"Accurate" Charting of Profanity

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Does anybody else in the ER/ED do this? If a patient is using foul language directed at staff (calling us names, every other word is F**K or Motherf****r, etc) I chart, in quotes, exactly what the patient is saying. I do this so that if later, the patient has a trumped up complaint then the chart reviewer has a good feel for the actions and behaviors of the patient.

Some in my nursing administration (imagine) frown on this saying it makes the chart look "bad". (Too much religious leadership in my hospital organization and way too much a**-kissing)

Anybody else do this?

[teeituptom, BSN, RN]

stevielynn said:

So even what Marla thought was perfectly clear could be miscontrued.

I've never given this much thought - always just charted in general terms, like pt. used profanity. Unless it was a direct threat.

We had a guy who couldn't speak in a complete sentence w/o profanity. It would have taken forever to quote him accurately.

steph

I agree, I always stick with something simple like, using profanity, verbally abusive, etc. Otherwise you spend way too much time writing or entering into a computer. And I dont know about you, I always have more work to do than documenting every profanity a pt uses.

[traumaRUs, MSN, APRN]

I too have been an ER RN for more than a few years and I too chart (with appropriate quote marks of course) exactly what patient states to me. I also chart actions so that the person reading the chart understands the tone of the encounter. I remain objective though and never put "patient appears to be..." "pt seems to be..."

[sbic56, BSN, RN]

I agree with those who chart that patient/faimily member is using foul language, swearing, yelling etc. Most important is really getting the point across by clearly chart behavior. So many people use cuss words in everyday language that it hardly means they are upset. Even with the "I'll blow yer f------- head off" quote, the person shooting their mouth off is not the important part, but the action of shooting is the part I want to make clear!

[psalm, RN]

...I work on a med/oncology floor. I document word for word. If the pt. isn't ashamed to call me a c***s*****, Mf, etc, why should I be shy of documenting? The behavior may not be typical of the pt. and alert staff & doc of problems. If it is somewhat typical of the pt but is escalating, we need to know and pass it on, for obvious reasons.

[NatashaArian]

papawjohn said:

Hey Y'all

The chart you're making is going to be a record of the entire process of dealing with the Pt's condition and behavior. Hypothetically, assume the Pt is an OD, has had NARCAN and now wishes to go score more drugs and resume his chosen state of consciousness--but finds himself in committment (which we in FLA call 'Baker Acted'). He ends up in restraints and etc (which most of us can write the script for).

The profanity, threats, etc are material to what we have to do as the stupid drama unfolds. Leaving out the profanity and such leaves the sequel events unexplained--IMHO.

I chart enough to make it clear that a reasonable person with our responsibilities MUST have done what I did.

But then I always imagine that I'm reading my Nurse'sNotes to a jury, or that they're going to be read by a Attorney who will decide whether or not to sue me based on what I write.

PapawJohn

I'm in FLA also, I had to "baker act" one of my friends who scored some phen from Canada. not a pretty sight.:chair:

[CT Pixie, BSN, RN]

I'm not an ED/ER nurse but may I chime in..

I work LTC, and we are told to chart on specific patients every shift regarding their behavior. If they say it, I chart it. I'll put something like "resident was agitated at 1300. Verbally abusive to staff and other residents, calling other residents "stupid mother f*ckers", telling staff "go f*** yourself"..blah blah blah

What is considered a cuss word/swearing varies from person to person, so by me charting EXACTLY what was said paints a bigger (and often more colorful LOL) picture. It also shows those family members who are in total denial that mom/dad/gramp/gram swear like a sailor and are verbally abusive is in fact the case, and no grandma didn't say "I'm so damn mad" what she said was "i'm so f***ing p*ssed off I could grab someone by the neck and shake the sh*t out of them" Big, big difference

[CraigB-RN, MSN, RN]

I guess after reading the thread, I have to ask, what is the purpose of charting the profanity? In a mental health situation, I can see the need. Not being there and only being able to read the short blurbs people are posting here, I can't see the whole situation. The chart is a record of the medical care of the patient, not a place to document that they and their families have poor protoplasm, and their family tree should have been prunes.

As to the comment about getting charges with kidnapping, and unlawful detainment, well in mast places, verbal abuse in itself isn't a valid reason to restrain someone. There would need to be documentation of threats and a good description of behavior.

[JBudd, MSN]

Craig, we chart it because it demonstrates the pt's state of mind, mood, affect and response to his situation. All of which are valid assessments (part of your general survey).

No, cursing alone does not get you put into restraints, but usually the profanity is a prelude to threats of harm to staff or self, and escalating behavior. When the cursing is violent in nature, aggressive in posture, with threatening body language, it needs to be charted.

In other words, if you get brought into my ER in cuffs, and procede to curse at me nonstop, I am not likely to ask the officer to release you any longer than it takes to get your initial assessment; as I do not trust you to stop with only verbal violence. If you cooperate with me, even while c/o that "mf-ing, p-y cop", I will not ask for physical or chemical restraints from the doc. When you try to kick my tech in a most sensitive place, not only will I chart your complete lack of imagination in verbage, I will also chart your asinine behavior, all in the most professional terms using your own language in quotes.

(Did y'all realize this thread was started 5 years ago? not likely to get answers from the OP ?

[Footballnut]

Too true, 5 years is a long time. I find myself wondering how many computer generated charting systems initiated over the last 5 years lend themselves to charting profanity without some sort of censorship program.

If charting profanity is applicable in the mental health setting, ED certainly applies. Not only do we see many more mental health patients with the shrinking mental health options in our communities, many of our medical patients have underlying mental health issues. I took stock just the other day and even though I didn't have any "mental health" patients almost every patient I was caring for had major chronic mental health issues that were affecting their current medical status. Their mental health issues were evident enough to impact their interaction with me in the department. (I must have taken stock because I might have started feeling a little crazy with my work load.) It's easy to get focused on patient's presenting problems and forget the high usage our departments have by patients with mental health issues.

Do I chart profanity? Only when it is abusive and/or out of control. I might give an example of the profanity but I have little interest in charting it at great lengths. If profanity continues I will chart examples at appropriate intervals. If a patient is out of control they generally have many more manifestations of their state and profanity is only one piece of the picture.

You have to wonder about someone who comes to see you for help and can't resist being abusive and oppositional toward you-the person with whatever they might need at the moment.

[suanna]

I'm not real sure what the important clinical difference is between " pt loud, using abusing language toward staff, swearing." and " "Pt called attending medical staff-Dr. Smith- a Mother F******* A**...." If it is really an issue for either side of the debate you need to sit down with your director and hash out a policy. Concerns for incomplete charting- your legal affairs department should weigh in. Personally, I don't see a reason to quote directly the specific insults of swear words a patient used- it is enough to indicate aggitated and abusive language- but if you like quoting colorful language- I can't imagine how it could be offensive to anyone. It isn't as if we are using our charts to tutor reading skills on bring your child to work day. If you are over 10y/o, seeing the words M*** F***" written out shouldn't be shocking for you. {unless you were transported by DR. Who from the Victorian Era and you suffer easily from "the Vapors".}

[JStyles1]

I do it. Especially if it is a threat towards me or staff

[NurseJacqui]

Does anybody else in the ER/ED do this? If a patient is using foul language directed at staff (calling us names, every other word is F**K or Motherf****r, etc) I chart, in quotes, exactly what the patient is saying. I do this so that if later, the patient has a trumped up complaint then the chart reviewer has a good feel for the actions and behaviors of the patient.

Some in my nursing administration (imagine) frown on this saying it makes the chart look "bad". (Too much religious leadership in my hospital organization and way too much a**-kissing)

Anybody else do this?

I quote them warmly and accurately.