Getting hit!

chadash · Mar 9, 2006

God bless you!

I think the discharge planner needs to spend a special day with these patients.

smk1, LPN · Mar 9, 2006

I am not a nurse yet so maybe this has no relevance, but i would be writing up all of these incidents to risk management. This sounds like a lawsuit waiting to happen. If these things are documented and nothing is being done by anyone and one of the staff sustains a serious injury or illness they have a legal standing i would think. getting hit in the side of your head is not a joke! You are supposed to have a safe work enviornment and if it is documented that this man cannot help maintain that enviornment, and the management does nothing then they are at fault. This reminds me of an evil old man (NOT demented, just plain evil) that lived at an ALF that i worked at, he would curse, name call, spit at us and call us to the room and throw his FULL urinal at us to clean up and his feces as well. He tried to run over one of our CNA's as well with his car in the parking lot. Management did nothing even with all of our complaints. The nurse on duty never did anything either because it never happened to her so she didn't really care. Well when the DON came to visit he threw his urinal at her and he was sent out of the facility that same day, and didn't return. The on duty nurse got into major trouble as well for ignoring the complaints, because one of the CNA's did sustain an injury from this man's abuse and sued. I don't know what happened with the suit because i left for a better job. My point is that this should not be happening to you. Human resources or Risk management need to be aware of what is happening.

crb613, BSN, RN · Mar 9, 2006

Just a thought :idea: ...what if all the RN's on this unit...CNA's too refused to accept these pt's??? Mgmnt would be forced to deal with it then. I am not a nurse yet, but just trying to think of ways to help. Good luck

ear · Mar 9, 2006

Wow, sorry to hear about this situation.

One thing that I have discussed in the past with families and Doc's (and management) is that these people have the right to be free of the feelings that they have to cause them to do these things....The "right to be free from restraint" is important, but you are not restraining them if you medicate them to HELP them. You are not out to dope these people up, it is for THEIR safety that they need a medication. Dementia is like any other illness/disease, it needs to be treated. If a diabetic had a low blood sugar, you are going to treat them, so if a pt. with dementia has a behavioral problem, they should be treated as well.

Sometimes families ( and Doc's ) dont understand that. :uhoh3:

Someday, they may just try to hit the wrong person (another pt perhaps) and they will get hit back.

Sorry to hear you are going through that, there are so many meds out there to help these people and it really frustrates me that no one wants to help them.

Good luck to you!!!

~ear

bargainhound, RN · Mar 9, 2006

These type patients need referral to a behavioral psych unit for geriatrics

where there medicatio can be adjusted....that is what will help them be

managable in care settings or at home for that matter..it is not chemical

restraint....it is medicating their illness to control their symptoms.

MissJoRN, RN · Mar 9, 2006

Uggh, I have no advice only sympathy. I was working as a CNA on a mixed dementia and elder-psych unit the year the facility decided to leap blindfolded onto the restraint free badwagon (back when that was a novel idea and restraint free facilities were hard to find, so it was a selling point) Over the course of 4 weeks we discontinued 90% of our various posey products as well as scheduled and prn "chemical restraints" Of course we didn't increase staff! A few months later I was drinking all my meals through a straw after trying to protect a resident from herself and getting a nice pop in the jaw! Managements response? "You should have ducked." What if I had? What if she'd fallen in that time? Gotten blisters or bruises from persistantly hitting/ rubbing her surrounings? Who cares about the nurses/aides right?

I left human care for veterinary care then came back to smaller humans after a brief stint in adult homecare.

Don't know what to say... that facility did almost throw out an alter man who was physically and verbally abusive but it took forever then he backed off "just enough"

I don't want to tie everyone down, either. Wrapping everyone is poseys wasn't appropriate, but throwing them all away wasn't, either. Why can't we provide tailored personalized care? Give every individual what best meets their needs? Certainly, their not in a safe position, either!

McGyverRN · Mar 9, 2006

So for the last two days I have worked with two different demented elderly gents at a local hospital. Both are very demented, neither can get placement outside the hospital because they are combative...and it seems the Doc's and Family members are going 100% against us nurses and CNA's that must care for them!
First day I got hit very hard in the right temple by one of the patients...I thought I was out of arms reach..but he was trying to get out of bed, and it was between me and the floor for him...LUCKY for me he had mittens on because he keeps pulling out his foley and his iv's so now we have a picc that must be protected...NOT THE STAFF..but the picc! UHGGGG~! Then a discharge planner chewed me out for the mittens saying "he will never be discharged if you guys don't let him free of the mitts! (remember..just mits, not tied down or restrained!). I explained that it was to protect the picc and foley and at discharge would not be needed since those should be d/c'd by then....she said point blank "yeah right, you guys are just tired of getting hit!".
Okay...even if that was the case...why not be tired of getting hit..he is a huge very strong man!
Second patient....no mits no nothing. Family wants him free of medication so no prn or any meds to stop him from constantly getting oob, or spitting/hitting/grabbing...and yesterday he aimed himself and peed on my CNA!!!!!!(he is MRSA precautions in urine!!!). I came in to stop him (while my other patient was starting to stroke!!!!) and both the CNA and I got our butts kicked royally!!!!!!! She had bruises all over her arms and sides...I had several on my arms and one on my left cheek!
So I called the MD and begged her to help us with some PRN medication. NO GO! "no, the family doesn't not want medications for him...they say he has a reaction to all medications". I almost said "well I will tell you for darn sure he is going to have a bad reaction from me next time he hurts me!!!" but I didn't! After begging...I got to give 10 mg of a med IM...which worked thank GOD!
I bring both these cases up to RN management...and got a huge lecture on chemical and physical restraints (like I don't already know that and quote the book better!)...and that they were sorry and not to accept that patient again if I couldn't handle him. HANDLE HIM??? I can handle patients quite well thank you...but how to you handle someone that is demented and wants to hit/spit/scratch/grab/urinate/throw feces/wants OOB/ and I can't use any type of restraint to protect myself and staff? It is like saying..okay box this kangeroo with your arms tied, legs bound, and blindfold please!
I know others have had the same experience...what did you do to try to solve it???? THe two men are actually quite nice when they are with it...and I do care for them deeply and they are sweet..but when they are demented they forget they like me and I am helping them and start swinging!!!!!

As for the first pt, the case manager needs a reality check. As for the second pt, if the family refuses phyiscal or chemical measures to ensure the safety of the pt and the staff, then THEY need come in and sit with him 24/7!!!!

bargainhound, RN · Mar 9, 2006

exactly!

lna2rn · Mar 9, 2006

My facility provides CPI training. It teaches us how to "divert" attacks and keep us safe. Maybe your facilty could have training provided to you.

chadash · Mar 9, 2006

I did an dementia unit, and though I really loved it, it required artful ducking and swerving because they used restraints only rarely. I know they eventually did a drug study there, and had quite a bit of success with some drugs. Not only was it safer for the workers, the patients were more content. A real win win situation.

I don't feel mittens are a real negative thing for patients who are no longer into small motor activities, and can be very helpful for compulsive picking etc. I do think some restraints, like bed belts and the such, require more vigilence on the part of the staff, the pt really needs more looking in on.

It is a shame that this becomes such a tug of war for the nurses who are really aware, really on the front line....they take all the risk and responsibility, yet family, management and others second guess their judgement.

elizabells, BSN, RN · Mar 10, 2006

Ugh - I swear people who don't get hit by patients have absolutely no understanding. I had a confused gentleman try to smack me during a bedbath, and I told my instructor I wasn't really comfortable going back in (he wasn't my pt, I was helping another student). In my evaluation she said I needed to work on my therapeutic communication with difficult patients. She compared it to this one time she had to take care of a woman who had just terminated a pregnancy, and since she was Catholic she had a hard time. Then later I was describing a different issue (unrelated to the hitting) with the pt to another student and my instructor pipes up with "I remember him, you had such a hard time with his personality!" Yes, not wanting to be hit = personality conflict. :uhoh21: