Verbally abusive patient, worried I could have handled the situation better - page 11
Let me start out by saying this is a little long winded, but it has been weighing on me and I have to get it off my chest, so bear with me!!! So, my last shift, I had gotten report on a male patient... Read More
Sep 25, '17Joined: Jul '16; Posts: 3,799; Likes: 16,998Quote from MunchYes. I've done that, too. If the patient is of sound mind, understands that he cannot have surgery after eating, and chooses to eat anyway- that's his problem. The doctor is informed, of course ...and the two of them can hash it out until they reach some sort of conclusion.The people saying they would just give to him..if the patient was NPO would you give him a sandwich if he demanded he was hungry?
Sep 26, '17Joined: Apr '17; Posts: 213; Likes: 786He was taking up a bed. Be glad he's gone. I would have ripped his Foley out with the balloon still inflated, to be honest. You handled it much better than I would have. Why do we even bother with such disgusting, worthless, evil patients?
Have fun with the urine retention/pulmonary edema, buddyLast edit by Zyprexa on Sep 26, '17 : Reason: Too much ranting...
Sep 26, '17Occupation: RN & RRT Specialty: critical care, ER,ICU, CVSURG, CCU ; From: TX, US ; Joined: Jan '04; Posts: 2,400; Likes: 4,307In my slightly over 45 years as RN, I set the boundaries, should said patients choose to cross that, it is their first patient bill of rights,but, is on them....I'm here to advocate, and providing safe care. " I simply refuse to be on jerry springer" best wishes, and just hate you had this experience
Sep 26, '17Joined: Dec '13; Posts: 2,416; Likes: 17,591Quote from NurseMom2016Better yet, you should have all chipped in to put him on a bus to a city far, far away!In this situation, our house supervisor issued a cab voucher to take him to the address he provided. Under normal circumstances we absolutely will not provide a voucher for those leaving AMA-but he would have had no way to get anywhere but our curb in front of the hospital. So that was our one kind act towards this guy I guess.
Sep 26, '17Joined: Sep '11; Posts: 2,479; Likes: 12,757Quote from EmergentGreyhound therapy.Better yet, you should have all chipped in to put him on a bus to a city far, far away!
Sep 26, '17Specialty: Pediatric Critical Care ; From: US ; Joined: Apr '13; Posts: 2,200; Likes: 7,019Quote from ZyprexaI just shuddered. Hyperbole right? .....right?I would have ripped his Foley out with the balloon still inflated, to be honest.
Sep 27, '17Joined: Aug '16; Posts: 57; Likes: 157Quote from ZyprexaImprovised TURP fantasy? Someone just had one of those shifts.I would have ripped his Foley out with the balloon still inflated, to be honest.
OP: There is something more thing you could have done. It's a method to deal with this type of patient.
Sep 27, '17Joined: Sep '12; Posts: 24; Likes: 20First off, he was already d/c'ed by the doctor, or at least had the order to d/c. Not your patient anymore, so don't worry about what you said.
Secondly he committed battery against a nurse, he's lucky YOU didn't press charges. We do NOT have to put up with abuse, especially when it turns physical. A patient is not exempt from laws surrounding assault and battery.
Thirdly, you followed doctor orders. The patient can do what they want, we are not their parent or jailer. Just document everything. If wants to drink himself silly, go for it. It's their right to worsen their condition. As the nurse I am there to care for them per dr orders and keep them as healthy and safe a possible. I wouldn't have brought the coffee without looking at the I&O sheet either; that's covering yourself.
Let it go because you are right. However consider having your own because you never know what lunatic will try to go after you in this field.
Sep 27, '17Joined: Mar '14; Posts: 73; Likes: 65I don't understand why people are so angry at the doctor. It was the smartest thing to possibly do (giving the coffee). It calmed him down, and stopped the situation from continuing to escalate. She also even made the coffee and give it herself allowing the nurses to keep their dignity (imagine after all of his behaviour the Dr telling the nurse in front of the Pr to make the coffee)!
About the other rescinding his discharge and you making him leave
1. He had signed the paper
2. He was a ....
3. I would of done the same thing as you
Is it technically 'right' what you did? Of course not! Will anything happen/ come out of it? No
Sep 27, '17Joined: Aug '09; Posts: 6,213; Likes: 25,400Quote from Julius SeizureMust wonder how the BON and the patient's attorney would interpret that.I mean....technically he wasn't anybody's patient at that point. He had been discharged. He was her former patient, I suppose.
Sep 27, '17Joined: Jun '17; Posts: 70; Likes: 175OP, you handled it a lot nicer than I would have. For what it's worth, I think you did just fine. Once someone starts verbally assaulting you and throwing things, communication should be immediately terminated.
It will be a cold day in hell when I put up with that much disrespect and rudeness from a patient. Oh hellllll no. He didn't need the coffee and was rightfully sent on his merry way.
Sep 28, '17Joined: Feb '15; Posts: 20; Likes: 10First of all, I think its awesome that the OP is self-reflecting on this as there is no one correct solution but only possible strategies to be applied and reviewed in the future when similar situations arrise, as they inevitably do!
I can definitely see both sides of the argument for giving him the coffee to prevent conflict and de-escalate as well as the obligation to follow MD's orders.
For me what I often do when patients are pleading for things that are contra-indicated to their treatment plan is I say something to the effect of i'm very sorry I can see/understand that this is difficult/ uncomfortable/ frustrating etc/ for you but LEGALLY by law I cannot give you coffee/ water/ food items etc and I could be sued if I do because the doctor has ordered this because (insert pt education of risks) and by law I have to follow the doctors orders. However you are an adult and can make your own decisions about what treatments you wish to accept and follow so I cant force you/prevent you from doing/having xyz and you are welcome to discuss this with the doctor I can call him/her for you if you like and in the meantime I cant stop you from getting it/doing it yourself, I just cant be the one to give it to you i'm very sorry.
This of course would be abbreviated for the agitated patient but usually once I throw around the legal terms they get it and attempt another strategy i.e asking family or negotiating.
While I do have an obligation to follow doctors orders I am not here to force any treatment on an a+o and competent person.
I would also use my judgment in the moment and weigh the risk vs benefit. For fluid restriction usually 1 extra cup of water is not life or death and sometimes sneaking an extra cup of water can make the difference between a calm pt and a code white (more often in confused pt's who dont understand why they cant have it though) In this case he ultimately prob just wanted his booze!