Disrespectful patient

[hwknrs]

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.

[Zelda, RN]

Have you ever heard of borderline personality disorder? Far worse (in my opinion) in boys than girls, it usually manifests itself in manipulation - and is not going to change thanks to a lecture.

And it doesn't matter what the drug screen said: if he wants to kill himself, that's cause for alarm.

Things I would've done differently:

- Walked away from computer and got on pts eye level - pull up a chair, crouch by the bed, whatever.

- Said, in a non-confrontational way, "I want to help you, but I can only do that if you answer my questions".

- If pt refused to talk, I'd turn to the mom, and get what I could from her.

[ayysolapsu09]

It's all been pretty much said, but I wouldn't mind putting in my $0.02. I'm currently in RN school, working as an EMT, and worked previously in a county prison as a Booking officer. I don't have a lot of RN experience, but I have a lot of experience with people who are emotionally disturbed. In the past six years, I've had my fair share of inmates/patients who were emotionally disturbed in some way. I can honestly say, if I were to approach and speak to those people in the same manner you did, I probably would A) have been assaulted more, and B) have more suicides on my conscience than what I already have.

I kind of roll my eyes during lectures when my instructors ask us to imagine how patients feel concerning their issues (how do you think they feel after they just lost their newborn? geesus), but it's not because I think how they feel isn't relevant. Rather, it is because it is second nature to me to figure out how someone feels when I speak to them. I need to suss out whether an individual is going to attack me, whether they like me, if they are going to talk to me or not, and how to approach individuals and situations and leave in one piece. Recently I had to juggle two different EDPs in one scene while managing a firefighter who decided to shoot off his mouth and become argumentative with one of the EDPs. Recognizing what you say and how you say it affects a scene is invaluable information.

Back to the OP. You have no idea what your patient is going through. You don't know his life story. You don't know what his mother is going through. And your response is to criticize and diminish the patient? I can think of a hundred different ways to approach a patient, and that is not one of them. Eye contact? Yeah, it's rude to not do that. So? You complained about not getting respect? Who do you think you are? No one is entitled to respect, it is always earned. He was on his phone. Politely ask him to get off, or come back in 10. You probably have more important stuff to do anyways. His mom probably does support his behaviors; so what? You still do your job, and be a professional. He began punching himself in his head? It seems like you didn't do anything to stop/help that, so again, you probably didn't do your job correctly there.

Hopefully you re-evaluate your clinical decisions and better yourself for the next time.

[TeddyBer]

Hello TheCommuter

I commend you for sticking up for yourself. I can understand your frustration in that situation. I am sorry that the rest of the staff did not support you. I was not there with you, so I cannot say if it was right or wrong how you handled it. However, I do see a lot of nurses roll over and take A LOT OF ABUSE from patients which I find repulsive and unacceptable.

I also did stick up for myself with a psych patient once as he screamed and yelled obscenities at us (nursing staff) and I told him "I do not want to hear that language. Please don't use obscenities it is not appropriate." I was told by supervisors the best way to deal with him is to be quite and walk away. Um, no. This is why he continues with this behavior. As nurses we have to set limits.

[hppygr8ful, ASN, RN, EMT-I]

I have a whole different take on this issue. This young man clearly has behavior/psych issues. Could be anything from borderline personality disorder to High Functioning Autism. The biggest key that there is a sensory issue is his refusal to make eye contact. so you telling him to stop what he is doing and make eye contact could be very threatening to him. I work in an acute psych environment and YOUR behavior could very likely end with your getting hurt. Every person who overdoses should be considered a suicide attempt until proven otherwise. Person's in the middle of a mental health crises can present as angry, rude, obscene, calm, happy, labile. As nurses we should not be passing judgement on these patients or their families who have likely been dealing with these maladaptive behaviors for years. Also where psych is concerned I have found that the mental health apple doesn't fall far from the tree.

The fact that he started screaming and punching himself in the head could be clear signs of psychosis and not necessarily bad behavior.

I honestly believe every nurse should work at least a year in a psych setting. These patients are not all locked away in psych wards anymore - they pop up on every unit.

Hppy

[TheCommuter, BSN, RN]

TeddyBer said:

Hello TheCommuter

I commend you for sticking up for yourself. I can understand your frustration in that situation. I am sorry that the rest of the staff did not support you. I was not there with you, so I cannot say if it was right or wrong how you handled it.

I am not the person who originally posted this thread. I was not the one who dealt with the patient who wouldn't make eye contact.

[FolksBtrippin, BSN, RN]

You made a mistake and let a patient get to you and stop you from doing your job.

If you realize this and understand where you went wrong, you can learn a lot from this incident.

If not, it's going to happen again. Eventually, You could get fired.

[Tenebrae, BSN, RN]

More accurate title for this thread would be 'disrespectful nurse"

Seriously OP...... SERIOUSLY

The fact that you seem unable to see anything wrong with how you handled the situation concerns me much more

I'd like to be able to be supportive of your position and am not able to do so in the slightest. You are there as a nurse, not a parent

[Tenebrae, BSN, RN]

VerticalHorizon said:

But he didn't try to commit suicide, he just said he did. He wanted the attention and he obviously has issues. Just because you are a patient does not give you the right to act like an animal and treat people who are trying to help you with disrespect.

You were there?

Patients dont get a free pass for treating nurses and doctors like crap. Then again neither should nurses, especially when its under the pretense of 'therapeutic communication"

And BTW, its nothing about being PC, its about treating our patients with the same degree of basic courtesy we would expect for ourselves and our loved ones. I have no doubt that if the OP, or yourself were spoken to in such a manner as the OP did, you would be the first ones calling for blood

[oldpsychnurse]

I have to say I'm fairly appalled at OP's behavior. She was obviously dealing with an immature kid who has zero coping skills. And while I'm sure he does need to grow up and fly right, she's not the one to lecture him on it.

If I want to talk to a recalcitrant patient, I first make sure I'm alone with that patient, or with another staff member if I feel they are a threat to me. I don't question psych patients in front of friends or even family, if possible. Psych patients often have shame related to their disorder or behavior and it's hard enough to get them to talk to us, much less when family and friends are standing there listening. I would have asked the friend to step out first thing. Often getting rid of the audience is enough to change the behavior (especially in teens/immature young adults).

If the patient still wouldn't communicate, I would have charted it as such, filled in as many blanks as possible with my observations, and left the rest.

I hope this nurse seeks out some education on handling problem patients. Otherwise, I see a short career for her.

[James W.]

A case of too many drama queens - for one small space?

I trust that the OP can use this as a positive learning exemplar.

For the future, perhaps..

Do try & inform yourself of the 'big picture'.. given the Hx data you have..

..prior to deciding on a likely best outcome intervention style.

The patient surely knew he'd get busted for his bogus OD story,

& looked to be seeking an opportunity to ramp up his 'crazy' presentation,

by using the next available 'sucker' to risk a (perceived as 'insensitive')

- baldly confrontational approach.

If you had been a wee bit subtle, & cooly - if not soothingly, 'asked' the patient

for his cooperation, while explaining your helping/understanding role/purpose..

..perhaps the acting out.. might've been saved..

..for the medical/psych Ax interview.. ..oops..

( Seriously though, some of the harshly judgemental posts on this thread

so critical of the OP - do present as a tad pot-kettle-black, IMO.)

[Anna Flaxis, BSN, RN]

Quote

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.

This is where you calmly, politely, professionally tell the patient that you will come back later to take their vital signs and do the admission history. Then you walk out of the room and document this interaction, then go on with your day. Simple.

[dream'n, BSN, RN]

I truly am shocked that any nurse would speak to a mentally unstable patient as the OP did. Do you talk to your confused, Alzheimer patient's like this?? This young man has a MENTAL ILLNESS. Mental illness is as real as dementia, diabetes, or any other disease process. The OP was judgmental to the extreme and let me tell you something; I've dealt with mental illness with one of my children. And yes at times he was certainly not pleasant to be around. BUT, if a nurse had ever spoken to him the way you spoke to this patient, I would have done everything in my power to get them fired and before the BON. And as for the mother being an enabler, you have no idea of the patient's family history. She probably was trying to prevent him from going over the edge and knew that it wasn't the right time to push him.