Caring for Violent patient

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Hi everyone. I am in clinicals and caring for a schizophrenic patient on a rehab floor. The pt. is classified as catatonic, he doesn't speak and moves rarely. He will bite,punch and kick whenever touched by staff though. He is not on restraints and is physically very strong. I don't know why he's still on the rehab floor, he has no physical impairments and his admitting dx was schizophrenia. I would like some advice on how to bath and provide mouth care for this pt. w/o trigegring violence. His RN is available to me, but seems irritated by my need for assistance and information. Does anyone have tips on working peacefully with psychotic patients?

Thanks!

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Specializes in Telemetry.

I would make sure to explain everything you are doing before touching him so he knows what to expect. Even though he doesn't answer, and might not appear to be listening, it's important. I've always had better luck with psych patients by talking and explaining, whether anyone else thinks they're listening or not.

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Specializes in Med/Surg.
I would make sure to explain everything you are doing before touching him so he knows what to expect. Even though he doesn't answer, and might not appear to be listening, it's important. I've always had better luck with psych patients by talking and explaining, whether anyone else thinks they're listening or not.

Exactly what he/she said. Explain in minute detail, and ask permission to touch them as you would any other patient. If the patient is intent on doing something ask if they would like you to return later. Even though these patient may not appear to hear what you are saying, chances are they are listening.

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Specializes in Family Nurse Practitioner.

What a shame you are in this spot and fwiw I'd bet the nurse has no clue what to do either. I'm sorry she doesn't have the decency to try and help you figure out what might be appropriate for this patient...her patient. Your instructor also should be told that you CAN NOT force hygiene on patients and imo physically striking out surely sounds like a patient refusal to me. I guess I'd try handing him a tooth brush with toothpaste on it and saying "here you go, brush your teeth", if he is paranoid you may need to bring a wrapped brush in and let him put the paste on it and that way you can at least stay at arms length. I love my schizophrenic patients but when one is actively psychotic just getting them to accept a cup of juice from me is a huge accomplishment. Good luck and please don't let this put a bad taste in your mouth for psych.

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In addition to explaining in detail, be calm, speak softly and always take another person with you. If you cannot provide care wo getting hurt, tell the person you will come back later when they are calmer. If your instructor is insistent that you do whatever for this pt, ask her/him to demonstrate to you how to accomplish this wo either you or the pt getting hurt.

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Specializes in Psych, M/S, Ortho, Float..

OK, first and foremost is your own safety. Getting injured by any patient is never a good way to get anything done. If the meds are not working, if he is on any, then you need lots of support. You should never go into a know violent patient's room alone, nor should anyone let you. I personally would never have assigned a patient like this to a student as he is a high risk patient. Too unpredictable and you cannot control him on your own.

Psych nursing is an entierly different setting than the rest of nursing. I work on a high risk unit and have never been hit. PRNs, lots of staff and not pushing stuff like mouth care or bathing until it is desperate are the way to go. Offer, suggest, assist or cajole them into doing it, but never force anything on people. Not only is it undignified and belittling to patients, it is a risk that you should never take without others there in the room with you. And even then, I, wouldn't do it for anything except to give an injection.

I would suggest that you speak with your instructor about the risks involved in caring for this patient.

Good luck and stay safe.

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I think the people who responded to this post have some very good ideas. I would ask for SOMEONE to stand by, if possible. Also definitely explain who you are and what you are doing as you go. It makes a huge difference, and after a while you don't even have to think about "narrating" your moves. Also, if you can get down to the patient's level (sit on a chair, raise the bed) so you aren't looming over them, that can help keep them calm. Of course don't do this in any way that might make it easy for you to be hit or knocked over. Good for you for keeping it up! Sadly there are a fair number of people out there who just wouldn't even try.

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Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

I do not understand why your nursing instructor is putting you in this very unsafe position.

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I do not understand why your nursing instructor is putting you in this very unsafe position.

I am not in nursing school yet, but I would imagine it's to help the OP prepare for the types of challenging patients they will no doubt encounter in the future...or maybe the instructor isn't fully aware of the situation. Either way the RN working with the OP could sure be a little more understanding of the safety and learning situation...

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