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.

[pockunit, ADN, RN]

RescueNinjaKy said:

We don't have to stand there and take it

Take what? He was talking to his friend and on his phone. It's not like he was trying to assault her. Document the interaction and move on. Try again later, no big deal.

Like you said, not our job to teach manners. I wouldn't even bother with telling him he was being in appropriate because it would not be helpful for this particular interaction. I totally get being wound up by particular patients, but it's OUR job to recognize that and move past it.

[pockunit, ADN, RN]

lnvitale said:

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.

I hope fired is the least traumatic result, because a lot of patients wouldn't have hit themselves overthat kind of interaction. They would have gone after OP.

[Ruby Vee, BSN]

Some of the previous posters have given excellent advice, and so much more eloquently than I could manage. I'll just say that I agree that the OP was out of line, and the fact that she posted the scenario here expecting to get support for her actions makes me wonder whether she is qualified to be working with psych patients. Perhaps a review of some mental health literature may be in order.

[pigginsrn]

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.

Psychiatric patients don't behave as you expect they should and to challenge him at that point was not only useless but dangerous. Why escalate?? What do you hope to gain?

[Anna Flaxis, BSN, RN]

I want to add that it's essential to establish a rapport with your patients. Scolding and shaming is the antithesis to this. This confrontational approach will only serve, at best, to prevent the patient from trusting you, and at worst, cause the patient to lash out, as in this case.

A great way to have connected with this patient would have been to take a phone charger with you when you went back in later. Clearly, his phone is important to him, and the idea that the battery was low was a significant concern to him. Showing concern for his concerns by bringing him a charger would have been a great step in establishing you as a person he could maybe open up to a little. This is assuming he's allowed to have a cord in his room, which would depend on whether he was on suicide precautions or not. If cords aren't allowed, then at least offering to take his phone and charge it at the nurses' station might have had a similar effect.

Responding to so-called "rude" behaviors with kindness and empathy is NOT synonymous with enabling. As others have mentioned, YOU are the professional. Your job is to help.

[dave5000]

I'm sorry to say, you were in the wrong in all aspects. Our job is not to judge but treat the pt. and did you really thing mother would support you?

[springchick1, ADN, RN]

James W. said:

( 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.)

Except the OP asked our opinions. The patient did not ask what the OP thought of his behavior.

[NotAllWhoWandeRN, ASN, RN]

James W. said:

( 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.)

If a patient cannot be bothered with accepting medical care, you attempt to discuss/educate, you document their refusal, and you move along to your next task or patient.

OP has proudly announced that she told a suicidal patient to grow up and that he's pathetic. All we know is that he didn't OD on benzo's; that doesn't prove he didn't OD on something else or that he doesn't have suicidal ideation. If he's not truly suicidal, he's still displaying obvious mental instability of some kind (BPD has been mentioned) by deciding to tell someone he is. When he started harming HIMSELF the response was to reprimand him... and we're supposed to offer a high five? There is no pot or kettle here.

[Dogen]

If someone I just met told me I had growing up to do and called me pathetic I'd speak language so blue you'd need to be able to see in ultraviolet just hear me. And I'm a relatively stable, adult type person. If I were unstable I'd strangle you with your stethoscope.

[cjcsoon2bnp, MSN, RN, NP]

To the OP, as a nurse who works in the Emergency Department and in Psychiatric/Mental Health settings I can see this situation from a few different perspectives. To your credit, I can understand how frustrating it is when we feel like patients are being non-adherent, argumentative and/or manipulative and that the behavior they are exhibiting is inhibiting us from doing our jobs properly. With that being said, it is our job as healthcare providers to display behavior that is professional even when our patients do not extend us the same courtesy. Many of the other posters have addressed the various pathologes that could contribute to this patient's behavior and when he is admitted to the inpatient psychiatric/mental health unit the team will delve further in order to determine the cause. For the purpose of delivering care in the ED, your job is to provide a safe and secure environment, assist with medical clearance and prepare the patient to transition to the next level of care (inpatient, discharge to outpatient/community services, transfer to another facility etc.). As difficult as it is, we are not in the role to pass moral judgments about our patients or act as their parents/guardians; doing so will only shatter the therapeutic alliance and escalate anxiety/agitation both in the patient and in ourselves as providers which can lead to some dangerous situations.

To the OP, please take some time to review the most recent literature related to psychiatric/behavioral health emergencies and therapeutic communication with patients. I might also suggest talking with a peer mentor or maybe someone from an Employee Assistance Program (EAP) to help work through this issue before it happens again or a significant safety issue occurs because of an agitated/aggressive patient. Best of luck!

!Chris

[canoehead, BSN, RN]

Anonymous865 said:

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.

The OP really whacked the patient over the head with how inappropriate he was being, so he got defensive and escalated. Your reply is doing the exact same thing to her. You can point out better ways to handle the situation, but still do it in the spirit of trying to assist. In forums, and in life, you'll get more change if you approach people as if they are doing their best, and need guidance.

[canoehead, BSN, RN]

Cultmember said:

Next, the fact that you are judging an individual who has presented para-suicidal tendencies indicates to me that you are not fit to work with patients in general.

Let's not attack someone based on one crappy interaction, that she recognized was bad, and asked for help with.