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Assualted by psych patient

Emergency   (2,445 Views | 18 Replies)
by Udmert Udmert (New) New

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On 1/12/2020 at 1:00 PM, Susie2310 said:

I don't think this situation has a simple answer.

Some people have made the point that psychosis or otherwise altered mental status at the time the assault is committed against the staff member should not merit criminal charges.  I think this is a complicated subject.  A number of medical problems and psychological problems can cause altered mental status and result in the patient's disorientation, confusion, misperception of events, lack of impulse control, anger, etc.  Fight and/or flight are primal responses to a perceived threat to one's safety and/or autonomy.  

Going/being taken to the ED VOLUNTARILY or being hospitalized VOLUNTARILY even when one is relatively healthy with a good support system is not a stress free experience under the best of circumstances as many of us know.  

The point was also made that some patients are very violent and are using the mental health system to avoid going to jail.  Staff need to be protected from being assaulted by these patients.  It seems that improved nurse to patient ratios would help and also having more security personnel available close by.  Facilities need to have plans in place for the assessment and management of patients who are violent or who demonstrate the potential for violence from the initial patient encounter.

 

I want to add after further reflection that I think that the idea of nurses, as part of the healthcare industry, filing criminal charges against patients or initiating civil lawsuits against patients for assault, has the potential to backfire on the profession and on the health care industry, and I think this is something to consider.

I think it is possible that some patients could lose trust in health care professionals/nurses protecting them and advocating for their health needs when they are experiencing serious health problems if they fear facing criminal charges filed by the person taking care of them, their nurse, if they commit assault even if their illness/health problem is known to result in an altered mental status.  I think this could have consequences both for the public/patients and for the health care industry.

A number of medical and psychological problems/illnesses are known to result in symptoms such as altered level of consciousness - delirium, confusion, poor impulse control, misperception of events, etc., all of which can lead to a patient behaving aggressively. Aggression/violence can be a symptom of significant medical and/or psychological illnesses/problems.  Also, some people behave violently or aggressively without significant illness being present.  So the situation is not simple.  Are nurses going to resort to legal recourse because they were assaulted by a patient with dementia, delirium, psychosis, acute stroke, traumatic brain injury, acute renal failure which resulted in delirium, acute psychiatric problems, severe hypoglycemia which resulted in an altered level of consciousness, severe sepsis which resulted in behavioral changes, intoxication or withdrawal from drugs or alcohol, drug toxicity from prescribed medications which could include intentional and unintentional overdoses, and so on?  I am not in any way seeking to minimize the trauma and devastation that an assault can cause for a staff member, but I think it is necessary to consider the above.   

I think it is an uncomfortable reality that patient aggression and violence are part of the healthcare workplace and I think that sufficient nurse to patient ratios, sufficient staffing, sufficient security staff close by and a facility plan in place for the assessment and management of violent patients/patients who are showing the potential for violent behavior is essential to managing this situation.  

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TheSquire has 9 years experience as a DNP, EMT-B, APN, NP and specializes in Urgent Care NP, Emergency Nursing, Camp Nursing.

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I was battered by a psych patient I was triaging, and ended up with a broken jaw.

I tried to press charges - the thing is, the local State's Attorney has to sign off on it, and they didn't.  I didn't actually want him to do prison time (although Tom Dart did famously say that he runs the largest psychiatric hospital in the country, i.e. Cook County Jail), I did want him to have a judge mandate his treatment.

No matter how many states pass legislation making assault/battery of healthcare workers a felony, many SAs/DAs don't want to prosecute these cases.  That won't change unless we apply political pressure.

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TCASII has 8 years experience as a ADN.

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I'm a little put off by some of the remarks in here.  It's as if people don't understand sociopathy, psychopathy, drug-seeking, or personality disorders.  I work exclusively in inpatient psychiatry.  After 8 years, I'd say that 80% of the patients I see are simply substance-use disordered and/or personality disordered.  Very few are truly psychotic or AMS.  Just because you happen to work in a system that is setting limits on people for safety (e.g., involuntary hold due to SI or HI, withholding addictive drugs) does not mean you should be subjected to injury.   It's one thing to understand how some medical conditions and a few mental disorders can impair reasoning, but I would venture to guess that a large number of assaults in the ER, psych, or other acute care facilities are not AMS.  

I have seen a handful of assaults, and 90% of them were born out of med-seeking or restrictions on leaving a hospital AMA or simply getting to do whatever they want.

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On 1/14/2020 at 1:03 PM, Susie2310 said:

So the situation is not simple.

It actually is pretty simple if you start with the issue of the occurrence itself (the fact that it happened) instead of worrying about the whys. The whys only need to be worried about to the extent that examining them might lead to solutions/interventions. The whys do not need to be worried about for the purposes of deciding whether occurrences are okay or "part of the job."

The idea that a professional who is there to attend to someone's healing should be punched in the head and knocked out in the course of duty is unacceptable regardless of any contributing factors or extenuating circumstances. Note that I didn't say the patient shouldn't be handled as therapeutically as possible or that they should be judged for their circumstances; it's just that when talking about people being punched in the head and knocked out or shot, stabbed, bitten, thrown around, etc, there is no circumstance that makes such things okay. Going forward we must start from the position that, at baseline, a care provider being punched in the head and knocked out while caring for others is, independently of everything else, 100% unacceptable. Whatever the solutions are, they need to flow from that idea and from thinking about it that way rather than acting as if various circumstances might excuse the problem at hand or make it so complicated that a solution is too difficult.

The phrasing is important. Note that I didn't say "a patient who...[punches, kicks, etc] is 100% unacceptable" or even that "punching someone is 100% unacceptable." I said being punched [kicked, knocked out, stabbed, bitten....] is 100% unacceptable. An occurrence of battery is not acceptable.

Once that idea is accepted, then it is useful to move on to the whys in order to enact appropriate precautions and prevention (which will not happen without increased man/womanpower).

But the whole reason we have been putting up with this for so long is because some people want to start and stop right there...with the whys.

Don't worry about judging patients' motivations or situations. Just deal with the fact: It is not okay. It is going to stop.

I say we advocate only that battery upon healthcare workers should be officially addressed as a "never event." This is totally possible, just like we can go to great lengths to prevent patient falls despite the overwhelming array and combinations of circumstances that may contribute to falls.

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On 5/23/2019 at 12:48 AM, Udmert said:

Hey everyone,

I currently work in the ED and was recently assaulted by a patient and was knocked out. The patient was being petitioned for suicidal ideation. I keep getting told by coworkers that I should press charges against this patient.  Although the patient assaulted me, I just find it hard to do knowing that the patient is obviously going through a rough time in their life. I almost feel guilty with filing a police report. Has anyone else dealt with assualt in the workplace from a psych patient? If so, how did you deal with it? Did you just let it go? 

I made a police report but never followed through.

The event was a life-changing event that still makes me perhaps hyper-vigilant and mistrustful, wary and just on high alert more than I might otherwise be.  I follow the life of the &*^@##$ attacker so I know where he is.  (locked up at present) I bought a gun and improved the security at my home.  I have a family to think about it, so feel quite justified in my reaction.  It's a violent, fickle world.  It can be beautiful, too, but you never know when something horrid will happen.

It was a long time ago and I wasn't  physically hurt, just emotionally  shocked, scared, and angry.  The job did offer counseling.

True enough these attacks don't happen too often, but every once in a while they do.  Once to me in my 20 years in Psych and Corrections, but other staff have been beaten up pretty badly.  One had a broken shoulder, one had a broken jaw, one was stabbed with a scissor that a visitor had brought in, and lots of emotional/mental anguish.  

The 2 suicides that I have known about and the sudden, unexpected death of one of our long-term patients  were also sad and scary events for staff and for the other patients.  Life happens, but a lot of life's happenings are really painful.

Do not feel guilty about standing up for yourself, Udmert.  God's blessings upon you, friend.

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mariav has 7 years experience as a BSN, RN and specializes in Psychiatric/Mental Health, Substance Use Disorders.

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I've been working in in-pt psych for 12 years.  I've definitely had my share of assaults.  I file a police report every time and leave it up to the DA to determine the appropriate course of action.  I don't factor in whether my patient knows right from wrong when filing a report because it's not within the RN's scope of practice to make that determination. The reason I file a report is to start a paper trail documenting that individual's history of violent behavior so that when law enforcement comes into contact with him/her they can see that there is a history of violent behavior and to proceed with caution.  A history of police reports can also help a DA or judge determine the best course of action for the patient in regards to psychiatric treatment/monitoring vs incarceration. At the very least, filing a report sends a message to your patient that violence is not okay. As healthcare workers, tolerating or excusing this behavior only allows it to continue and, at the end of the day, we have to take care of ourselves. I love being a nurse and I love working with the mentally ill but I won't be able to do much good if I'm stuck at home on disability because of an assault.

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So, Udmert, what did you decide to do?  

I re-read your original post.  It's hard for me to believe that you think it's right to possibly not file a police report after having been KNOCKED OUT.

You think the person who did that to you should get a free pass because he was HAVING A BAD TIME IN HIS LIFE?????

Please.  Get real. If you haven't already done so, make that report immediately.  Have some self respect.

1 hour ago, mariav said:

I've been working in in-pt psych for 12 years.  I've definitely had my share of assaults.  I file a police report every time and leave it up to the DA to determine the appropriate course of action.  I don't factor in whether my patient knows right from wrong when filing a report because it's not within the RN's scope of practice to make that determination. The reason I file a report is to start a paper trail documenting that individual's history of violent behavior so that when law enforcement comes into contact with him/her they can see that there is a history of violent behavior and to proceed with caution.  A history of police reports can also help a DA or judge determine the best course of action for the patient in regards to psychiatric treatment/monitoring vs incarceration. At the very least, filing a report sends a message to your patient that violence is not okay. As healthcare workers, tolerating or excusing this behavior only allows it to continue and, at the end of the day, we have to take care of ourselves. I love being a nurse and I love working with the mentally ill but I won't be able to do much good if I'm stuck at home on disability because of an assault.

Nothing is more true.

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