Combative/Violent Confused Patients

[missmiamoore]

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.

[Laurie52]

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]

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.

[Techy214]

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.

[jegalink]

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.

[serenitylove14]

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]

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, BSN, RN]

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]

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.

[Twinmom06, ASN, APN]

I think your management was very generous. I had an 89 year old patient whacked out on anesthesia who was bound and determined to either A) rip his member off, or B) rip the catheter out of his member that was causing him to want to rip his member off. He hit my aide with the call bell, kicked me in the chest, and tore my arm open with his fingernails. He was also spitting at anyone that came near him and tore through not one but 2 sets of wrist restraints. Took 7 people to hold him down to buckle him in to velcros and a lap belt. I threw a 4x4 and a tegaderm over my arm and went to employee health the next day. I realize being pregnant magnifies the situation but I think your management was more than generous. Not sure what part about the situation they didn't give a feces about.

[RNlmk]

These things happen frequently. If a pt seems off- step away from the bed until you can determine their state of mind.

[Nola009]

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.

What you went through at work does sound pretty terrible! I'm not trying to sound rude, but mocking elk park isn't helping anything. If you got time off, rather than boasting of your ability to 'stand up for yourself' or your great manager, how about showing the same compassion you seek?

[Salebow]

Sorry to hear your troubles. Hope you don't have health related problems because of it. I'm generally the kindest nurse on my floor, but if someone gets like that to me, I turn into mr. Not do nice and very direct and to the point with plenty of assertiveness nurse. I don't play that game with those types.

I had pt rip his Iv out, rip tele leads off, refuse meds, drop f bombs left and right at me and the DR, and was refusing care in other ways, plus disrupting the floor so much that pt families were complaining. Dr ordered 1mg of haldol. House sup distracted while I gave it. After several f bombs amd attempts to hit me failed, he finally calmed down and I was able to provide adequate care on him. It's just sad that we have to deal with this.