Hostile patients?

RN1982 · Nov 13, 2008

Security.

Flare, ASN, BSN · Nov 13, 2008

i'll second that! No one has the right to get physically aggressive with anyone - sick/ injured/post elective surgical or not.

Parting thought though - i can recall a patient that was convinced that we had an open *private suite* on the floor so he decided to pick fights with his roommate to get moved there. When roommate was moved - he was annoyed because he thought that roommate was getting the mythical suite but then thought he was going to be left in the room by himself. He was rather disappointed when we moved another patient in with him. The new guy was so HOH that he couldn't hear the other patient trying to pick fights again.

racing-mom4, BSN, RN · Nov 13, 2008

physically agressive?? Code strong followed by Geodon!

StNeotser, ASN, RN · Nov 13, 2008

I've just been experiencing the very same trouble over night. Trouble is, it's an old lady who pinches people hard on transfers, and pulls her whole weight down also when being transferred. Has no dx of dementia, any psych problems but depression. She asked someone to tie her shoes yesterday and when the CNA bent down she kicked him in the face. After the 2nd time up to the potty I told her she was only going to get a bedpan from now on because she had been told not to attempt to punch, pinch and pull down on people twice when transferring. I also called the SW on her but apparently they already had some sort of meeting about this patient yesterday.

Can't very well call security on someone that old though - she's 72.

Oh, and she pulls hair too.

RN1982 · Nov 13, 2008

What a crotchety old lady!

MAISY, RN-ER, BSN, RN · Nov 13, 2008

Don't know where you are but many states are cracking down on violence perpetrated on healthcare workers, and the facilities those workers are in. Anyone with a history like this should be attended to by several personnel to get things done, and in whatever form that takes. As a healthcare worker I have a right to be reasonably safe, it's obvious this patient has a known history and your facility is not protecting it's workers.

While psych has normally fallen outside of this umbrella, THIS IS A KNOWN PROBLEM PATIENT, and it should be addressed by your administration. Failure to do so, should be seen as failure to protect employees.

Check Joint Commission, your state law, and OSHA

Maisy

Flare, ASN, BSN · Nov 13, 2008

I've just been experiencing the very same trouble over night. Trouble is, it's an old lady who pinches people hard on transfers, and pulls her whole weight down also when being transferred. Has no dx of dementia, any psych problems but depression. She asked someone to tie her shoes yesterday and when the CNA bent down she kicked him in the face. After the 2nd time up to the potty I told her she was only going to get a bedpan from now on because she had been told not to attempt to punch, pinch and pull down on people twice when transferring. I also called the SW on her but apparently they already had some sort of meeting about this patient yesterday.
Can't very well call security on someone that old though - she's 72.
Oh, and she pulls hair too.

Ya know - the bottom line is What would happen to this lady if she were pinching people in the supermarket? Or if she asked someone on the street to help her and tie her shoe or get something she's dropped and kicked them? I think this lady either needs another psych eval or needs to have the you know what scared out of her by security. Just because someone is old doesn't give them the right to assault another. (and yes... they are assaults - if you ever have a doubt ask yourself how it would be viewed if it were someone else doing the same to her...)

StNeotser, ASN, RN · Nov 13, 2008

Yes, but this is on a rehab unit in a SNF. If I called the police/security on her they'd laugh.

Her whole reason for being this way when I asked her is because she didn't want to be there. She also told me I belonged in jail. When I told her that punching hitting and pinching people were felonies she laughed.

I also told all the staff not to transfer her anymore no matter what she asked because she really could injure someone by pulling down like that. I had gone in with the CNA on both transfers.

Anyway, I hope that social services and the MD will do something with regard to behaviour and meds today. I next go in on Saturday and I doubt she'll be gone.

mama_d, BSN, RN · Nov 13, 2008

I second the security and Geodon! I used to love orally disintegrating Zyprexa, but IM Geodon is my new favorite.

Set limits in a calm but firm tone of voice, assuming they are oriented. "Mr. Jones, it is not acceptable to yell/hit/pull hair at any time. If this continues, I will call security to assist with all of your care. If you strike me in any way, I will call the police. You do not have the right to verbally or physically abuse staff, and it needs to stop now." Then follow through on it.

I had a patient just the other night who called me every name in the book, advised me to become a prostitute, tried to hit me, etc. Security was not available at that moment, so I got the most physically intimidating male nurse on the floor to come in and help me out. Of course, behavioral restraints are frowned upon, so I was actully glad when he started trying to pull out his PEG tube and port-a-cath access; it gave me a legitimate medical reason to restrain him. I ended up spending the entire shift doing his care and treatments without saying a word to him, since talking to him, even just to say "I'm giving you your meds now" was enough to get him ramped up.

Sometimes when they're demented, all you can do is have as many people as is necessary in the room when it's time to do care; one for each limb and one to do the wiping etc. is usually best in my experience.

chevyv, BSN, RN · Nov 13, 2008

I worked on Gero psych and we called security on a cute little old lady that was chasing me around the floor to get me. She couldn't have been more than 85# but it took 5 security guards to hold her down so we could sedate her. It was comical when one came up and then had to call a few more guards. I'll never forget it.

morte, LPN, LVN · Nov 13, 2008

Yes, but this is on a rehab unit in a SNF. If I called the police/security on her they'd laugh.
Her whole reason for being this way when I asked her is because she didn't want to be there. She also told me I belonged in jail. When I told her that punching hitting and pinching people were felonies she laughed.
I also told all the staff not to transfer her anymore no matter what she asked because she really could injure someone by pulling down like that. I had gone in with the CNA on both transfers.
Anyway, I hope that social services and the MD will do something with regard to behaviour and meds today. I next go in on Saturday and I doubt she'll be gone.

if she is alert and oriented, and she doesnt want to be there, WHY IS SHE THERE?.....give her taxe fare and get her the heck out......