if I were."

In particular, when an elderly parent says "Help me," "That doctor is no good," or "The facility is cold," they easily fall into the thinking of:
➡ "I have to do something about it"
➡ "I have to listen to them."

This is also called the "trap of responsibility" and can trigger depression and fatigue in caregivers.

🧠 An example of family cognitive patterns (actually common)

$$
\begin{array}{|l|l|l|l|} \hline
\text{Complaint} & \text{Family's thoughts} & \text{Emotion} & \text{Action} \\ \hline
\text{"The doctor is incompetent so I'm not getting better"} & \text{"Maybe that's true... I have to get them changed"} & \text{Anxiety/Impatience} & \text{Contacting/complaining to staff} \\ \hline
\text{"They don't do anything for me"} & \text{"I feel guilty... I have to do something"} & \text{Guilt} & \text{Increased visit frequency/fatigue} \\ \hline
\text{"I want to go home"} & \text{"Was it a mistake to put them in a facility?"} & \text{Regret/Confusion} & \text{Self-blame/Inability to act} \\ \hline
\end{array}
$$

When such "cognitive distortions on the family side" exist, it is necessary to carefully attempt to correct them.

🌼 Pillars of support: 3 steps of "family support"

🔹1. Ensure consistency in information sharing

When there is a "gap" between the staff's approach and the family's approach, Resident A's confusion intensifies, leading to an increase in problematic behavior.

💡 Countermeasures:

• Explain the "background of Resident A's behavior" and the "importance of consistent responses" during mini-meetings with the family

• Regularly share a simple "communication sheet" or "request note" that summarizes the response policy

🔹 2. Teach the family how to "accept emotions"

Families tend to think, "I have to respond to everything they say," but
in reality, there are many cases where "just listening is enough to provide peace of mind".

✅ Example:

• "That must be hard," or "You must be feeling anxious," byempathizing with their emotions

• Then, "But it's okay because you are being seen by the doctor for that now," byreturning to a realistic response

➡ It is important to practice the flow of **"Empathy → Reassuring Information → Setting Boundaries"** together with the family✨

🔹 3. Suggest "self-care" for the family themselves

Protecting the family's own health and life also leads to the stability of Resident A.

💬 Examples of what to say to the family:

• "Thank you for coming every day. It might be good to limit visits to a few times a week and take some time for yourself."

• "For your mother's sake as well, the family being healthy is the greatest support of all😊"

🌟 Let's support the family so they can notice if they are "sacrificing themselves too much."

💡 Concrete "tool" suggestions (strengthening cooperation between family and staff)

• 📔 Visit record notebook: Record the resident's complaints → Staff check the content and write down replies or response plans

• 📅 Posting a weekly schedule: Visualize medical exam dates, recreation plans, bathing days, etc.

• 🧩 Information sharing card: Hand over a paper briefly stating "Resident A's condition this week," "current treatment details," "doctor's opinion," etc.

This leads from "anxiety due to lack of information" to "conviction, peace of mind, and trust"🌈

This concludes [Chapter 2: Support and Organizing Perceptions in Relationships with Families]😊
Next, in [Chapter 3: Concrete Behavioral Interventions and Habit Building for 'Dependent Complaints'], I would like to delve into coping methods at the behavioral level that staff can take💪✨

🌟Chapter 3: Concrete Behavioral Interventions and Habit Building for 'Dependent Complaints'

For someone like Resident A, the balance of "responding without getting too caught up in emotions" and "increasing the person's sense of security without strengthening their dependency" is very difficult, isn't it?😌💦

Here, we will organize concrete countermeasures that staff can take by applying the techniques of behavioral activation and environmental adjustment from Cognitive Behavioral Therapy (CBT)!

🔹1. View 'complaints' as 'behavior'

Resident A's complaints like "Change the doctor!" or "Let me go to the hospital quickly!" are emerging as behavior to reduce anxiety or discomfort.

In CBT, such behavior is analyzed as follows:

$$
\begin{array}{|l|l|l|l|l|} \hline
\text{Trigger} & \text{Cognition (Thought)} & \text{Emotion} & \text{Behavior (Complaint)} & \text{Result} \\ \hline
\text{Felt pain} & \text{"Maybe it's another fracture..."} & \text{Anxiety/Fear} & \text{Complains of wanting to go to the hospital} & \text{Gets a response/Sense of security} \\ \hline
\end{array}
$$

💡If staff understand this flow, it becomes easier to devise ways to aim for the 'person's sense of security' while avoiding the 'complaint reinforcement loop'.

🔹2. Strive for responses that are not 'reinforced'

❌ Examples of what not to do (reinforcing dependency):

• Just denying it by saying "That's not true!"

• Immediately calling or contacting someone (family, doctor)

• Making an exception just once

✅ Responses to take (security + boundaries):

• "You're feeling anxious, aren't you? I have already informed your doctor about the pain.☺️"

• "I am checking on it now. There is nothing to worry about. The doctor will be here at 3:00 PM."

• "I will write that down in the record notebook. Let's have the doctor take a look at it."

→ **"Security" + "Established procedure" + "Predictability"** are the keywords✨

🔹3. Increase attention to behaviors other than "complaints"

To break the loop of "getting attention by complaining," it is necessary to increase experiences where other "appropriate behaviors" receive attention.

✅Concrete examples:

• When they are spending time quietly: "Ms. A, you are so calm today, aren't you?☺️"

• When they help out: "That was a big help—you're amazing!"

• Staff engaging with positive topics (hobbies from the past, cooking, family stories)

→ As the sense of security that "I can get attention without complaining" increases, their behavior will begin to change.🌼

🔹4. Shift the timing of complaints with "preventive vocalization"

By speaking to Ms. A *before* she feels anxious, you can reduce the frequency of her complaints.

✅Examples:

• "I will tell the doctor about your legs this afternoon. It will be okay."

• "I will come by again in the evening, so please rest easy until then."

• "I will check on your pain at [time], so please rest until then."

→ By providing a "reservation" of security, you can help them achieve peace of mind.

🔹5. Prepare "security tools" (environmental adjustment)

✅Examples:

• 🔖"Ms. A's Personal Security Card":
  Example: "Dr. XX checks on your physical condition every week," "Leg swelling is currently being observed," "Pain medication adjustments are being discussed with the doctor."
  → Post a card summarizing these points in simple words by the bedside or on a cart.

• 📝"Complaint Notebook":
  Example: Record "things told today" or "things to check tomorrow."
  → Having "proof that they were heard" left for the person often increases their sense of security.

🌟Effective communication examples (behavioral therapy perspective)

$$
\begin{array}{|l|l|} \hline
\text{Ms. A's words/actions} & \text{Effective response} \\ \hline
\text{ "I have to go to the hospital!"} & \text{ "It's worrying to have pain, isn't it? We are currently consulting with the doctor, so it's okay.😊"} \\ \hline
\text{ "You always ignore me!"} & \text{ "We are definitely looking out for you, Ms. A. You are spending your time quite calmly today.🌸"} \\ \hline
\text{ "Something is wrong!"} & \text{ "That sounds worrying. We are keeping a close watch for any changes, so please rest assured."} \\ \hline
\end{array}
$$

This concludes the content of [Chapter 3: Concrete Behavioral Interventions and Habit Building for 'Dependent Complaints']🌿
Next, as the final chapter, [Chapter 4: Mental Care for Staff and Team Collaboration], I will introduce perspectives on mental support and strengthening collaboration for all of you involved in caregiving✨

Thank you very much😊🌼
Now, let's move on to the final chapter, which covers the most overlooked yet most important theme in the nursing care field.

🌟Chapter 4: Mental Care for Staff and Team Collaboration

Providing support for someone like Resident A, who has dementia and a tendency toward anxiety and makes strong complaints, is something thatimposes stress on staff that cannot be solved by 'correct responses' alone.

😓 Do you ever feel like, 'I'm trying so hard, but...'?

• No matter how many times I explain, they don't understand...

• Silent pressure from the family...

• Even when I use the same approach, the reaction differs depending on the person...

• I blame myself, thinking, 'Maybe I said it the wrong way'...

These are all due to 'compassion fatigue' and 'cognitive load' unique to interpersonal care professions.

🧠 From the perspective of Cognitive Behavioral Therapy (CBT)...

What often worsens staff stress is 'excessive expectations and assumptions about oneself'.

$$
\begin{array}{|l|l|l|} \hline
\text{Automatic Thoughts} & \text{Emotions} & \text{Results} \\ \hline
\text{'I must do everything perfectly'} & \text{Tension/Impatience} & \text{Chronic fatigue/Self-denial} \\ \hline
\text{'If I fail, I will cause trouble'} & \text{Anxiety/Guilt} & \text{Shrinking from response/Wanting to avoid} \\ \hline
\text{'If I change, it will be solved'} & \text{Helplessness/Loneliness} & \text{Depressive tendencies} \\ \hline
\end{array}
$$

🌱 Steps for Staff Self-Care

🔹1. Visualize your mind with an 'Emotion Diary'

After responding, try writing down even just one word about 'what emotions remain inside you'🖊️

✅ Example:

• Complained to by Resident A -> 'Tired', 'Irritated', 'I feel like I responded well'

• Interaction with family -> 'They understood', 'I felt blamed'

-> Just by 'putting emotions into words', the brain's stress response is alleviated✨

🔹2. It is not about the "correct response" but "consistent response" that matters

In caregiving, "consistent responses" rather than a single "correct answer" lead to trust and effectiveness.

💡Tips for standardizing responses:

• Create a "response manual" as a team

• Confirm with each other during morning and evening handovers, "We're sticking to the same approach today, right?"

• Share successful examples like, "This way of saying it worked well"

→ "Not carrying the burden alone" is the best way to protect your mental well-being😊

🔹3. Leave a "Thank You Note" to yourself

Every day, make it a habit to focus on what you were able to accomplish🌸

✅Examples:

• "I treated Resident A kindly today, good job me"

• "I was able to smile during mealtime"

• "I was able to listen to another staff member's concerns"

→ Small acts of self-acknowledgment are highly effective for preventing burnout!

🔹4. Create a space for "emotional sharing" within the whole team

Even if it's just occasionally, it is very important to make time to talk about things like, "How did the response to so-and-so go?"

📌For example:

• Mini-conference (15 minutes)

• A word of "You're doing a great job" during tea time

• Write down and share memorable words or responses on sticky notes

→ The experience of being "empathized with" by others boosts one's emotional resilience🌟

🎯 Checklist: What is your current state?

$$
\begin{array}{|l|l|} \hline
\text{Check Items} & \text{YES/NO} \\ \hline
\text{Recently, I can't relax even after work} & \text{} \\ \hline
\text{I sometimes dream about the residents} & \text{} \\ \hline
\text{I often think, 'Did I cause this trouble?'} & \text{} \\ \hline
\text{I get irritated or cry over small things} & \text{} \\ \hline
\text{I find myself thinking 'I want to quit' more often} & \text{} \\ \hline
\end{array}
$$

→ If you have two or more "YES" answers, seek consultation and a space to share emotions within the team early on✨

🌸 Summary: Supporting the caregivers is the best form of care

To deal with a resident as delicate and demanding as Resident A, an environment where you yourself can work with peace of mind is very important.
When staff can smile, residents also gradually become more stable😊

With this, all chapters up to [Chapter 4: "Self-care for staff and team collaboration"] are now complete✨

🌸 Conclusion: Aiming for "caregiving where you don't carry the burden alone"

Through this case where I received a consultation from T-san, I felt once again that "caregiving is a job where hearts touch hearts."

Especially for those who are difficult to deal with, there is "a reason unique to that person".
To be close to that reason, more than knowledge or technique, a "posture of trying to understand" and a "perspective of supporting as a team" are necessary.

But precisely because of that, it is also important for us caregivers not to carry worries alone.
Talking to someone, sharing information, and building relationships where you can empathize with each other—that might be the secret to preventing burnout and sustaining kindness for a long time😊

📣 Do you have these kinds of worries at your workplace too?

• "Even after responding, the complaints don't stop..."

• "Collaboration with the family isn't going well..."

• "I feel like I might be doing something wrong..."

If there is anyone who is worried just like T-san, I hope the content of this note will be even a small hint for you🌿

Also, if you read this article and have opinions or experiences like
"There is a similar case at my facility"
or
"I am doing this kind of ingenuity," please let me know in the comments✨

I would be happy if we could think about "caregiving where kindness lasts" together😊

Please feel free to arrange, cut, or quote this as you like🌸