How do you deal with a patient slapping you?

  1. Hi everyone,
    Hope everyone is doing well. Work is going good. I will be off my orientation June 1st. I've already learned a ton. However, I was wondering how some of you would deal with a certain situation. We have a patient on our floor who's been there approx a few weeks. She came in with acute abdomen, they had an NG tube in her. They are trying to run tests but she refuses a lot of them. She's getting TPN for nutrition, and just recently we were able to take the NG out. They are thinking she has pancreatitis, gastritis. Well, she's 35, has a state guardian and is from a nursing home, has a history of schizophrenia. She has a very childlike manner about her. But, at times can just stare or not talk at all. She goes from hot to cold a lot. Well, the other day she was like in a manic phase and I was hanging a new IVPB on her and she came up to me and said "Hey, let me fix that." I thought she was talking about my hair because the previous shift had warned us she was playing with people's hair all day. Well, she outright slapped me across the face. And HARD. I was shocked, but held back of course like a good little nurse. I told her not to slap me. Then she apologized. One of the nurses said I should have filled out an incident report. I didn't because I don't think she even realized what she was doing and it's not like I got seriously hurt (maybe my feelings that's about it....") I had her again today and she was again trying to touch my face, saying it was pretty. When I told her not to slap me like she did the other day she said ---"I didn't do that!". So I know she's clueless. How would you guys have dealt with it???
    Thanks,
    Amy:kiss :kiss :kiss
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  2. 46 Comments

  3. by   sasseynurse
    Amy,
    IMHO, you did the right thing. I would persue the documentation if it happens again. Reason is that if there isn't a filed report of threatening behavior--treatment can be delayed or even ignored. Even if I didn't fill out an incident report, her behavior would have been documented in my nursing note.

    Good luck in your new job! Sounds like your oriemtation is giving you nursing in a nutshell.


    Schizophrenic or demented--they all seem to act up during a full moon. See if her behavior changes in the upcomming week.

    Judy
    SasseyNurse@webtv.net
  4. by   Teshiee
    I agree documentation is the mightier than the sword. I was working in a nursing home and a woman socked me dead in my mouth. My first instinct was to knock her silly but I did not. I just told her that wasnt appropriate. Needless to say I stay clear from mental and violent patients. :-)
  5. by   Andy S.
    I would have probably handled it the same way. And like everyone else said I would just document in my nurses note. I wouldn't fill out an incident report unless I was hurt. Good Luck on the new job!
  6. by   MollyJ
    Wow! sounds like you handled it well and did some good limit setting.

    My only thought is--does your hospital have a psych mental health CNS or experienced psych nurse that could consult on helping you guys deal with her and discretely evaluate her meds? with the GI intolerance, you probably cannot give her some of her routine meds, but she seems to be acting out alot and being in the hospital environment is probably pretty frightening for her.

    Good luck.
  7. by   fedupnurse
    A friend of mine at work got slammed in the face a few weeks ago. She ended up with a bruise on her jaw and needed stitches in her mouth. She did the incident report and documented it. If the patient is metally stable it is a whole nuther ball game though. That I wouldn't tolerate at all!
    You did good!!! Keep up the good work and good luck with the new job.
    Sasseynurse wasn't kidding about the full moon thing either!! I've even seen colleagues get wacky during full moons!
  8. by   zumalong
    AmyRN1227--You dealt with situation nicely. Violence in the clincal area is always a concern. This women sounds like she needs a psych referral. Even though she has been sweet since to you.

    A word of the wise--always know who and what is going on around you. Always have an exit if you are in a room with an aggressive patient. Nurses should NOT have to be subjected to violence and think it is acceptable. No matter what the developmental, cognitive level of the patient (resident) is. If she is going to be on your unit for some time--I would suggest a case conference (with mental health) and begin some limit setting.


    I was as
    saulted by a nursing assistant about 9 years ago. It was a horrendous experience. At the time, the situation was shuffled off to another department in the health care network (she went and worked with the elderly--real safe) We nurses tend to allow ourselves to be abused because we are caregivers. Here is a great article about workplace violence:
  9. by   zumalong
    Health-care workers at risk.
    Author: Arbury, Sheila Brown. Source: Job Safety and Health Quarterly v. 13 no2 (Winter 2002) p. 30-1 ISSN: 1057-5820 Number: BBPI02109612 Copyright: The magazine publisher is the copyright holder of this article and it is reproduced with permission. Further reproduction of this article in violation of the copyright is prohibited. To contact the publisher: http://www.osha.gov/.


    --------------------------------------------------------------------------------

    Last spring, a Florida nurse with 20 years' experience in psychiatry died of head and face trauma at the hands of a patient, a former wrestler, who had arrived at 1:45 a.m. for involuntary admission to a private mental health-care facility. On duty in the Intensive Treatment Service unit were two women: the nurse who died and a mental-health technician who was on break when the incident occurred. Other staff members realized there was a problem when the patient appeared outside the unit with the nurse's keys. They found the nurse on the floor bleeding from her injuries, initiated CPR, and transported her to a hospital, where she died.

    The preliminary investigation revealed that the facility did not have a specific policy on workplace violence, although the administrators stated that they were in the process of writing one. There also were no written policies on staff breaks and no communication devices except the unit telephone and overhead paging system to summon help in an emergency. In response to this tragic event, the facility made plans to purchase two-way communication systems and personal alarm systems, hire a security guard, and add a "floating" staff member to relieve personnel going on break so no staff member works alone on the unit.

    Homicide in health-care settings is part of the larger picture of workplace violence in health care. According to the Bureau of Justice National Crime Victimization Survey, 69,500 nurses were assaulted at work from 1992 to 1996. The National Institute for Occupational Safety and Health reports that 9,000 health-care providers are attacked on the job every day. Bureau of Labor Statistics figures for 1999 show that 43 percent of all non-fatal assaults and violent acts resulting in lost workdays across all industries occurred within health-care services. The incidence rate for non-fatal assaults and violent acts in health services in 1999 was 9 per 100 full-time equivalent workers, compared with the national average of 1.8. Of almost 5,000 nurses who responded to the American Nurses Association Health and Safety Survey last September, 17 percent had been physically assaulted and 56.9 percent had experienced threats or verbal abuse on the job during the previous year. As high as these percentages may be, there is strong speculation that workplace violence is underreported because of the victims' fears of blame or loss of their jobs. There also exists an unfortunate and persistent perception that within the health-care industry, assaults are part of the job.

    OSHA's publication, Guidelines for Preventing Workplace Violence for Health Care and Social Service Workers (OSHA 3148), addresses the problem and can help employers establish effective violence prevention programs adapted to the needs and resources of their workplace.

    In response to the Florida nurse's death, OSHA's Atlanta Regional Office staff recently presented a conference on "Reducing Workplace Violence in Psychiatric Facilities: Cost-Effective Strategies That Succeed." The conference attracted 137 participants: administrators, nurses, security personnel, risk managers, and OSHA staff, all interested in strategies for decreasing workplace violence in psychiatric facilities by decreasing worker risks and lowering costs, both human and financial.

    Speakers at the conference came from OSHA area, regional, and national offices, the American Psychiatric Nurses Association, the American Nurses Association, the Bureau of Labor Statistics, the Joint Commission on Accreditation of Healthcare Organizations, the Center for Violence Prevention and Control at the University of Minnesota, the University of Maryland School of Nursing, the Cape Cod Community Mental Health Center, and the New York State Office of Mental Health.

    The speakers described the problem of violence in health-care facilities, presented relevant statistics, and offered strategies to decrease workplace violence in psychiatric facilities. Kevin Murrett, an architect in Buffalo, NY, who serves as a consultant to the New York State Office of Mental Health, discussed building design elements that discourage workplace violence. Nurses Ellen Farley and Anne Schuler described the successes of Massachusetts' Assaulted Staff Action Program. This volunteer peer help and crisis intervention program has resulted in decreased symptoms of acute trauma and post-traumatic stress disorder among assaulted health-care workers.

    "OSHA's off to a good start," commented a participant in the Florida conference. "I hope this is just the beginning of great things to come." The agency plans to explore other activities on workplace violence based on regional partnerships among OSHA offices and state branches of national organizations such as the American Nurses Association.

    OSHA believes that cooperative efforts with its stakeholders will help to reduce workplace violence and its harmful effects. For more information about workplace violence, visit the OSHA website at www.osha.gov. The American Nurses Association Health and Safety Survey is online at www.nursingworld.org/surveys/.

    Added material.

    Arbury is a health scientist in OSHA's Office of Occupational Health Nursing, Washington, DC.

    NIOSH reports that 9,000 health-care providers are attacked on the job every day.

    RISK FACTORS FOR WORKPLACE VIOLENCE IN HEALTH-CARE FACILITIES* Prevalence of handguns and other weapons among patients, their families, and friends.

    * Increasing numbers of acute and chronically mentally ill patients released from hospitals without followup care.

    * Situational factors such as unrestricted movement of the public in health-care settings, the increasing presence of drug and alcohol abusers, and long waits for services, resulting in patient and family frustration.

    * Low staffing levels at night and during times of increased activity such as meals, visiting hours, and transport of patients.

    * Isolated work with patients during examinations or treatment.

    * Lack of staff training in recognizing and managing hostile and assaultive behavior.

    * Lack of specific safety and health program to address workplace violence.
  10. by   thisnurse
    i would have done the same as you. she didnt really mean to do that. im sure i would have yelled at her as a reaction. i wouldnt have filled out a report unless i got hurt but i certainly would have charted it. and id prob mention it to the doc if i saw him in the hall or in the room.
    id certainly pass it on that the pt can be violent and id be damn sure to stay out of slapping range in the future.

    you did a great job
  11. by   teeituptom
    Howdy yall
    From deep in the heart of texas

    Violence in the workplace,, hmmmmmmm does that actually exist. This is from a RN of many years in the ER, Who lost 3 teeth from being kicked in the mouth by a 16 y/o intoxicated kid, Who has had A old silver dollar sized chunk of flesh bitten out of my left forearmm and the it was swallowed by a 26 y/o intoxicated and drugged up female. I also had my right shoulder dislocated when the police left a prisoner unattended. Ive also had my ribs cracked by strange patients. And this is in a facility that has a policy prohibitng violence in the workplace, but has a security force that is strictly hands off. They will call for help while watching you get assaulted, Thats about all they are allowed to do. They do drive their little golf carts around the hospital and will give you a ride to your car.
    2 nurses who I knew were just gunned down outside their hospital last week right up the road from where I work, as they were coming back from lunch. The world indeed has gotten to be crazier and more violent all time... But if you look at the large majority of hospitals, most have totally ineffective security forces, with the exception of your large major metropolitan hospitals. When is this going to change. Hell if I know.
    Somehow I dont see things changing anywhere in the near future. All you can do is be carefull and alert to protect your self, and your coworkers. And document as much as you can and always save a copy for your own personal records.
    always be alert
    always be aware
    always watch out for your coworkers and them for you.

    Keep it in the short grass yall

    Teeituptom
  12. by   live4today
    Slap 'em back? :chuckle No-no-no! Just kidding, but it was my first knee-jerk reaction when I read "How do you deal with a patient slapping you?" I think you handled the situation beautifully. Perhaps we nurses need to start wearing armor from head to toe like the soldiers in olden days wore when they went to battle. I could see us now...head gear that covers the entire head/face regions, knee shins, elbow shins, arm guards, steel shoes for the patient foot stomps, iron gloves... :chuckle
    Last edit by live4today on May 29, '02
  13. by   P_RN
    I was kicked by a patient in DT's. I had a concussion, LOC, and a fractured zygoma. Nothing was done. His psychiatrist said he thought we were trying to "kill" him. Hmmmmmm.

    You handled the slap appropriately. She obviously had no clue.

    *MY* assaulter had lied about etoh history, had lied about being in a psych facility for 3 months and knew well what he did was wrong. (I still have a dip in my left cheek where it didn't heal exactly right.)
  14. by   kaycee
    I also think you handled it well. There have been many times I have been pinched, hit grabbed and bitten by pt's that didn't know what they were doing. If I was actually hurt I would do an incident report. No matter what I always documented it in the nurses note.
    In the ER though occasionally you get violent people that do know what they are doing. Those I report to the police and file charges.
    Renee,forget armor, we kid all the time where I work about being armed to the teeth. If we all carried around our 357 magnums I don't think we'd have half the problems in the ED, and I think pt's would stay in their rooms when we told them.

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