Well, we've had some experience with patient on nurse violence. One of my former orientees, who went on to become a nurse anesthetist, one of my best students, was working with a confused patient with an anterior communicating artery aneurysm with a grade II SAH. He was about 5'6" with a round, muscular abdomen, powerful muscular arms and a voice that could raise the dead. He was trying to get out of bed despite a-line, several pivs, drips to keep BP within specified paramenters per MD orders, foley..etc....my orientee attempted to use therapeutic communication, logic and just basic human decency to get the patient to return to bed, he was nearly standing up by this time.
Guess what happened?? None of you would ever guess in a hundred years...this ex-marine in his late fourties grabbed my student's PEN ON A ROPE and strangled her with it using both ham sized fists to do so.
We all got him off of her, she was understandably upset and had pen on a rope bruises on either side of her neck.
This patient already had an incident where he attempted to escape sans clothing....
. Sometimes MDs think that we can control the patient with the minimum of intervention. As most of you know the goal is to use the least physical and chemical restraint as possible.
Patients' like this need to be protected from themselves and from injuring staff. I can see why pressing charges against this type of patient would be futile...
A couple of weeks later this man and his mother came to our unit, looking for my orientee who was understandably hiding in another patient's room and did not want to see him.
He was contrite, embarrased and had no memory of his hospitalization for a cerebral aneurysm and SAH. He still had trouble understanding what happened and why he did what he did. He apologized profusely and said he would understand if his apology would not be accepted. He was actually a very nice man, normal affect, embarassed, but wanted to own up to his behavior.
This is not the first time a patient in our neurosurgery ICU can not remember events, sometimes they can't remember being in the hospital or being as sick as they were. This includes not just our cerebral vascular patients, but trauma patients as well. Some have pre-existing social issues such as never having been civilized in human society, drug, alcohol abuse..every excuse in the book. It is important to differentiate the legitimately confused patient from the psychopath and act accordingly.
We had another patient who strangled one of our nurses (not with pen on a rope, no one uses these any more...big DUH!!!) and punched out another nurse as another staff member restrained one of the patient's arms so he couldn't strike with both arms. This person was actually normal and getting a f/u MRI. Pending discharge to home. He was insulted when police and hospital security arrived. He apparently looked at the entourage of police, then at the three women he assualted and said "You called the police?" Then he claimed not to speak or understand English..
Fortunately these incidents are rare!!!!!!!!!!!!! and no one pressed charges against this man. Don't ask why. I think that everyone just wanted this to go away.
We had nurses' kicked in the head, punched in the head, kicked in the chest..this last nurse can no longer work in the clinical area as the kick to her shoulder also caused a cervical spine injury. Fortunately she loves the type of nursing she is doing now...no, no one pressed charges..
I think that as a rule it is difficult to press charges against our patient population. Most of them simply can not understand what is happening to them, or understand why they are in the hospital and what the hell is that dressing doing on the top of my head anyway? Why am I tied up? Why can't I go home?. Sometimes these patients' are so confused and/or frightened they scream for help. These behaviors understandably upset family and friends. It takes a great deal of patience to work with these people. We enlist the help of our physicians and neuropsychology as necessary, certainly our social worker who covers this service is a valuable asset as well.
I have had only one real incident. A patient sat up abruptly and took a bite out of the back of my upper arm. He was also an ACOMM aneurysm with SAH. A friend of mine, a PCT, decided to help me by bending over and screaming "help....help...help..." while I tried to shake this patient's giant head off my arm. (I still tease her about this)
Unfortunately I had watched the new version of "Dawn of the Dead" probably four times in the last two weeks, the last viewing just two days earlier...I was so creeped out!!!!!!!!!! I had visions of the guy in the parking garage with his legs chewed off, so he was now a zombie type person, who traveled hand over hand on pipes over the cast of survivors and jumped on one of the mall's security staff and started chewing on his neck. I started sweating as I continued to try to shake him off of me, then had a full blown asthma attack.
I got a tetanus shot out of this and ended up in the asthma room in the ER.
Patient later complained that he felt disrespected because we didn't understand him, he spoke Creole, and he did not want the bath and linen change we were doing, he wanted to go home and wanted ivs, foley, everything OUT! despite the fact we had another staff member speak with him in his native language, obtaining his consent. This was another instance of a neurologically impaired patient not fully understanding what was happening and reacting defensively the best
way he could at that time.
We all have war stories..It would be better if these things would not happen. We can't use chemical restraint...God forbid you restrain a patient when they appear so normal..yet anything could set the patient off because of impaired thinking and altered perception of his environment.
We must find a way to reduce the threat of harm to the patient and hospital staff that can meet the goals of patient, visitor and staff safety. I don't believe there is any one solution that can address these issues. No quick fix for these problems..prosecution is not always an option for certain patient populations.
I guess we just have to handle what ever happens the best way we can, document everything, use hospital P & P protocols to guide you when something like this happens, notify charge nurse, nurse managers, risk management, certainly the residents and attending physcian working with this patient and follow up with what ever action needs to be taken. Honestly patient on staff violence can get real ugly as some on you have noted.
No easy solution!!!
Good Luck..End Game RN