Got Beat Up Badly In Face By Patient

faithful11 · Mar 6, 2008

I think maybe you didn't read my post carefully. Of course we (in psych) have a right to protect ourselves -- what I said was that we don't have an absolute, unrestricted right to protect ourselves, in any way one might choose. I made that statement in response to your suggestion that the OP learn karate. We have a professional obligation to respond to clients within established ethical and legal guidelines.
In my state (and probably in yours, also) using anything other than facility- and state-approved intervention techniques (like the karate you suggest) would not only get you fired, but investigated by the state for possible abuse of clients, possibly disciplined by the BON, and open to criminal charges.
I am certainly not advocating anyone being a "punching bag" in psych settings, or allowing clients to "do anything and everything they want," and I agree completely with everything you said about avoiding physical confrontations except the karate. It is always best to be alert and proactive, and avoid/prevent situations getting physical in the first place. I would even agree with the idea of studying karate to simply improve your balance, reflexes, etc. -- but if you are talking about actually using karate techniques against a client, again, that would be illegal in my state and, I would guess, in yours, also.

I agree..as far as I am aware, at my state facility, if you are unable to EVADE or GET AWAY...and the state approved techniques ARE NOT WORKING or your LIFE IS IN CLEAR AND PRESENT DANGER--then we are reasonably allowed to use reasonable force. Anyhoo, this is what I was trained, retrained and retrained to understand since 1996. We have always been told that whatever decision you make, that you feel is NECESSARY to protect and defend YOUR life (not just your safety mind you) then YOU do that certain thing, and it is up to YOU to be able to defend/justify it should it come to that.

So..if a patient picks up a chair, can I pick up a chair? Sure can. What will I say in court? "Your honor,people of the jury...this patient was presenting an imminent danger to myself/others...although I did try to de-escalate the situation by using verbal redirection, and then by trying to run away, he/she picked up a chair and blocked the exit while continuing to threaten to harm/hurt/kill me/others. I,in turn, picked up a chair to protect and defend myself."

If a patient is 6 ft 8" (and btw I am 5ft 1)and is choking me from the rear as my legs dangle in the air and I cannot get away, may i kick him in his B*LLS??? SURE THE HELL CAN. If I don't I may die. Can I poke him in his eye...sure can. If one of my male coworkers who is also 6 ft 8" was being choked from behind by the same patient, HIS reasonable force would of course be DIFFERENT. He could do the head tuck possibly, allowing him space to breath...he could maybe toss the patient over his shoulder...there are different interventions or actions he could use that I WOULD NOT BE ABLE to use simply because of the difference in size.

If a patient walks by me and slaps me, can I jump on his back and attack him in return? No. Regardless of his or her size.

Again...everyone must be aware of what they can and cannot do...and in ALL cases, do what not only feels appropriate to you but whatever you are willing to explain to a court of law, licensing board, department of justice, etc...if you slap a patient, strap down a patient, spit after being spit upon etc...just be willing to accept that you may not have a job, license or even the RIGHT to work in your chosen field if you are found to be in the wrong. :twocents:

The_Wonderkid · Mar 20, 2008

I have heard several times of 'lost privilages', needs for patient to be put in 'restraint' and 'seclusion' and I must say it concerns me greatly. Is the way Mental Health (I hate the term psychiatric) patients treated different in the U.S than it is in the UK?

Restraint should be used ONLY in a situation in which the person is an immediate danger to themselves or others. Therefore a 'calm' patient should under no circumstances be restrained AFTER an incident. This (as some have stated in the thread) would be using restraint as a form of punishment which of course isn't upholding patient rights (this is the same with seclusion). If the person however was deemed as still volitial then restraint should be used to the minimum until the situation is calmed. If the patient is offered medication and accepts (Via PO) then there is also no valid reason to restrain on those grounds either.

As for withdrawal of privilages. It sounds like patient's should feel grateful to be able to have 'privilages' in Mental Health Units, and that for 'bad behaviour' or actions which aren't acceptable these 'privilages' should be withdrawn as a punishment. For whatever reason this patient lashed out. The focus should be more on how to manage the patient in a way which neither puts a person at risk nor places unreasonable restriction on the patient.

What I find most concerning is a number of members are calling for 'immediate seclusion'. Isn't it the case that to provide an intervention you first need to assess the person and what would be most beneficial for the person involved (and everyone around them)? If the person is deemed to be 'calm' then wouldn't it go against that theory? Wouldn't a good Mental Health team (not Nurse, as that is too individual) be able to assess a person and place them in a situation which is appropriate?

Within the UK system alone there are a number of practices, policies and the like put into place to protect both patient and staff during and after situations such as this. There are protocols for debriefing, constant restraint updates (including de-escalation) as well as support systems and the like in place. Incident forms are a big part of UK health services as a way of ensuring the risks of aggressive behaviours are reduced to a minimum.

RN.38SPCL · Apr 18, 2008

NEED ADVICE....yesterday we were short staffed and our charge nurse usually dont take patients...have u ever heard of such....he said he is not supposed to...anyway we were short with rn and tech...one of our patients who was a wrist cutter went into mens bedroom where there were x2 male patients sleeping....i told her not to go to the male room and got punched close fist multiple times on the head, face, eye, and i have lacerations on my hand and MY face is swollen...i went to er and thankfully the facial bone xray came out negative..but i have soreness the next day. the patient never get into restraint...they put her back into her room and gave her prn shot later....we all know she did not go into restraints so charge nurse wont be bothered with paperwork and utilizing rn to do 1 : 1...they never notified security saying SHE WAS CALM AND COOPERATIV3E..i was in er x4 hours..nobody from my unit even bothered to call how i was doing...i ended up calling house supervisor / security/ etc myself.
2. MY BOSS SAID SINCE SHE WAS CALM AFTER I GOT BEATEN UP...THERE WAS NO NEED FOR HER TO GO ON RESTRAINTS...WTH?:smokin:
3. when security called charge nurse and asked why they were not notified of battery...they said " no need to bec she was calm after she hit me"
moral lesson of this story: in psych unit where i worked, staff just take care of themselves and choose to act depending only on certain staff/ person...they make their own rules depending on who is in charge:yeah::yeah:...every minute the rule change on our job...
thanks everyone for listening everyone:bowingpur:bowingpur:bowingpur i know what im going to do for my carreer future...

The patients' rights end where yours begins. All jobs that have risks also provide a means for protection. All psych nurses should be taught how to physically defend themselves without causing any injury to the patient. it can be done. Cops take people down all the time and don't cause any serious injury. why can't psych nurses use mace? I would sue the employer. I am sick to death of employers not being fully staffed. There are always staffing agencies to use in a pinch.

showbizrn · Apr 20, 2008

1. BE SURE to fill out an Occurrence/Incident report and Workman's Comp ASAP. Take pictures of your face. It ought to be very colorful today. Consider getting a lawyer. Not to sue the pt., to sue the hospital. (not sure about that part) Also, see an eye doctor to make sure your eyes are OK.
2. Your CN has a boss. Talk to her. No way was any part of this handled correctly, and probably not in keeping w/Hospital Policy.
3. Ask security if they filed a report.
4. Get a new job? I'm sorry this happened to you.

*************************************************

DITTO.

Sorry for your pain, cebugirl--both physical and emotional.

My prayers and hugs go to you.

showbizrn.

:redbeatheFrom the heart.

RN2begin · Apr 28, 2008

This is outrageous! I just posted in response to another nurse who got slapped in her face. She was doing nothing wrong. Maybe these two assult posts should be combined, but either way, I'd file charges against the patient and/or your facility for failing to protect you. Things have swung too far in favor of the patients. I know, I know, we advocate for them, and I have done so all of my career, but who advocates for the healthcare worker? I am so sorry this happened to you, her, me, and all others who have dealt with this.

Absolutely press charges against the hospital AND the patient. I often find at my hospital that patients are not held responsible for behaviors that would result in very serious consequences "on the outside". Regardless of the mental illness piece, the basic concept of treating people as human beings goes both ways.

showbizrn · Apr 30, 2008

Cebugirl,

I've got to give it to you---straight-up.

I'm not speaking for other healthcare facilities

I'm not quoting the law

I'm not spouting federal/state regulations...

WHEN A PATIENT HITS THE STAFF

THE PATIENT "GITS" AN INJECTION---PERIOD!!!

:nono:I can't play the violins with my other colleagues----YOU DESERVE BETTER!

MANY BLESSINGS TO YOU!!!

Aviationurse · Apr 30, 2008

showbizrn, rn2 begin

thanks for your kind reply. staff dont care about co workers...when i was screaming for help....the secretary, boyfriend (mht), male social worker came to respond by looking at me all so shook up and hurt and they stood about half a mile away so the are not too far from nurses station and. from the doorway of patients room where i got hurt..no code grey (security) was made...and all the dingbat male charge nurse said was "fill in this employee injury sheet and go to er".....

in my unit...nobody cares....all they care is their pay check and thats it.....charge nurse sets rules on how he feels every day and aint do nothing but act as entertainer to staff....cutie pie to nurse manager/md/adm , brag about wife /kids/grandkids/car/bootleg movies/stereo/shoes/coat all day and ....blah blah blah ...

in our psych unit...the most dingbat/dangerous psych nurses ..the ones who dont do nothing but endorse everything to the pm nurse

gets the " nurse excellence award during nurses week"..:smokin::Crash::Crash::Crash::Crash:

i still love psych nursing..been on it x 11 years after being burnt out from med surg/icu nursing...this unit is a joke:sofahider:sofahider:sofahider looking around to get out from this hole....thanks again for listening to me vent

medsurgrnco, BSN, RN · May 3, 2008

Haven't worked in psych yet. But I don't get it. A patient beat staff in the face and now appears calm - the fact that the pt assaulted staff isn't considered as part of the assessment to determine that the pt needs a prn med, timeout, or something to ensure the pt ACTUALLY IS CALM and NO LONGER presents a danger to staff or other patients?

psalm, RN · May 3, 2008

Haven't worked in psych yet. But I don't get it. A patient beat staff in the face and now appears calm - the fact that the pt assaulted staff isn't considered as part of the assessment to determine that the pt needs a prn med, timeout, or something to ensure the pt ACTUALLY IS CALM and NO LONGER presents a danger to staff or other patients?

...that would be like saying Ted Bundy wasn't all that bad, he is now calm, etc...

vashtee, RN · May 3, 2008

This may have already been mentioned, but where I live, injections are considered "chemical restraints".

And yeah, I think you should file charges if the patient was A/O.

RN2begin · May 4, 2008

As a charge nurse, I would at least medicate the attacker. Being calm is no guarantee of the patients next act. She was probably calm before attacking the first time. Some people are just violent. The best way to affect the behavior is for some type of consequence. The hospitals should automatically press charges in such a case, if the nurse agrees.
I wonder how long it took to get help. Such patients should be placed in isolation for a time also. There should be state facilities available to ship such patients to :madface:after they attack. This should be automatic. Or they should go to jail. The jails like to give us their "suicidal" patients, but don't want the violent ones.
It is too easy for criminals to feign suicidal thoughts, then hide out in the psych unit.

Unfortunately, there is no place to send anyone. I work at a state psych hospital and we are bulging at the seams with referrals to SPU (secure psychiatric unit) at the prison...there is just no room and no money. Let me rephrase that...there is money, but not for psych. High need / low priority. Because nobody had revisited the law that allowed patients the right to refuse treatment (which at the time was inadequate and often barbaric), it remains in place, despite drastic changes in treatment options...people can still remain in a state psych facility for the rest of their life...refusing to take meds and remaining too ill to be discharged...we take everyone, so cost is not a factor at all (for the patient). I think that the idea is wonderful, but the reality is horrifying...especially when I am consistently told to get a real job, by a person who hasn't had one in years... :twocents:

jhamrn · May 9, 2008

Where you given a choice or encouraged to press assault charges against the patient. When it comes to assault even patients need to be held responsible. Did the patient show any nonverbal cues that she may become violent. Your facility should investigate this incident and the charge nurse should be held accountable for his poor judgement, and apathy.