Disrespectful patient

[hwknrs, BSN]

Tonight I got a 20 y.o. pt from the ED who came in saying he tried to harm himself by benzo OD. A&O drug screens neg. I went to his room to check vitals and get his admission history done. He was talking to his friend and did not stop to respond or even acknowledge that I had entered. he complained that he wanted to be released ASAP in the AM and that he didn't even have his cell phone charger with him. When I asked for his emergency contacts he sighed and rolled his eyes at me then went back to talking to friend.

Then mom came in from the hall. Pt then started playing with his cell phone and would not make eye contact. Just incredibly rude and snotty. I asked him to please put his phone down, show some respect and make eye contact so we could get this done He rolled his eyes & sighed ugh fine is that better. At that I told him it looks as though he has a lot of growing up to do and said that this is unacceptable behavior how he is acting towards me. I reminded him that he is here because of a choice he made and not to get smart with me as I'm trying to help and it's not my fault that he's here. His mom then told me that I shouldn't be talking to him that way that he just tried to kill himself (which he really didn't) and I should be more understanding. I said that's what I'm trying to do my job and no matter he still should not be so rude. It's not ok for him to be talking to me like this.

Then pt started screaming at me sayin you ***** you don't know and punching himself in the head. I stood back and watched and said this is pathetic how you are acting this is terrible behavior. Other staff heard him screaming & security was called. I then left the room and family requested another nurse and acted as though I was in the wrong. What do you all think? I just felt that his behavior was awful and inexcusable- needed to be brought to his attention that this is not the way to behave.

[Jensmom7, BSN, RN]

There's a time and a place to have someone face the consequences of their actions. This wasn't it.

By setting up a you-against-him atmosphere, and lecturing him in front of his mother (did you really think she was going to thank you? That's a family dynamic you aren't going to get close to unraveling in an acute care setting), what you did was ensure that he wasn't going to tell you anything, and mom was going to request another nurse.

You say he wasn't really trying to kill himself. Maybe not, but something happened to induce the behavior. That's what the Psychiatrist and counsellors are for.

Believe me, over the years I've had rude, obnoxious, and snotty patients and family members. I've practically shredded my tongue at times holding reactions in. Yes, he was rude and disrespectful. Sounds like it's pretty much his MO.

[caliotter3]

Somewhat doubtful he would have been acting this way in front of his mother if it was not his usual behavior. Her behavior clearly demonstrated why he acts that way. Can bet a paycheck that your employer will chastise you for this incident, not the patient/parent.

[hwknrs, BSN]

I was hoping the mom would back me up and help remind him of basic manners. This has worked in the past but not this time. I know if my child was acting this way I would be embarrassed and definitely tell them to knock it off.

[caliotter3]

We all wish that parents will keep their children in check, but it doesn't always happen. Where I live, the parents of my nasty neighbor children are right out there instigating the bad behavior and modeling bad behavior for the children to emulate.

[hwknrs, BSN]

Very true Caliotter3. At the time I felt that holding my tongue would be a dis service to him and reinforce that he act this way again in the future. I just need to remember that I can't save the world!

[LadyFree28, BSN, LPN, RN]

Not a great situation!

Sometimes we have to be mindful of our own pts and families and the different backgrounds and situations that they come from; when it comes to an admission where a psychosocial issue is at the forefront, you even have to take pause before diving in.

I agree about the cellphone issue, however, the eye contact could've been feelings of shame or embarrassment; along with other internal and external issues resulting in maladaptive behavior that we have nothing to do with us.

My issue is from your own post:

hwknrs said:

Tonight I got a 20 y.o. pt from the ED who came in saying he tried to harm himself by benzo OD. A&O drug screens neg. I went to his room to check vitals and get his admission history done. He was talking to his friend and did not stop to respond or even acknowledge that I had entered. he complained that he wanted to be released ASAP in the AM and that he didn't even have his cell phone charger with him. When I asked for his emergency contacts he sighed and rolled his eyes at me then went back to talking to friend. Then mom came in from the hall. Pt then started playing with his cell phone and would not make eye contact. Just incredibly rude and snotty. I asked him to please put his phone down, show some respect and make eye contact so we could get this done

The bold and

Quote

At that I told him it looks as though he has a lot of growing up to do and said that this is unacceptable behavior how he is acting towards me. I reminded him that he is here because of a choice he made and not to get smart with me as I'm trying to help and it's not my fault that he's here.

There could've been a more levelheaded response for addressing his needs, even if they weren't the priority; you response interpreted to him (even though he was wrong) was dismissive; then to reduce what was the cause of his behavior and his admission was also dismissive.

Words and tone are important; sometimes we have to remain even keel even when others are being nasty.

[Anonymous865]

You had a patient that presented to the ED stating they had attempted suicide. You seem to think that because his drug screen came back negative, he doesn't have a psych issue. Just the fact that he went to the ED and said he had attempted suicide should be enough for you to assume a psych issue.

Then your behavior toward him caused him to escalate from ignoring you to screaming and punching himself in the head.

You stood there and mocked him by saying he was pathetic and his behavior was terrible. How did you think that would de-escalate the situation?

Other staff had to call security for a patient who had been calmly talking to his friend until you started lecturing him and demanding he respect you.

What part of this interaction do you think you handled well?

Yes. His behavior was inappropriate. He is not the professional. You are.

[hwknrs, BSN]

I'm not denying that he has a psych problem. I only pointed out the drug screen to show his manipulation. He told a terrible lie to his friends and family in order to get them to run to him and it worked. He also got the attention he wanted from a certain girl. He came to my hospital knowing this and then acted as though I was inconveniencing him by doing my job and that he was angry that he had to be there. This is repeated behavior for him as well. Obviously his mother has never told him this is wrong and I beleive that SOMEBODY needed to let him know this is not right. He should have been admitted to the psych unit as he had no medical problem and that probably won't even happen either since 9/10 OD patients just get d/c home because our psychiatrist won't take them. It's clear that he takes no responsibility for his behavior and then gets angry when the obvious consequences happen. ignoring his rudeness and acting like this is all ok just further implants the idea he has that threatening or attempting suicide and throwing temper tantrums is how to get what you want. When is somebody or anybody going to check what this kid is doing? It's disgusting

[LeChien, BSN, RN]

That communication wasn't therapeutic. (Half joking, half not)

[whichone'spink, BSN, RN]

In that situation, with a disrespectful patient, I would hold my tongue with his family, especially his mother, around. There is a 50% chance that he is the way he is because of his mother, and the mother won't back you up if you put him in his place. I've had disrespectful patients who gave me crap in front of their families and their families would yell at them for their actions. I just acted as the neutral party in those cases. If families have any self respect, they'll usually tell the offending patient off.

When the family, especially the mother, is not in the room, and the patient is disrespectful, then I would happily put him in his place. He won't have mother to fall back on.

[springchick1, ADN, RN]

hwknrs said:

Obviously his mother has never told him this is wrong and I beleive that SOMEBODY needed to let him know this is not right.

Yes, somebody needed to tell him. You are NOT that somebody.