Verbally abusive patient, worried I could have handled the situation better - page 10
Let me start out by saying this is a little long winded, but it has been weighing on me and I have to get it off my chest, so bear with me!!! So, my last shift, I had gotten report on a male patient... Read More
Sep 24, '17In this situation, our house supervisor issued a cab voucher to take him to the address he provided. Under normal circumstances we absolutely will not provide a voucher for those leaving AMA-but he would have had no way to get anywhere but our curb in front of the hospital. So that was our one kind act towards this guy I guess.
Sep 24, '17Quote from kiwinurse18Ok, first of all that concept doesn't mean you get to dump all over the people in the outer circles and treat them poorly. It's just who is crying on whose shoulder.There's this really great article called "care goes in, crap goes out". Worth a read. Basically the patient is the centre. Nurses, doctors, family, friends are all in outer circles and the patient is allowed to dumb their crap out to their support.
I buy that concept for like, if you friend's parent dies. When someone dies, you support the people who are in the circles closer to the center than you (spouse, kids, etc. being the center circle). You avoid asking people in the inner circles to use their energy to support you during the time of grieving, and you are in turn supported by the people in circles further out than your own.
I don't find this at all applicable to the nurse-patient relationship, anyway. That is a professional relationship, not a personal one.
Sep 24, '17Quote from Ruby VeeI'm glad someone rebutted the "worst day of his life" thing.Hospitalized people are still pretty much the same person they are outside the hospital. The verbally and physically abusive ones don't miraculously become kind, gentle folks just because they're discharged. I don't believe this "you're meeting him on the worst day of his life" crap. He's a donkey behaving like a donkey.
I just have not found it to be true, as far as being an excuse for poor or abusive behavior. That is to say that many, many people are stressed when we are caring for them (or their loved ones), but the worst that most people do is perhaps give a "short" answer, or become flustered or a little anxious or mildly over-bearing with their requests or their mannerisms - - and then a lot of them apologize because they themselves perceive that their interactions are stressed and different than what is normal for them! These are the majority of people. They are not screaming profanities and throwing things when they become stressed.
For people who do not regularly scream profanities and throw things, doing so would be about the last thing to come to mind when stressed.
Those who do such things when stressed/ill/hospitalized already believe that those are acceptable ways to behave on a day-to-day basis.
Sep 24, '17Quote from NurseMom2016I would have paid for his cab fare myself.In this situation, our house supervisor issued a cab voucher to take him to the address he provided. Under normal circumstances we absolutely will not provide a voucher for those leaving AMA-but he would have had no way to get anywhere but our curb in front of the hospital. So that was our one kind act towards this guy I guess.
Sep 25, '17not sure why you are taking this personally.
Buh bye, dont let the door hit you.
I fail to understand why these people come into the hospital in the first place. I absolutely sympathise that it must really really suck to not be able to drink when you want to( id say its more like torture).But if you come in, an ddont want to comply with what the doc says needs to be done, then you should have a palliative consult, and drink all the water you want.
I absolutely hate being the fluid police, but we get yelled at by the docs for not "enforcing " their orders.
A 1 liter fluid restriction is the pits. Thats why I dont take it personally when pt goes off on me about it.
Sep 25, '17Yes, a liter fluid restriction does suck. But so does fluid overload when you have CHF.
Personally, I would like to see more physicians fire patients who are non-compliant. For example, patients who are admitted to the hospital for COPD, who then leave the unit to smoke. Why bother coming to the hospital?
Some physicians do refuse to care for these patients, and that is a step in the right direction.
Healthcare resources are limited and shouldn't be wasted.
Sep 25, '17I would educate and advise a friend to bring him coffee. I would not bring him coffee, especially acting like that.
Sep 25, '17I don't think you could have done any more than you did. First of all, while he's a patient in your care, which you are providing under doctors orders, giving him the coffee would have made you culpable if he then experienced a CHF exacerbation. If the patient is belligerent, verbally abusive, and willingly non compliant with his care, it is not your responsibility to 1. Put your job on the line by disobeying orders that have a clear medical purpose and 2. No professional- no- no human being should be expected to suffer physical and verbal abuse just to perform their job duties.
Sure, you are a compassionate nurse who cares about patients, but you also have to protect your dignity, health, and license.
You cannot save the world, my friend. Just do the best you can while respecting and protecting yourself.... that's all we can do in such situations. I urge you not to ruminate over this any more!
Sep 25, '17Where I work we would get our behinds handed to us if we would have given him the coffee when he wasnt able to have it. The people saying they would just give to him..if the patient was NPO would you give him a sandwich if he demanded he was hungry? I work in an innercity hospital and just like fullmoon some people can be quite demanding...my favorite being the homeless drunks looking for 3 hots and a cot during inclement weather..but that's a different thread all together.
You have to remember the patient demanding coffee when they aren't able to have it will be the first to list you on a lawsuit when they go into CHF from being overloaded.
As far as being the worst day of the patients life. The way the OPs patients acted was completely unacceptable and being in the hospital isn't going to turn a usually mild person into a violent person..it just isn't.
It wasn't even about the coffee quite frankly. It was about not being able to get what he wanted. Come on now most reasonable people won't be embarrassing themselves(naked in bed because he threw his gown off? That's pretty atrocious behavior) over a cup of coffee. Nothing was going to make this patient happy..no sense in trying to be rationalal with complete irrationality..you are going to get absolutely no where.
Sep 25, '17I'm in an 80s mood...so bear with the references.
Patients like this remind of a line from The Three Amigos: "Could it be that once again you're angry at something else and are looking to take it out on me?" Three Amigos-What Is A Plethora? - YouTube
Easy Armchair Nursing aside, he's fluid restriction, but is he restriction restriction? Is this guy supposed to //always// be on fluid restriction and is he //always// noncompliant?Depending on the situation I think I probably would have tried giving a small cup of coffee, establish the relationship, educate, lay down some ground rules, you know, plan of care and go from there. (I should patent that rhyme) And always listen to Swayze, which by the way should be standard nursing orientation and totally applicable: Be Nice - YouTube
Honestly, really honestly, your response to a patient depends on how much junk you've already had to deal with that day. You're only human. Maybe you've already got a really sick person down the hall. Maybe this is the second guy like this you've had today. Maybe even if you're trying everything you can with this guy he's still verbally vomiting all over you. There's only so much one can take. It depends on your hospital and unit policy. Depends if you have backup when you tell the patient "no." But your response (especially when you're already in the weeds) will show what kind of person you really are, and I think you did ok. As far as the early discharge: I have no qualms in letting someone sign out AMA if I tried. If you're already deep in it on your shift, sometimes you just can't do it and have to let these guys out the door. That's unfortunate maybe, but that's the truth. And the truth hurts.
I feel like a lot of comments on this thread could possibly come from a place of having a more normal patient population. However, those with experience where ornery patients may be more frequent, the nurse will have an entirely different arsenal of response. Psychosocial stuff aside doesn't change that this guy, for whatever reason, was being a jerk. Dude needs a Care Plan to address this, which probably wont be completed upon this hospital visit.
The verbal abuse: "It's not me, it's you." Don't feel bad because someone else is a jerk. But in saying that, don't ever anticipate what a patient is going to be like because someone else told you or gave you report that's what they're like. That will always set you up for failure. Always be direct and on the level with patients like this. Never beat around the bush. They can smell a fake from a mile away.
Sep 25, '17Do not feel bad.
The man chose to leave. He requested to go. He signed the paperwork. Those were his decisions, and he is responsible for the consequences of his actions.
If he had been as peristent on staying as he had been about the coffee, then he would have stayed.
Perhaps he got home and relatively thrived in a less stressful, do-as-he-likes environment.
I don't have time to read all previous comments, but if someone has said the same thing I have, then that counts for something too OP.
Sep 25, '17The fact is, the doctor put in the discharge order and he signed it so it's no longer your concern that he's manipulating the situation saying he now wants to stay. You did the right thing telling him he had to leave and as someone who was A&O could have taken his butt right back to the ED. I don't work medical, I work psych and we have psychiatrists put in discharge orders all the time for patients who manipulate and try to overstay their welcome. For us, the patients don't even have to sign the orders to leave, we can put on the papers that they declined to sign and send them on their way. Sometimes we will even have security standby in case they get violent or otherwise refuse to walk out the door. Bottom line, doctor ordered discharge, so just document and then wash your hands of the situation.
As far as you not being able to get over the verbal abuse and name calling, I know it's tough. I deal with this behavior all the time in psych and though I don't have the thickest of skins I try to just tell myself this "I'm getting paid to be here and at the end of the day I get to go home to my dog and my kids, happy and healthy while patient X has to deal with whatever mental, physical, or drug issues they have. Boy, am I glad I'm not them!"