Violent patients

  1. I am a student nurse in Scotland. I work in various care setting as a care assistant and support worker.
    I frequently, encounter violent behaviour. One employer says it is part of the job another says staff safety comes above patient safety and dignity. For me, I will walk away if the person is not at risk of injury or say exposing themselves.
    I still have a mark on my arm from a man digging his nails into my arm whilst we were changing a pad. Yesterday I was in tears after washing and dressing a very unpredictable man, really pleasant then wild and violent.
    I dont know what my legal and ethical responsibilities are. How much should I put my self at risk for the benefit of the patient? I looked on the NMC site but couldn't see any guidelines.
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  2. 6 Comments

  3. by   KR
    "How much do you put yourself and your safety at risk?"
    Very easy question, YOU DON'T. Your safety comes before anyone elses, patient or no patient. You can't help anyone else if you are hurt.
  4. by   nancykday
    Quote from ratnurse2b
    I am a student nurse in Scotland. I work in various care setting as a care assistant and support worker.
    I frequently, encounter violent behaviour. One employer says it is part of the job another says staff safety comes above patient safety and dignity. For me, I will walk away if the person is not at risk of injury or say exposing themselves.
    I still have a mark on my arm from a man digging his nails into my arm whilst we were changing a pad. Yesterday I was in tears after washing and dressing a very unpredictable man, really pleasant then wild and violent.
    I dont know what my legal and ethical responsibilities are. How much should I put my self at risk for the benefit of the patient? I looked on the NMC site but couldn't see any guidelines.
    It is managements resposibility to provide a safe and secure workplace. It is NOT PART OF THE JOB!!!!
    OSHA recognizes this as a hazard in the workplace for nursing and has written recommendations to prevent and improve. Mamnagement should show more concern for their valuable staff. You can check out OSHA's recommendations at http://www.osha.gov/SLTC/etools/hosp...ence/viol.html
  5. by   Silverdragon102
    Because this is UK related and we have different issues regarding violent patients and safety I am moving this to the UK forum

    To the OP

    Not sure if Scotland have different rules but here in England hospitals are supposed to support staff and help protect against violent patients. If you have issues and have raised them using the appropriate chain then the responsibility is with management. It is not part of the job and they shouldn't say that.

    Welcome to the site
    Last edit by Silverdragon102 on Sep 13, '07 : Reason: add a bit more info
  6. by   nightmare
    Welcome to the forumI work in a nursing home ,in Scotland,mainly Dementia residents and some very unpredictable ones.No you should not be subjected to violence but sometimes it happens especially with unpredictable dementia related diseases such as Lewy body etc. Predicting and "reading" possible flare up of challenging behavior is something you learn by experience. There are some who develop a "look" it is a blank faraway expression on the face, which if noted ,remember well because it is best to go away and come back to them later.This "look" will precipitate aggression if you try and get them to do something they don't want to do.
    Approach to challenging residents is also important,you can not go in there and grab and drag a confused person and not expect them to "defend" themselves.Be light and cheerful ,give them space,don't invade their"comfort" space (usually just out of their arms reach)Try and take time to tell them what you are going to do before you actually touch them.People with Dementia and Parkinson's need time for the thought to get through to them and being hurried is a frightening experience (and I certainly know that speed in a care home happens)Above all do not put yourself in a situation where you cannot quickly and safely leave a room,don't let the person get between you and the door.If possible leave the challenging ones to the more experienced staff or watch how they deal with them.If they deal with them and defuse any challenging behavior they are getting it right,if they wade in there and the situation gets worse then reflect on how differently the situation could have been handled.Are there some nurses there that always seem to be able to handle these residents?learn from them,it is a gift!
  7. by   ratnurse2b
    Thanks all
    It is hard to refuse to continue with a situation when other staff feel they should continue. The mark on my arm is from changing someone, his anger has increased to the point I had to rap his hands in towels, no I have not had restraint training either. I liked to change him on my own so I could walk out if he got violent but I was supporting another staff member so didnt that time.
    I know what you mean about that glazed look, the chap that whacked me yesterday gets that, even if Im not looking at him I can feel the pause but its split second before he lashes out. Today when I was changing him I got him talking constantly so I could hear in his voice any changes. I think he has been abused, just sorting his collar is a threat to him.

    Can I ask, what do you do for the people who are medicated and still constantly hit? What if they only have a few good days a week? Should they sit wet getting sore? I guess this brings in restarint, eather chemical or physical. I would love to go for CALMS training.
    Is the distress of restraining someone worth protecting there personal hygiene for?
    Should you ever use restraint when you have not had training to allow personal care? I have seen and unfortunately been involved in this in an NHS surgical ward. Again I liked changing the man on my own cus I could talk him through it. Im the loon whisperer lol

    Oh is there any literature I can waggle in the right folks directions? NMC guideline would be great but I didnt find any, so I can say "I'm not doing that and the NMC/RCN/???? agrees" :P
  8. by   nightmare
    There is an RCN guideline somewhere called "Focus on Restraint" it is a few years old now but I remember reading it.
    You sound like you have the "gift", ratnurse ! good for you,some nurses never get it and just keep making the same mistakes and then complaining when they are hurt.
    Medicated residents who still hit out,have a few of them!One partial solution is to try and get bigger incontinence pads for them,at least that way they are not soaking wet so frequently. In 17 years I have only had to physically restrain a resident once and that was because they were attacking another resident,although given the Care Commissions obsession with restraint even holding their hands can be seen as restraint nowadays.Most of our challenging residents are prescribed quitiapine or haloperidol and it does have a calming effect which makes their lives a bit better, unfortunately they soon become tolerant to the dose but in general it does seem to improve their quality of life.Very few of these residents would have been combative before they became ill with dementia and that is what we must remember,keep doing it your way,ratnurse and good luck with trying to change others opinions.

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