Verbally abusive patient, worried I could have handled the situation better - page 7

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

  1. by   Racer15
    Bye Felicia! You did nothing wrong. The ED is a bit of a different beast, but if you don't comply, you go bye bye. I don't have an endless amount of time to fool with people that won't do what we ask, and if they are completely with it and verbally abusive? Definitely no time for that. I would bet my britches that giving him coffee would not have helped. He was on a power trip.
  2. by   zeeblebrox
    Having learned from experience I would not have given him the cup of coffee. Had a patient like this and once he got the coffee he decided it wasn't good enough and threw the whole cup at us. Boiling hot coffee as a projectile NO THANKS.
  3. by   Kooky Korky
    Quote from Julius Seizure
    This doesn't ring true to me. Patients can refuse treatments. Are you saying that if I go to insert an NG tube on a patient and they say they don't want that treatment, that I am at risk of negligence/malpractice? Or if I offer a patient their enalapril and they say they don't wish to take their medication, that I am open to negligence/malpractice? I think not. If the patient refuses a treatment, then my duty is to educate, document their refusal, and update their attending provider on the patient's wishes. Not to force them to accept the treatment.
    Pts can refuse tx and we then try to explain, inform, educate. We notify doctors if the missed treatment is significant. But we can't be complicit in helping them to refuse. And we don't run and get some other med to substitute for the enalapril he doesn't want.

    OP's situation, though, included a violent, rude, disrespectful, assaultive pt, who demanded that the nurse go get the coffee and enable this guy to harm himself. He was screaming at her and other staff, he threw stuff and got her wet.
  4. by   Kooky Korky
    Quote from Sour Lemon
    I'm in the "just give him the coffee" group ...and yes, it's to shut them up so my shift goes smoother. I used to try a little harder, but then I realized something. These patients don't stop. They just don't. When you don't give them what they want, they ask for the charge nurse. When the charge nurse won't give in, they want the supervisor. In the end, the original nurse is undermined and the patient ALWAYS gets their way from someone up higher in the chain of command. I've made the mistake of wasting hours of my time dealing with these sorts of issues in the past, but never again.
    I spent nearly an entire 12 hour shift going back and forth with a patient who wanted to go outside for "fresh air" (cigarettes). Policy was that if a patient left the unit, they were discharged AMA ...but that was not acceptable to my patient so she just kept whining, begging, causing huge scenes and contacting anyone who might be able to overrule me. Fifteen minutes before my shift ended, she was given permission to go outside for "fresh air" by the director. I wanted to SCREAM. I could have done that 12 hours ago and actually had a good night.
    Except that she would have wanted to go out every couple of hours, thus tying up staff who I am thinking had to go with her to make sure she didn't run away, fall, or burn herself smoking, or burn down the building, thereby harming a great many people.
  5. by   silasozzie
    making him take responsibility for his actions and not backing down yourself was the right thing to do. Alcohol/drug user etc??? Many many more decent people to use your time to help. Harsh? dont care.....
  6. by   1056chris
    We all question some things we do, because often we have to make decisions in the moment taking all things into consideration. I probably would have started by giving the guy half a cup of coffee and said we have to save some fluid to take with your medications. It might have appeased him for awhile but I think based on his history, this guy would have been out the door anyway. Don't forget he signed out AMA. I know that still you worry because you know it was unhealthy and probably unsafe for him to leave that way, but that was his decision , and as you say he was AOx3. Being that no family member or friend came to pick him up it could be he has alienated them with his non-compliance. You did the right thing, but keep in mind next time that these patients might call you names, but what they are really fighting and mad about is their lack of control because of the disease process. Don't take it personally.
  7. by   Julius Seizure
    Quote from silasozzie
    making him take responsibility for his actions and not backing down yourself was the right thing to do. Alcohol/drug user etc??? Many many more decent people to use your time to help. Harsh? dont care.....
    Harsh is a kind word for this sentiment. Too kind.
  8. by   blondenurse12
    I personally think you did nothing wrong. I've noticed this trend, especially on this board, that nurses have basically turned into enablers. Not giving this guy coffee is not violating his autonomy, are you kidding me? It's not like forcing a pill down his throat or forcing a test on him. By just giving him the coffee, you are allowing this bad behavior to continue and encouraging him to not only turn abusive to get what he wants, but also that he has to put forth no effort in his own healthcare. Not only that but so many nurses take this abuse and feel like it's our cross to bear. No, we did not sign up to be assaulted and harassed, I'm sorry.

    What has the human race become? It used to be survival of the fittest. Now we are coddling these massive drains of resources that are contributing zero to society. If he doesn't want to do what the doctor asked, to help himself, then get out. I also think it was wrong for the physician to get the patient coffee. He was undermining you and it obviously was the catalyst for the latter part of the scenario.
  9. by   she244
    After the second ranting and cussing episode of not getting coffee, I would have called his doctor and ask him to okay the coffee or to come and speak to the man himself if I have to keep that close of a watch on his fluid restriction. As I have no problem telling someone I refuse to stand there and be cussed or threatened. Understanding the man may be frustrated as well as mad is one thing, but to have him throw and push things your way should not be tolerated. As he was AxO and knew what he was doing. You did the right thing by letting him leave. My dad was one of those people who felt he could cuss medical people. I am a nurse myself so I would set him straight and let him know doctor's and nurses want to help people, but do not have to stand and be abused. Really, this is one of those situations where you would have to have been there to know how you would have reacted.
  10. by   NurseMom2016
    I have read through each one of your comments. I am very thankful for those of you who are supportive in how I handled the situation, and very thankful of the constructive criticism I have received. However, there is one point I don't think I did enough justice to in my original post: that this man had been educated numerous times. It was documented throughout the chart. The physician had even said that she had spoken to him at length the day before while he was still in icu. So yes, he had the right to refuse following the order of the fluid restriction. But when does that make it appropriate to behave like he did? (He was also sitting 100% naked in his room during all of this, his gown went on the floor with the other stuff he threw).
    Within the two hours this was going on, the physician, security guard, charge nurse, the tech, and myself witnessed his behavior, along with him saying numerous times "get me the hell out of here." The physician and I agreed that yes, it could have been related to withdrawals, but at that point I don't know if he would have let me give him any Ativan through his IV, as he had already began to pull off the tape to get them out himself.
    Also, I think the patients and family were thankful he left as well. They had heard him numerous times overnight yelling and cursing through the walls. The patient next door was an elderly woman who had just been put on inpatient hospice the day before, with a good bit of family in the room with her.
    One other thing: where I work, the physicians normally do not put in an actual "discharge order" for pts leaving ama. The pt signs the Ama paper (or refuses to), then leaves, and we document.
    Looking back on this, I think this guy was at the end of his "sober period" of being in the hospital, and probably needed a fix of whatever drug of his choice.
    Let me make this clear as well:
    I think giving him the coffee, fluid restriction or not, would have solved the immediate problem, but not the problem that would have inevitably arisen 20 min later.
  11. by   lifeatthebluffs
    Your title says "verbally abusive," but this sounds like there was some physical violence there, or at least a very good suggestion of it. Also, sad as it is to say, I have no doubt he would have found something else to fume about even if the coffee situation had been addressed, and it seems likely that a situation like this has happened before with this person, and likely will again. Only things I would say to do are the things you did--got the physician and security involved.
  12. by   kim47
    You say your patient has a history of etoh and drug use. Addicts typically have maladaptive ways of dealing with reality as evidenced by their substance abuse. He's probably functioning at the developmental level at which he began using. Tough population to work with.
  13. by   RNrhythm
    As I often tell my friends: My patients are very sick, and sometimes they are a******s.

    While it is good and useful to look back and consider what else you may have said or done, DO NOT BEAT YOURSELF UP ABOUT IT.

    You did great and, believe me, you will have ample opportunities in the future to work with noncompliant, verbally abusive patients.

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