Hostile patients?

[T123G123]

Hi everyone,

Just wondering if anyone has had a really unco-operative or hostile patient. What do you do? If they are physically aggressive or very loud and disturbing other patients at night, how does a nurse respond?

Thanks.

T123G123

[nursejohio, ASN, RN]

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 don't care what unit she's on, or how old she is! If a patient is A&O and being violent, it's assault and needs to be treated as such. If your facility security won't address the issue, you've got the right to call the real police and press charges. She's also welcome to leave AMA if she's being so nasty simply because she doesn't want to be there... I wouldn't be able to get the papers to her fast enough!

[DeepFriedRN]

If an A/O patient struck me, forget security, I'd call the cops!! That's assault, and it's unacceptable. Cursing and name calling are still unacceptable, but I've found that if you get sweeter as they get uglier, it really ticks them off. People like that hate not being able to get a rise out of someone. If they are demented or psych, sometimes the best you can do is get a group in there with you to hold on so they don't injure themselves or you.

[country mom]

Security.

Any suggestions on what to do if your facility does not have a security dept? Also the suggestion in another post to call the police is not always helpful either- often they make it worse. Where I used to work there was a AFC group home in town that had a resident that would lash out periodically and the home would call the police to bring him into ER. Once they brought him in face down on a backboard, with hands cuffed behind his back- I couldn't do any kind of an assessment. They would also come in with a real bad attitude, making us feel like a bunch of idiots because we had to call for help. And there wasn't a psych unit anywhere that would take this patient because he also had a developmental disability. Another time he bit one of our LPN's- it was scary because he was Hep +. Then the doc wanted me to give him some ridiculously low dosage of Haldol IM. I refused and told him if I had to risk my safety to give the pt. an IM, he'd better make it worth my while.

[sissiesmama, ASN, RN]

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.

OMG!!!! That is horrible to have to deal with, whether or not the lady is lucid or confused. That could lead to a potentially severe injury. Agree, I wouldn call a "Dr. Strong" and a nice shot in the toocus for some sedation. I know the little confused patients can't help it, but it doesn't make the injury she or he caused feel any better.

Anne, RNC

[sissiesmama, ASN, RN]

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.

Hey chevyv - that's one thing, some of the sweetest little ladies that don't weigh 90 lbs soaking wet can do the most damage!

Anne, RNC

[prowlingMA]

When I worked in LTC we had a patient get violent one night. Grabbed an aids arm hard and wold not let go. We eventually had to call the cops. The finally got him off her and held him until his family found a new home for him. Our manager would not allow him back in the building.

Just the other day in the office I work in I had a patient that is a hard blood draw get verbally abusive, insulting me and a nurse, making rude comments, etc.He saw a picture I have on my badge of my pets and even insulted them. I told the doctor I am not drawing him anymore. He now has to go to another lab and have blood work before he comes to our office.

It's one thing to pick on me, but don't talk about my pets. Especially while I'm the one holding a needle.

[mom4josh]

No reason in the world you can't call security... that is part of why they are there.

We had a LOL who suddenly became combative one night (funny, it was the stroke of midnight!). We called security after she pulled my stethoscope off my neck and tried to hit me with it. She was kicking and screaming, so once security arrived, we tied her down and called her son. She was back to her normal self by morning.

[RN1982]

No reason in the world you can't call security... that is part of why they are there.

We had a LOL who suddenly became combative one night (funny, it was the stroke of midnight!). We called security after she pulled my stethoscope off my neck and tried to hit me with it. She was kicking and screaming, so once security arrived, we tied her down and called her son. She was back to her normal self by morning.

I'm guessing she had Sundowner's?

[StNeotser, ASN, RN]

Well, I've had time to sleep on it and have decided if nothing has been done about this individual by the time I go back on Saturday, and she's still there, I'll be following the advice you've all given me.

I also suspect though, that she might have a dx of some sort of psych disorder by then.

[life_aknew]

this is probably irrelevant(sp?) but i can't help but notice that sign i see on the public buses that says "assaulting a bus driver is a felony..."

i'm not saying that just because someone drives a bus that they should be abused-but jeez, nurses care for others and save lives. where are the signs like this for nurses????

[StNeotser, ASN, RN]

Where are the signs like these for nurses indeed?

[Flare, ASN, BSN]

I also slept on this one a bit last night - i'd say if your facility has no security then do they have a risk management person? If not then management personnel meed to be nitified immediately and incident reports need to be filled out once the situation is under control. It also would not be out of line to call in a family member / POA to #1 inform them of the incident (again - do this ASAP) and #2 to sit with the patient following/ during a combative period. I can remember my father having to sit with my grandfather during a stay after a CVA because he got combative.