A nurse in New Zealand who reacted to being punched in the head several times by a mental health patient by punching the patient back, was found guilty of breaching the Code of Health and Disability Services Consumers' Rights and ultimately suspended.
At the time, a female patient had been admitted to a medium security mental health facility "due to increasingly changeable mood, psychosis and associated aggressive behaviours." "The patient punched the nurse several times in the head leaving her ear bleeding and her earring torn out."
The nurse in this situation was a new nurse and probably without the experience and training needed to work with such volatile patients. But, even with training and experience, situations happen. Nurses and other healthcare professionals become the target of sudden violence.
While hitting patients can certainly not be condoned, what do you think about acting in such a manner in self-defense? Have you ever been in a situation where you were the victim of bodily injury inflicted by a patient?
One of our local hospitals offers a kind of "self defense" course for nurses and other in high risk areas (ED, Psych, etc.). It's not really a course in how to fight, but focuses on techniques for de-escalation and blocking punches. Think "wax on, wax off".
Personally I would use diplomacy and deescalation until there truly was no other choice (and 90% of the time that works), but some patients are immune to this. I'm not talking psych patients as much as I am drunks, EtOH withdrawal, acute crack/speed/PCP intoxication. I'll try to talk to them but if they come at me or a coworker violently they're going down no questions asked.
Had a PCP nut get out of bed, raise his voice, and then his fist to one of my female colleagues who was giving him a medication. Now I don't doubt she could've handled herself at all (probably could kick my ass if she wanted to), but I kindly stepped in to give him one of my peace, love, togetherness hippy dippy deescalation speech. When he gripped her up and pushed her into the wall I kindly put my arm across his chest and "replaced" him in bed. Then he got restrained and B52'd. Johnny Law has stayed at home so far, and I have a feeling he'd take the word of two college educated professionals over some spaced out junky anyway.
I'm sorry, but if a grown male or female patient decides to attack me, I will do my best to defend myself. Nurses/nursing staff are not punching bags and therefore should not have to put up with physical assault. My state alone is now enacting a law stating that nurse is allowed to press charges against a patient if the patient assaults him/her anyway (man how we're behind the times!).
That being said, if the patient was a small child or an elderly person, I would hold them down or restrain them before punching them. I've had to do that with some very confused yet volatile patients.
I was assaulted by a private duty aide because I had to knock on the patient's locked door to gain entry to do the patient's treatment at 4am. I didn't lower myself to her level by attempting to defend myself. Charges were filed and that person no longer works in that field, at least she's not supposed to.
Specializes in Cardiac, ER, Pediatrics, Corrections.
I believe a nurse should do whatever she needs to do to escape a dangerous and violent situation. I'd rather hit a patient who was attacking me than break my arm or lose an eye.
Generally, in psych nurses become certified in ProAct or CPI. So this is to say deescalation of a situation is the priority and then protecting yourself if the patient becomes violent. I don't know what the law is in New Zealand. Here in the states, the patient threw the first punch so I would hope that the nurse would have a legal case against the patient AND that the BON would also have that nurse's back.
Generally, in psych nurses become certified in ProAct or CPI. So this is to say deescalation of a situation is the priority and then protecting yourself if the patient becomes violent. I don't know what the law is in New Zealand. Here in the states, the patient threw the first punch so I would hope that the nurse would have a legal case against the patient AND that the BON would also have that nurse's back.
It would be interesting to know what the BON stands when a nurse punches back...I'm not trying to find out, but I don't know if the BON wants a nurse to punch in retaliation.
As far as defending and self-preservation: learning some self-defense moves and using them very limited way would probably help more than a punch; not every "defense" involves a punch, just sayin'...something to think about...
imintrouble, BSN, RN
2,406 Posts
I have no idea what I'd do in a similar situation. Two scenarios come to mind.
Fight or flight.
What other choice is there? If you can't run, and you can't subdue, what else is there to do but start fighting back?