Aggressive family member

[Jerez]

So I was placing an IV in a pediatric pt about 6mo and she was of course not happy. She was crying and the mother was comforting her the best she could. As I was placing the IV though, the dad reached across the bed while I had the needle in the child's arm and literally pushed my hands away and told me to stop & get another nurse. I was shocked that someone would do that and was taken completely off guard. The wife had jumped when he did it too and almost intervened but stopped herself. Anyways, I became angry and flustered over the whole ordeal as the doctor had explained in great detail what to expect and gave them the option of PO fluids & meds vs IV. I pulled the needle out and wrapped the child's arm, apologized, and told them I would send in another RN. I spoke to my charge RN about the situation and decided to transfer the child's care to another RN because I felt very uncomfortable at this point. I couldn't help but ask myself over and over what I did to set this man off but at the same time don't think any pt or family member has a right to lay their hands on any staff especially during a procedure. A simple "stop" would have worked just as well. Also, I do understand the frustration of having a sick child that ends up going through painful procedures in order to help them get better so I know that plays a part. I guess I just need to suck it up as part of the job. I just wonder as nurses, should we expect to be abused, whether physically or verbally? Or should I have said something about the inappropriateness of what happened right then & there? I'm not sure what was the most professional thing to do but I did not want to escalate the situation any further but at the same time I wanted to let him know that touching me or any other staff member in an aggressive manner would not be allowed.

[caliotter3]

To give the benefit of the doubt, I would say that the father instinctively reacted. However, he was warned beforehand, so less of an excuse. That still does not mean that he should not have not been confronted for accosting a staff member. Where I work, all manner of effort would be made to place total blame on the nurse, i.e. you reached up with your opposing hand and forced the father's hand onto the IV needle. Then you would be in the office listening to a diatribe about how you are a bad nurse. No exaggeration meant.

[Crush]

there is no situation where a patient physically touching a health care provider is OK. A simple " please stop, get someone else" would had been effective.

To the OP, not sure how long ago this happened or if the patient is still in the unit; however, an incident report should had been filed to keep everyone on the loop for future incidents.

Hopefully there is documentation in the chart, " Procedure interrupted related to ..............." And then an incident report.

I think you handled it pretty well. I may have said something about not ok to touch me but I think you did fine.

[AnnieOaklyRN, BSN, RN, EMT-P]

It was only you and the parents while you started the IV? We either take the child to a treatment room, away from the parents. Or have staff hold the child, never the parents.

I think you handled the situation fine by not escalating and getting another nurse. Just pushing your hands away doesn't sound so bad.

I completely understand the father's reaction to stop someone from hurting his child.

To hear the doctor explain in complete detail, then to see, to the parents eyes, a big needle being stuck in their screaming child's arm is very different. I imagine the father scared, confused, upset, feeling guilty for what he agreed to.

I am gonna guess you do not regularly care for kids.

The worst thing you could do for a child getting an IV is take the parents away from them, that is how they get some comfort during painful procedures. The problem is the father, not the child, so don't punish the child. I want you to picture yourself going for moderate or major surgery without anyone to comfort you, no family, no one you know.. how would that feel? That is the equivalent of sending a child in for an IV without a parent, or family member present!

I have been doing IVs for 14 years and can tell you that having a parent lay on the bed and hold the child during an IV attempt IN MOST cases not all is the best way. They more easily restrain them and I find kids move far less when they are held, once again because they are being comforted by the person they trust the most in the world. Are there parents that just cannot do this effectively yes, but you will know before you stick the needle in because the target will be moving to much. If this happens then yes, you readjust and maybe wrap the kid, but NEVER kick both parents out unless they are totally emotionally out of control.

When you care for kids you do whats best for the child (keeping the parents, or at least one, or even a grandparent in the room), and not what is easier for you (which is to kick the parents out and just get the IV done without the emotional responses of mom and dad in your way).

I have had this happen in the past, not necessarily pushing my hands away, but a parent that was being unreasonable. I find that if you prepare them ahead a time (not the physician telling them what is going to happen, YOU telling them since you are doing it ) by telling them it is going to hurt, the child is going to be more upset because they are being restrained, and that I will do my best to get it in on the first time, but little Johny is dehydrated and has little veins so it can be challenging so I cannot promise anything. Often times after you give parents this information they realize that it isn't easy and that the child is going to feel some pain, you are allowing them to prepare themselves emotionally ahead of time so that they can better control those emotions when they start to feel them.

It is NEVER ok for a patient or family member to lay hands on us in an aggressive manner, no matter what we are doing. You idea that it is acceptable is the reason this is allowed to happen and staff are getting hurt because of that acceptance. People need to know that they can control their emotions and keep their hands to themselves, and that this is NEVER acceptable behavior, especially when those hands are in control of a contaminated sharp!

Annie

[JKL33]

I think you handled the situation fine by not escalating and getting another nurse. Just pushing your hands away doesn't sound so bad.

I completely understand the father's reaction to stop someone from hurting his child.

Touching the nurse inappropriately (anger or otherwise) will never be okay whether or not it's as bad as it could be. Gripping an arm, poking a finger in the chest, a "light shove" - none of these are as bad as things can get, but none of it is okay. You (plural) may not put your hands on people in this way, period.

Not sure if it was the case here or not (I suspect it was to some extent), but there's a general "hurting my child" mentality with respect to receiving healthcare that I have never quite understood. I would fully expect a child to process things this way, not a reasonable adult. Have parents never noticed the wide range of things kids and babies sometimes scream bloody murder about? Pre-education can help with this; explain the developmental stage and how it may make a particular reaction very likely as soon as the child is touched by caregiver or leave's parent's arms...etc.

As for the parents, they have options (spoken sternly, or even screamed if one prefers):

"Okay - stop."

"That's enough, I want you to stop."

"GTF away from my child - NOW."

All of these are effective and don't involve physically threatening or touching anyone.

I will not be treated like a criminal, though, because a parent:

-Changed their mind

-Feels guilty about some aspect of the situation

These are the kinds of things that education and communication can generally improve, but when those things are not effective, making excuses for the behavior is not the answer.

[brownbook]

I am gonna guess you do not regularly care for kids.

The worst thing you could do for a child getting an IV is take the parents away from them, that is how they get some comfort during painful procedures. The problem is the father, not the child, so don't punish the child. I want you to picture yourself going for moderate or major surgery without anyone to comfort you, no family, no one you know.. how would that feel? That is the equivalent of sending a child in for an IV without a parent, or family member present!

I have been doing IVs for 14 years and can tell you that having a parent lay on the bed and hold the child during an IV attempt IN MOST cases not all is the best way. They more easily restrain them and I find kids move far less when they are held, once again because they are being comforted by the person they trust the most in the world. Are there parents that just cannot do this effectively yes, but you will know before you stick the needle in because the target will be moving to much. If this happens then yes, you readjust and maybe wrap the kid, but NEVER kick both parents out unless they are totally emotionally out of control.

When you care for kids you do whats best for the child (keeping the parents, or at least one, or even a grandparent in the room), and not what is easier for you (which is to kick the parents out and just get the IV done without the emotional responses of mom and dad in your way).

I have had this happen in the past, not necessarily pushing my hands away, but a parent that was being unreasonable. I find that if you prepare them ahead a time (not the physician telling them what is going to happen, YOU telling them since you are doing it ) by telling them it is going to hurt, the child is going to be more upset because they are being restrained, and that I will do my best to get it in on the first time, but little Johny is dehydrated and has little veins so it can be challenging so I cannot promise anything. Often times after you give parents this information they realize that it isn't easy and that the child is going to feel some pain, you are allowing them to prepare themselves emotionally ahead of time so that they can better control those emotions when they start to feel them.

It is NEVER ok for a patient or family member to lay hands on us in an aggressive manner, no matter what we are doing. You idea that it is acceptable is the reason this is allowed to happen and staff are getting hurt because of that acceptance. People need to know that they can control their emotions and keep their hands to themselves, and that this is NEVER acceptable behavior, especially when those hands are in control of a contaminated sharp!

Annie

I have been poking kids since around 1988 throughout my varied, floating, nursing career. Irregardless of anything else in this post I don't think a nurse should be put in the position to be alone while starting an IV on a child with only the parents to hold, restrain, the child!

All your ideas and suggestions about IV's in kids are correct. There wouldn't even be a need for this post if any of them had been put in place prior to the procedure.

[trytounderstand]

It was only you and the parents while you started the IV? We either take the child to a treatment room, away from the parents. Or have staff hold the child, never the parents.

I think you handled the situation fine by not escalating and getting another nurse. Just pushing your hands away doesn't sound so bad.

I completely understand the father's reaction to stop someone from hurting his child.

To hear the doctor explain in complete detail, then to see, to the parents eyes, a big needle being stuck in their screaming child's arm is very different. I imagine the father scared, confused, upset, feeling guilty for what he agreed to.

As a parent who has watched children suffer from iv's shots etc etc., removing the parent from the room should only be done as a last resort. To have extra assistance in the room is fine to help keep a situation like this from happening. An assistant may have noticed that the father was becoming upset and was going into protective mode and may have been able to step in and explain what was happening. Again as in many situations in life, you do not know what the patient or family have been through and they just may be reacting to hearing their family cry out. But to remove the child's one source of comfort and protection would be wrong.

From my own experience listening to the description and then actually having the procedure done is sometimes two completely different issues even on your adult self, but once it is being done to the child you are there to protect can be very upsetting, scary and you carry the guilt for a long time after. But to not know how you child was treated and know that may have been screaming "no" and you were not there to help or console is heartbreaking and will haunt you for forever. Although there are things that have to be done no matter what to be alone and going through sticks with a child and parent for forever. Take my word for it.

[trytounderstand]

explained in great detail what to expect and gave them the option of PO fluids & meds vs IV. I pulled the needle out and wrapped the child's arm, apologized, and told them I would send in another RN..

As a patient or a parent if I have the option of taking by mouth and skipping iv I would be singing the doctor's and nurse's praises. From experience it can be a very painful procedure.

But he did not have a right to put his hands on you. Because it was not right and he could have caused damage to the child. But to yell out to stop we've changed our minds. Or say don't whatever it would take to get the message across would have acceptable.

[mtmkjr, BSN]

It has been many years since I worked in pediatrics. More since nursing school.

Back then, the thinking was that parents did not accompany their children to "treatment rooms". It was believed that having the parent present during a potentially painful procedure would confuse the child, who might not understand why the parent was not protecting them from harm. Even more, the parent should NEVER be the one to restrain the child... same thinking. The child can't understand why the parent HELPING to hurt them. Remember, a child's thinking is not going to be rational in those situations.

It seems we have moved far away from that way of thinking, and now the guiding principle is that parent-child separation is never in the best interest of the child?

I'm not sure how I feel about that. Since I have not worked extensively in pediatrics since then, I don't believe I can offer an expert opinion, just a look back at how times have changed.

I do think however, that starting an IV for a child with ONLY parents in the room is a very bad idea. You just really can't predict the reaction of a parent to their child in pain. No matter how much "information" can be given ahead of time, emotions will take over and all rational thought go out the window.

Not only that, if another staff member had been there, they would have been able to see the dad's increased agitation/anger at his perception of incompetence if that's what was happening. The nurse doing the procedure would either be completely focused on the needle and miss those cues, or be distracted by his behavior and more likely to be unsuccessful in what might have been a difficult stick.

Bottom line, this would not have happened if the dad was not put into a position where his inappropriate reaction had the potential to injure his baby and others. Yes, I think there should have been a follow-up by a person with authority...

[DisneyNurseGal, BSN, RN]

I completely understand the father's reaction to stop someone from hurting his child.

.

Are you kidding me?

I do things all day that hurt children. Lumbar Punctures, IVs, CPap, NasoPharengeal suctioning, I could go on and on.

We do our best to mitigate pain with numbing creams, distraction, positioning for comfort, even medications; however nothing is going to take away all the pain. We explain procedures thoroughly to parents, and we also tell them that it is okay for them to step out of the room if it is too painful for them to watch (most often this happens with babies).

Does not give any parent the right to lay their hands on me... ever.

[broughden]

I guess I just need to suck it up as part of the job. I just wonder as nurses, should we expect to be abused, whether physically or verbally? Or should I have said something about the inappropriateness of what happened right then & there?

As long as you keep "sucking it up as part of the job" you will keep being abused.

If a patient or family member puts their hands on you in violence get security, and if they arent a patient have them removed.

If it rises to the level of a crime, have them arrested and press charges.

You want to stop abuse? Stop the abusers. So then maybe next time they will think twice before assaulting someone, whether its a nurse or not.

[RNrhythm, BSN, RN]

My only experience with the pediatric population was in nursing school and I could tell then it was not an area I could ever work in.

AMEN!

[MunoRN, RN]

While I completely agree that nurse shouldn't tolerate abuse, I'm having a hard time make the jump to calling this violence, assault, abuse, etc. 'Pushing a hand away' is certainly inappropriate but at the most is worthy of a reminder "I understand your concern but you're potentially causing your kid more pain by touching a hand holding a needle".