Verbally abusive patient, worried I could have handled the situation better - page 12
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 28, '17"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"
Sure, as per the general agreement, you could have just educated and given him his coffee. Perhaps that would have been the best outcome and he would have not left AMA.
But, I'd like to point out that none of us handle everything perfectly 100% of the time, and it sort of sounds like the patient had gotten to the point that NOTHING you could have done would have pleased him: he was looking for a "reason" to leave.
It's not worth loosing sleep over. You did the best you could do at the time...and our best is not always the perfect outcome. You are obviously someone who cares and reflects upon your actions and decisions. Log this for future reference, and don't worry about it.Last edit by Zombie_NSG_Student on Sep 28, '17 : Reason: minor correction
Sep 29, '17Also, I don't know how I missed that he THREW A CUP at you the first time I read this. Glad it was the water and not the coffee: at the hospital where I work, the hot plate keeps it scalding hot.
So no, do not feel bad AT ALL about telling him to leave even after he was calmed down. That was assault, and that was AFTER he got what he wanted. Nope nope nope: "bye, Felicia".
Sep 30, '17Do NOT feel about about this yahoo leaving. You didn't make him go. He's a grown man and if he wants to refuse treatment he can. You can't fix stupid and you can't teach him manners. "Here's your AMA form, have fun going into fluid volume overload with your venti PSL and don't let the door hit ya on the way out" would be my attitude all day about this one. Don't you waste a minute of worry on it.
You wouldnt go to his job and throw drinks, or curse at him, or be anything but a decent human, why is it allowed just because he's in the hospital and you're a nurse? You do not deserve to be treated this way as "part of the job", good for you for calling security! (Also whyyyyy did the doc have to undermine his own orders and give him the coffee?! Gah)
Sep 30, '17This! ^
A lot of people you encounter these days are out of control, rude, and have a lot of issues. When patients start to act out like this, always redirect...specifically to their care needs and your role as the nurse. These days, much of the autonomy that we had as nurses has been removed by the customer service gods and goddesses who roam the hospital halls in suits and pumps. And, we must also accept the fact that not everyone who comes into a hospital with symptoms really wants to be helped. Best you can do is provide education and encourage compliance. If they are noncompliant with the ordered medical care plan, you document the details and notify the provider. And that patient should be discharged. What would be the point of keeping him in the hospital if he is going to keep drinking and going into fluid overload?
The doctor did the right thing. I would have given him the coffee, too. He would have kept on escalating otherwise. This guy evidently has a LOT of anger issues that have nothing to do with you. You were just an easy target for him to unload his verbal abuse. Given his history, he will be back soon anyway.
Sep 30, '17Quote from Been there,done thatPatients in jail may refuse care and are allowed the same privileges as any other inmate in regard to their food, exercise, etc. They receive education and special diet if desired, regular diet if desired. The down side for them is we are the manager of care so their choice is pretty much our care or no care and we will make them safe whether they want that or not. Would probably not be able to enforce a fluid restriction and it would probably be up the patient to do that for himself. We make people sign a refusal letter stating education was given concerning risks(given in the letter- disability, worsening if condition, death). Then it us on them pretty much. Bet your patient has spent at least a few nights in jail. Maybe hospital should get signed refusal documents!Any patient has the right to refuse a doctor's prescribed treatment. YOU had no right to refuse the patient's request. It's a hospital, not a jail.Last edit by NottaSpringChik on Oct 1, '17
Sep 30, '17Quote from Been there,done thatI think you haven't considered the fact that he "WAS" discharged. Once a pt has been discharged he/she needs to go through the entire process of being admitted once again, which means going through the ER. The doctor discharged the patient, not the OP. Orders are orders and 'just giving him the coffee' is not following the orders, period. Calling the Doc, advising of pt. requests, pt. abuse, etc. is the first thing I would of done besides documenting the heck out of the encounters with nurse and other staff, including the complaints from the other pts. on the unit. If the doc said give the coffee, so be it but it isn't up to you to 'just give him the coffee'. If the pt is that sick and is re-admitted, so be it as well, perhaps he will have learned that our job isn't defined by 'what the patient wants', but what the pt needs."He was saying he now wanted to stay since we gave him his coffee. THIS is the part I am questioning myself about-I told him "no sir, I have already removed everything and you have signed the paper to leave. The cab is on its way to pick you up." He did leave, and had to have assistance from the tech and officer to transfer from a wheelchair to the cab. "
Did YOUR patient ask to stay?Was YOUR patient too weak to ambulate alone? So many risk factors and legal ramifications over a mis -handled cup of coffee request.
Oct 2, '17He was manipulating staff. You're too busy for that. He's being non compliant, so I wouldn't feel bad to have him leave. People like that usually don't get better. Now you have time to care for the ones that really need you and want to get better.
Oct 3, '17Really, I probably would've just given him the coffee, as long as he remained nice to me.
But since you took the long road (which I'm totally for, too), once he started pushing his table at me and cursing at me like that, he would not have seen my face again until he decided to leave AMA and I was removing his IV/foley. And the moment he threw that water cup at me, I would've been talking to the cops about pressing charges, because that is wrong. I don't care how "anxious" or "powerless" he felt. Don't throw things at me.
So, AMA, and pressing charges would've been my response. Also, I couldn't care less about how appropriate or not it was to send him away like that. Leave. Bye. Go back to the ER if you have any issues.
Oct 3, '17I don’t believe we should we rewarding and encouraging such behavior. By giving in, it only teaches him that if he escalates his behavior, he gets what he wants. Either he wants treatment, or he does not. Every PT we see like that, have learned that such behavior rewards them. Keep in mind, such a patient will NOT give you or your hospital a good review. And WILL take all your time running through hoops. Basically taking your time away from other Patients.
Your comment about looking at the record wasn’t out of line, no matter what others said. He might be way over the amount he could have. Who knows, his behavior could have rewarded him all through the night with extra drinks. Better CYA, than be sorry. If he wasn’t WAY over, then maybe, or maybe not.
The problem isn’t wither he could have a drink. It was his response that is the problem. And shouldn’t be rewarded.
Either way, he wasn’t ready for treatment. When he is ready, he will come back. And hopefully he will know to behave better.
Oct 5, '17This patient was being verbally abusive and almost physically abusive. So no, he isn't going to die when he leaves. He's most likely a non compliant rude gigantic PITA. You aren't there to coddle patients on their every whim. This isn't a hotel. He needs to learn he has a problem. That is why you are restricting fluids. Put your foot down and DONT give in.
Oct 7, '17Quote from NottaSpringChikYup! My best friend is a charge RN at the county jail(LPNs do most of the hands on patient care, med pass etc..all RNs are charge at this jail) and while the medical provider can recommend treatment, order meds and certain diets they are then at the medical providers mercy when they don't comply. My friend tells me all time about this one 300 plus pound type 1 diabetic inmate that is on a special diabetic diet tray and this inmate she always comes down to get her finger stick and insulin and she is always almost over 400. Turns out she is always trading her tray for a regular one(diabetic trays get a lot of sliced turkey, shredded chicken, turkey burgers and hardboiled eggs so a lot of inmates actually prefer some of those choices as bland as they may be to some of the things served there I don't even want to know what) and she will take anyone else's that doesn't want it and eat it. Then of course she is the first to complain about the jails medical provider, how negligent they are, how the care they provide is horrible because her diabetes is out of control and how she is suffering from complications like neuropathy and how her sugar is always 400 plus and she equates all of this to the medical provider. My friend is not negligent..she is a darn good nurse. I guess it hasn't clicked that she needs to stick to her diet and lay off the crumb cakes and the cookies(inmates apparently can buy snacks and toiletries from the jail)..the correction officers tell my friend and her collegues all the time this inmate piles on the sugar and never sticks to her diet..but when she gets out she is suing the medical provider and jail for negligence. But just like OP patient..he wants his coffee but the second he goes into fluid overload he won't hesitate to get a lawsuit going against the hospital or the nurse who gave him the coffee. Sorry but no patient and his cup of coffee is going to cost me my job or a cent of my hard earned money.Patients in jail may refuse care and are allowed the same privileges as any other inmate in regard to their food, exercise, etc. They receive education and special diet if desired, regular diet if desired. The down side for them is we are the manager of care so their choice is pretty much our care or no care and we will make them safe whether they want that or not. Would probably not be able to enforce a fluid restriction and it would probably be up the patient to do that for himself. We make people sign a refusal letter stating education was given concerning risks(given in the letter- disability, worsening if condition, death). Then it us on them pretty much. Bet your patient has spent at least a few nights in jail. Maybe hospital should get signed refusal documents!