question: can you chart on a pt. being rude?

[aligar89]

Is it just part of our job as a nurse to deal with rude behavior and the name calling or can i document on a pt being mean, grabbing my arm tight when yelling at me, accusing me or just mocking me? These a various pt by the way all elderly men....

[TheCommuter, BSN, RN]

You can certainly chart on a patient's unbecoming behavior. However, it is recommended you do it in an objective manner that states the facts and leaves your personal opinions at the door.

"Patient grips this writer's arm and yells, 'All of you nurses are stupid witches!'" sounds more objective and factual than "Patient is mean, rude, and mocks this writer."

[SwansonRN]

I have written things like irritable, frustrated, resistant to care, combative, demanding, although I agree it's important to be as objective as possible. Quotes are great. & that patient seems like my worst nightmare. NO TOUCH!!!

[jadelpn, LPN, EMT-B]

If you are gonna write it, I agree it needs to be in a "patient with increased agitation" as opposed to subjective information--and be sure that you tell the MD, and then you are able to either get a prn for agitation, or "patient with increased agitation, MD aware, no new orders (or prn med ordered)" Then you can follow up as well about if the med worked or not.

[rn/writer, RN]

Document what you see, hear and feel (not emotions but things like getting hit or scratched)--not what you think it means. Not, "Patient became rude and hostile," but, "Patient threw wash cloth, grabbed this writer's arm, and used vulgar language." This takes your judgment out of the picture and allows the facts to speak for themselves.

If you're going to be giving this patient for something for anxiety/agitation, it's much better to have an objective record of their behavior than your personal conclusion, which could make it look as if you medicated them because you were upset.

[loriangel14, RN]

You could write " pt became physically and verbally aggressive".

[Rhi007]

Haha at my ED we can fine people!!! One of the nursing staff, when he first started didn't speak great English and was told by a patient 'go back to where you came from' so he fined the patient $200

[BrandonLPN, LPN]

You could write " pt became physically and verbally aggressive".

To be honest, even that could be considered vague or too subjective. What you consider "verbally agressive" and what someone else does may be two different things. Idealy, you should just chart concrete facts. Chart exactly what he *said* and exactly what he *did* and let the facts speak for themselves.....

With that said, I've charted phrases along the lines of "resident became verbally abusive" more than once myself. In a perfect world we'd all have time to chart perfectly....

[SleeepyRN]

We have sections for behavior charting. This would definitely be charted and monitored.

[xoemmylouox, ASN, RN]

I try to document this clearly as well. I often quote things said and if there is any physical contact I make sure to document this as well.

[uRNmyway, ASN, RN]

Haha at my ED we can fine people!!! One of the nursing staff, when he first started didn't speak great English and was told by a patient 'go back to where you came from' so he fined the patient $200

Oh wow, if we could fine for that kind of behavior I can tell you LOTS of people would be paying out the Wazoo.... Although by my experience, in Quebec, they don't pay out of pocket for healthcare so it wouldn't apply, and since I've been in the US the behavioral issues tend to also be with those not paying out of pocket...Unless it is done like something legal, a fine for verbal/physical assault, have to go to court etc. That might miraculously teach some people manners!

[SoldierNurse22, BSN, RN]

I'd chart something like that under psychological/behavioral. It's not about being petty or trying to "get back" at a patient for offending the staff. Charting on behavior/psychological/pt's affect has a legitimate place in your assessment.

And yes, I definitely chart it with lots of direct quotes and objective observations. It not only helps to create a baseline for the patient, but it can track increasing aggitation, long and short-term psych issues, how patients are coping with their diagnosis/hospitalization/treatment course and it also warns your fellow staff: docs, nurses, PT/OT, techs--everyone who has to venture bedside.