dealing with perverted patients

[shock-me-sane]

I am only a nursing student, but have a job at a hospital as a patient care assistant. I float all over the hospital and many times end up being a 1:1 sitter for patients. I can't count the number of times that I have been invited to snuggle up with a patient, asked if my boyfriend would be willing to share, been accused of "peeking" at genitals, asked to "hold" a member, and heard stories about how large someone is, etc.

Now generally I have no reaction to these things, unless someone actually touches me or becomes overly aggressive/graphic. But I don't know if that is the best way to handle things. I have thought about directly stating that I don't want to hear that, none of their business etc. But I also am aware that I am essentially trapped in the room with them and I don't want to give them the perception that their words are making me uncomfortable. Because it appears that many of them would keep at it if I let on and I don't want to escalate anything.

It is just weird, that somehow I will tolerate these things because I am at work and these people are sick.

Anyone have any thoughts or experiences?

[traumaRUs, MSN, APRN]

Hi there and welcome. This speaks to boundaries. You are the boundary-maker. At the first inkling of impropriety, stop it dead in its tracks. That is the only way to not let things go so far. Yes, these people are sick, but that gives them no right to abuse you...take care.

[EDValerieRN, ASN, RN]

Make sure and not get to where they're between you and the door either. That happened to me once as a CNA, and I thought I was going to be killed... schizophrenia with sexual urges.... scary.

As soon as they make the first inappropriate remark, tell them (professionally) that you will not tolerate remarks such as that, and you would appreciate if they would please refrain in the future. If they try to touch you, usually you can tell them that assault charges can be filed for things such as that, and they'll quit. If not, they're usually psych or drunk, and then I don't know what to tell you, besides stay close to a door.

[AfloydRN, BSN, RN]

I agree w/ traumarus. You must establish the boundary and let them know this is not acceptable behavior. I used to ignore it but that only made it worse.

[SCRN1]

I can relate! Not too long ago, I had a 70-something y/o patient who started off during my shift talking about how some of his past girlfriends slept with a pillow between their legs. His current girlfriend was sitting right there and I wondered if it made her feel uncomfortable listening to him tell someone about how his past girlfriends slept. Well, when I went in later to give him meds and they were both sleeping, he woke up, sat up & reached for his hearing aids and purposely dropped one on the floor with a grin on his face. I bent over to pick it up for him (my behind was not toward him) and when I did, he reached around and slapped me on the butt. I immediately stood up and he just grinned. Then he said, "guess I won't be sleeping tonight. Nobody can sleep with you around here." Then, still grinning, reached around and popped me there again. I was so surprised he did that, I couldn't think of the right words to say. Trying to remain professional, I handed him his meds. He took them and I left the room. I told the other nurses what'd just happened. So for the rest of the shift, another one of the nurses volunteered to go in there for me when needed and I did the same for one of her patients.

[nursemike, ASN, RN]

Been there, done some of that. As a male, I don't usually get sexually inappropriate remarks from male patients, and while female patients can occassionally be inappropriate, they aren't usually as threatening.

I agree wholeheartedly with the above posts--especially never letting the patient get between you and the door. Always give yourself the option to just leave the room. You are never obligated to put your own safety at risk, regardless of the patient's needs or situation.

As stated, setting boundaries is important, although it may at times be more effective just to ignore the remarks. A few patients with severely altered mental status may not be able to understand that what they are doing is wrong, and in such instances the risk of escalating the conflict may outweigh the potential to set boundaries. Many patients will, however, respond to firm, calm correction. I never use restraints as a threat or as punishment, but I do believe it can be ethical to explain that your are present as an alternative to restraints, and if that alternative becomes un-workable, restraints are the only option left.

One thing I've found is that I always address the patient as sir or ma'am, Mr or Ms. Some patients appreciate the gesture of respect, but in any case, it adds an element of formality to the relationship. You are there in a caregiver capacity--you aren't their friend. (A patient with severe neurological impairment, however, may recognize their first name more readily than their surname. you kind of have to play it by ear.)

For what it's worth--I've only had to do this once since becoming an RN. We're just too expensive for that. Woo-hoo for being expensive! On the other hand, having been where you are, I do feel a responsibility to assure that if one of my patients has a sitter, the sitter is safe. Hopefully, you'll do the same when the time comes.

[gitterbug]

Hi Shock-me-sane

Nursemike gave you some valuable information, attempt to use it in your practice. Crude remarks, cursing, inapproiate touching do not need to be tolerated. Make sure you do make an incident report of these actions, in case an assault charge is filed. Stay safe.

[nurseangel47]

One of the things you'll learn quickly in nursing school is that when a patient makes a comeon, you'll need to set boundaries and quickly! Simply stating something along the lines of: "I'm a professional attempting to care for you. I will not tolerate being talked to in such a manner. If you continue in this vein of conversation, I will need to speak to my supervisor about your behavior or be reassigned." Or something along those lines. Draw a line and stick to it. Don't be trapped or feel that you are trapped by someone's behavior if it makes you feel uncomfortable. Even little ol' men in nursing homes will sometimes grope if you allow it. And believe me, there've been some who knew what they were doing and pretend they are confused. Just remember to maintain your self respect and that includes mandating the same from patients, staff, supervisors, everyone. Ours is a profession where decorum must come first.

[vampiregirl, BSN, RN]

Even little ol' men in nursing homes will sometimes grope if you allow it. And believe me, there've been some who knew what they were doing and pretend they are confused.

Been there, dealt with that. I had a gentleman that I cared for in a LTC that at every meal would ask staff what was on his plate because he "couldn't see it" and ask for extra assistance to cut up meat etc... so he didn't hurt himself because he couldn't see what he was doing. One evening though, I was leaning over the table to pick up something, across the table from him when he commented that he really liked my bra (as he was looking down my scrub top). I looked at him and commented back that I found it interesting that he couldn't see the food on his plate, yet he could see down my shirt across the table. I also told him his comment was entirely inappropriate and then went back to what I was doing. (Later though, I did let his nurse know so she could document). He never did make another inappropriate comment to me (or ask me what was on his plate).

And ever since that day, I have worn a cotton t-shirt under my scrub tops:) I'll never understand why scrub tops are v-necked...

[ilovechadkrause]

Quote: "I have thought about directly stating that I don't want to hear that, none of their business etc. But I also am aware that I am essentially trapped in the room with them and I don't want to give them the perception that their words are making me uncomfortable."

It's good that you are concerned about your client's comfort and ability to have a nurse/client relationship with you.... but just because he/she is your patient doesn't make your comfort level any less important.

I once worked with an elderly male client who always made passes, along with inappropriate touch and talk with new female staff members. Once he got to know you and understand where boundaries were, he laid off.

Here are a few things I found helpful:

1) Never allow someone to get between you and the door. Always have a way out.

2) Some people with decreased cognition can be easily directed. If my client started doing something inappropriate, I would ask him something obscure like, what time it was, or if he saw that bunny outside, etc. It usually worked very well.

3) Talk about a significant other while around this client. Knowing that you are in a relationship with someone else can be a deterrent.

4) SET CLEAR BOUNDARIES! At the first ink-ling of inappropriateness, politely but firmly say that it is NOT acceptable and will NOT be tolerated.

A male client recently asked me what we do when patients get "fresh." I looked him in the eye and sternly said, "They get in trouble!" He hasn't been perverted since.

Hope these tips help, and good luck with your nursing studies!

[Roy Fokker, BSN, RN]

Hi there and welcome. This speaks to boundaries. You are the boundary-maker. At the first inkling of impropriety, stop it dead in its tracks. That is the only way to not let things go so far. Yes, these people are sick, but that gives them no right to abuse you...take care.

Wise words.

I recently had a very belligerent drunk in the ER. He ended up being taken down by 4 security guards (and me!), strapped down to the stretcher and put in 4-point locked restraints.

We pulled a tech to sit 1:1 observation for him. At first, he was just wild and belligerent and my primary concern was for his safety - I ended up placing a wash cloth over his mouth (because he kept spitting at us) and pillow/padding the rails lest he hurt himself.

Once he figured out that his 'tough guy' antics weren't working, he resorted to other means. The tech watching him was a young girl and she wasn't used to the ED (plus, she was new to the job and had just recently become a CNA). He resorted to obscene, lewd talk and suggestive 'gestures'.

It was fairly obvious it was making her uncomfortable. It would have been simple for me to interject and handle the situation - but by doing that I'd be doing her no favors.

So, I just plonked down next to her seat and had a quiet discussion about "setting limits and boundaries", intimidation and de-escalation. IMHO, it's pretty pointless to try and talk sense to drunks (especially those with a BAL of 560...) but it depends on the situation and how you handle it. There are certain things they'll respond to and there are certain things best left ignored (so long as it doesn't harm the patient).

In any case, I let her handle the patient. I did let her know that I was only a few feet away and to either get me or security if the situation worsened...

And she did magnificently! Her confidence grew with each passing hour and she was less frustrated and more in control.

Bottom line? Like traumaRUs said - YOU are the "boundary maker". Identify inappropriate behavior and kill it in it's tracts. Yes, they are our "patients"... but that never excuses inappropriate behavior.

cheers,

[NewWayofLife]

It was fairly obvious it was making her uncomfortable. It would have been simple for me to interject and handle the situation - but by doing that I'd be doing her no favors.

So, I just plonked down next to her seat and had a quiet discussion about "setting limits and boundaries", intimidation and de-escalation.

Give a man a fish, he eats for a day... teach him to fish....

What an excellent way to handle that situation!