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Combative/Violent Confused Patients

Specializes in Med-Surg.

I am feeling traumatized and numb at the moment. Maybe it is because I am 6.5 weeks pregnant and my hormones are out of control. There was an "incident" at work tonight that threw me right off and has left me feeling disturbed. I am sure it is not new to most nurses.

I had just started my night shift, received report, and began my initial rounds. One patient in for Falls, 80 year old, with CKD, on daily hemodialysis, appeared confused. The patient had been admitted late in the day shift. On report, the day nurse told me that he had been projectile vomiting and they had to change the curtains, but she said he was alert and oriented with no behavioural issues. That is not what I encountered.

I approached him and after introducing myself and him seeming appropriate, I attempted to put the bed rail up as he was sliding down and his legs were hanging out. He then kicked at my stomach. I was able to back away quick enough so I didn't receive the full impact of his kick. He said if you touch this bed I will knock your head off. He then appeared like he was going to vomit and I went to pass him the basin, and when I was just in front of his face, he spat blood-tinged thick sputum into my face.

I was shocked and disgusted. I was frightened for mine and my baby's health as the sputum went into my eye, nose and mouth. I screamed when he spat in my face I couldn't help it. My colleagues came running and told me to wash off. I did as best I could and reported to the ER. I was a basket case at this point. I told them of my pregnancy and they could tell I was traumatized.

They were quite wonderful. The ER charge nurse was like a kind mother, who told me confidently that she had found someone to cover my shift. The ER doc told me he was generous with time off and gave me the week off with pay.

I am just so upset that we as nurses have to be exposed to this type of abuse. These patients are confused and I know they are out of their minds, but how can nurses be protected against this type of violence?

I am feeling resentful towards the management as it seems that they do not give a s__t what happens to their employees, as long as they have bodies to cover staffing needs.

I am in the last week at my first nursing job, and am leaving for similar reasons. It's LTC, dementia care. I understand now why it "takes a special kind of person" to work with dementia patients. I am hit, spit on, cussed at, etc. every single shift. Just trying to help them be clean and well. I know it's not their fault. But management just goes on about "change your approach, be calm." Seriously, I'm one of the only nurses there that treats them like humans, and I still get abused. I'm still struggling with feeling like a failure that I can't endure.

But being pregnant, that's a totally different concern....

Laurie52

Specializes in SICU/CVICU.

What would you like management to do?

OP will probably have a different answer, as acute care is a different environment from LTC, but I'd say just a sense of understanding from management would be nice. Not enough to make me stay, but for my coworkers who are stronger than me. It would be helpful if the boss maybe understood that some residents are not going to be dressed every morning, or sometimes they refuse their meds, and there's nothing (humane) we can do to force them. But instead we are looked down on as if we aren't doing our jobs. I think this leads to poor treatment of the residents as they become tasks instead of people.

Okay, you had a bad experience at work. We've all been there. I've had much worse happen and nobody (including me) suggested that I needed paid time off from work to "recover" from the trauma. Wow.

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion.

You have a "spitter"..you just happened to be the first nurse that identified it! I hate it when when healthcare facilities do not have spit hood masks available. That is what this patient needs otherwise you are just left with applying a mask to the patient and other various other not so great options. I would use this an opportunity to make certain you have this product at your facility. If is is not there get it there...make it your project. Then you need a mechanism to identify these patients so ALL healthcare workers entering the room also are aware the patient is a spitter. I am sorry this happened to you and you are correct that the organization need to have PPE available for you and you can bring your own too. Please please get a few pair of goggles and always have them at the ready. You can even get a peel wrap around shield if you wear glasses that will cover any possible entrance into your eyes of patient's bodily fluids.

GCom24, ASN, RN

Specializes in Medical-Surgical, Emergency.

You have a "spitter"..you just happened to be the first nurse that identified it! I hate it when when healthcare facilities do not have spit hood masks available. That is what this patient needs otherwise you are just left with applying a mask to the patient and other various other not so great options. I would use this an opportunity to make certain you have this product at your facility. If is is not there get it there...make it your project. Then you need a mechanism to identify these patients so ALL healthcare workers entering the room also are aware the patient is a spitter. I am sorry this happened to you and you are correct that the organization need to have PPE available for you and you can bring your own too. Please please get a few pair of goggles and always have them at the ready. You can even get a peel wrap around shield if you wear glasses that will cover any possible entrance into your eyes of patient's bodily fluids.

Suit up! I love it! Can't go into a war zone with no armor!

It sounds like management DOES give a $hit since they gave you an entire week off with pay. Sounds pretty good to me. Sorry that happened to you, but as nurses we don't get to pick and choose our patients. If you're feeling like this floor isn't going to be a good fit for you it may be time to move on. I used to float to the psych floor while I was pregnant and it was easy for my husband to say "Oh I don't want you working there it's too dangerous". Doesn't work like that, though. Good luck.

I'm also curious about the fact that an ER doctor granted you time off, since it doesn't appear that you work in that department. And even if you did, wouldn't you report to someone else? Just seems strange to me..I'm a fairly new nurse, though. So what do I know.

For what it's worth, I'm sorry for what happened to you. It must have been pretty awful. Wishing the best for you and baby.

missmiamoore

Specializes in Med-Surg.

I am going in on modified duties, meaning I won't have a patient assignment for two shifts. It really upsets me hearing fellow nurses not supporting others because they themselves have had bad experiences. This is what I call lateral violence.

My manager is very understanding and they took this event seriously. She said she would feel the same as me and gave me lots of support. Perhaps elk park is bitter as she never stood up for herself before in the workplace.

missmiamoore

Specializes in Med-Surg.

Very sad. This is why I am hesitant to post on all nurses.com. It is full of bitter people who seem to enjoy being rude and cold to other nurses. This is pathetic and I would never respond to a comment by disregarding it. I am done posting on this site.

Laurie52

Specializes in SICU/CVICU.

I am just so upset that we as nurses have to be exposed to this type of abuse. These patients are confused and I know they are out of their minds, but how can nurses be protected against this type of violence?

I am feeling resentful towards the management as it seems that they do not give a s__t what happens to their employees, as long as they have bodies to cover staffing needs.

I'm sorry this happened to you and that you were so traumatized by the event. I don't think that someone saying that this has happened to them constitutes lateral violence. I am also interested in why you are resentful towards management. It seems to me that they have been extremely supportive of you. What would you like them to do? Confused patients are always going to be with us. I feel sorry for them. They are scared and don't know what to do. They lash out at anyone who comes into their path. Put yourself in their shoes, imagine being scared and not knowing what to do and not having anyone who cared.

MrChicagoRN, RN

Specializes in Leadership, Psych, HomeCare, Amb. Care.

My manager is very understanding and they took this event seriously. She said she would feel the same as me and gave me lots of support. Perhaps elk park is bitter as she never stood up for herself before in the workplace.

Very sad. This is why I am hesitant to post on all nurses.com. It is full of bitter people who seem to enjoy being rude and cold to other nurses. This is pathetic and I would never respond to a comment by disregarding it. I am done posting on this site.

You complain about management, yet both the ER Doc and your manager were very understanding, and no one "gives a s--t"

And if people don't totally agree with you, they are "bitter people who seem to enjoy being rude and cold to other nurses."

People led will often disagree with each other. That's ok, and if someone disagrees with you, or me, or Elkpark, that doesn't automatically mean that any of those people are cold or bitter.

Sorry to hear of that. In future, if he goes to kick you, just leave him to it. It's hard but he is refusing your attention. You would not be blamed after that for leaving but persistently offering care they will hold against you!!!

I remember being bitten so hard that I had a six inch purple bruise on my arm. All I did was hold the man up so he didn't fall and he sank his teeth in as I transferred him to the bed. I was told I should have just let him fall. No support was given, I was made to feel embarrassed. The family apologised for their dad which was nice.

It's important for all of us to stay alert to the fact the confused patients can be capable of anything - and watch our position. I'm sure none of us had violent patients pictured in our minds when we signed up to become nurses, so it can be traumatic for sure. Yet there's more and more of it. The largest part of our population (boomer) is aging into the dementia years. This problem isn't going away any time soon. Add to that the fact that more and more of our population is on psych meds of one sort or another. Hard to tell where things will be in 10 years.

This is one of those areas of need that will require more hands on deck in affected units to deal with it appropriately - lower patient ratios. We also need more sitters.

I understand how you feel. When I was pregnant I was always hypervigilent and never told patients that I was pregnant because I know some who would purposely hit or kick me just because. But, we all encounter patients like this at some point. I wonder if we are allowed to press charges against patients who abuse us?

Caffeine_IV

Specializes in LTC, med/surg, hospice.

I'm sorry you had that experience. I been hit at and pinched before. It's no fun. We always tag team when we have a combative person.

I think the time off is very nice because that would not have happened at my facility. It seems that everyone was sympathetic to you and maybe your hormones have you ultra sensitive. For future reference, if someone is confused and angry like that do not go to their bed until they are calmer. I would have let him throw up on the bed if has already threatened to hit me. Then I would have gotten some assistance to get him cleaned and situated and been prepared for whatever.

Scarlettz

Specializes in Med-Surg, Psychiatric.

I feel for you! I guess it has something to do with wanting a baby very much and if I ever were to fall pregnant and this happened to me, I would be pretty darn upset, too. I would have talked to my charge nurse and see if I could switch pts with someone. I would not normally do this, but if I were pregnant and I had a violent pt, I'd try and switch for safety sake. Though, I would offer to help the nurse willing to switch with me in any way possible. I would just be extra careful, as hard as that may be with a pt. with dementia. Keep a safe distance when they are upset, ask for help when needed, use protective garments.

Ruby Vee, BSN

Specializes in CCU, SICU, CVSICU, Precepting & Teaching.

Very sad. This is why I am hesitant to post on all nurses.com. It is full of bitter people who seem to enjoy being rude and cold to other nurses. This is pathetic and I would never respond to a comment by disregarding it. I am done posting on this site.

You posted on a public site. Some people agreed with you; some did not. Those that did not agree with you are called "bitter people who seem to enjoy being rude and cold to other nurses." You go on to say that you would never respond to a comment by disregarding it. This right after you bashed elk park for disagreeing with you.

You had a rough experience. Your management was very supportive. I'm sorry you encountered a spitter, but it's not the end of the world. Of you think it is, then perhaps this isn't the job for you.

Now I'm waiting for you to bash me.

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