How do you chart verbal aggression by a client?

[RxOnly]

I participated in another thread and some of my advice to another nurse here was to document that the client was "verbally aggressive" among other things (the client had reamed her a new one, unprovoked). Other posters seemed to disagree with that and said that they write down word-for-word what a client says in their chart.

I'm definitely going to check with my nurse manager and ask her what is appropriate charting for my facility (as we encounter this behavior from our clients quite a bit). However, I'm just wondering what other nurses chart when they run into these situations.

Say, when you went into his room to give meds, Mr. Smith says "$%^! you and this whole &*!%%$ place, you are a &^%$#@ piece of &%*$!" Fill in the blanks with whatever words you like :) ...would you put curse-words in the chart, or write that he was "Verbally aggressive", etc. I guess I just feel funny as a professional writing the F-word in a client's chart... but if that's what my manager wants me to do, I certainly will!

How do you nurses chart these things??

[pedicurn, LPN, RN]

I quote exactly what the p't said .... word for word .... in all it's glorious ridiculousness.

I also state exactly what the p't did .... every single action.

I also state what their family members said and how they behaved. Plus state names and positions of any witnesses.

I feel better when I do this and it provides some entertainment for my coworkers.

It also helps to save my butt :)

[nurse2033, MSN, RN]

Does the exact verbage matter, or is the idea of being verbally aggressive? Sometimes the exact words do matter, and sometimes not. There is nothing wrong with charting the patient as uncooperative, verbally abusive, or any other behavior. I think if the patient is altered the exact words don't matter, but if the patient is just being an a**, then I would record the exact words. They might come back later with a complaint, and their exact words will haunt them and deny them credibility.

[Silverdragon102, BSN]

This happened to me the other day and I quoted the client word for word

[Bella'sMyBaby]

As I stated on another thread, you need to document exactly what the patient says.....this is appropriate charting for your facility & every facility. If Management is telling you something different, then they must be trying to cover up something.....You need to look out for yourself & cover your "Act".

Charting exact wording is Fact, charting your opinion, isn't.

[GM2RN]

The problem with just saying the pt was verbally agressive or verbally abusive is that it is open to interpretation if there is ever any question about the pt's behavior. Even charting that the pt is uncooperative still does not give the entire picture, since many patients will be uncooperative with some things but cooperative with others.

In my opinion, it's always better to use exact quotes and be as descriptive with behavior as possible, even if it means using swear words or describing things that make you uncomfortable. That way there is no question about what was said and done, which could save your job or license if it should go that far.

[APRN., DNP, RN, APRN, NP]

Paint a picture with words.....no matter how "colorful" they are.

A large part of our charting at this time, versus historical nurse's charting, is to please the court.

When you chart, you want to be able to communicate effectively enough that there is no question on a date five years out that this patient was acting and saying the things that were said and done.

When you are asked to describe for the court what the patient was doing or saying that made him/her "verbally aggressive", and you don't already have your definition charted, you will spend a large amount of time having your opinion of what constitutes verbal aggression versus whatever other slant the attorney is trying to focus on. If you contradict yourself, you've just made yourself look even worse.

[GM2RN]

Does the exact verbage matter, or is the idea of being verbally aggressive? Sometimes the exact words do matter, and sometimes not. There is nothing wrong with charting the patient as uncooperative, verbally abusive, or any other behavior. I think if the patient is altered the exact words don't matter, but if the patient is just being an a**, then I would record the exact words. They might come back later with a complaint, and their exact words will haunt them and deny them credibility.

It may not matter in some cases, but you never know when it will matter. That's why it's best to use quotes and be as descriptive as possible every time.

[merlee]

If the incident was lengthy, it's not necessary to chart every word. However, it is appropriate to chart as best you can.

My butt has been saved by my quotes of what the patient has said. The pt/family made a complaint, my charting covered me. And I wish there was a way to video tape what some of these people say and do.

[apocatastasis]

Word for word. If there was a lengthy exchange, then the most salient quotes suffice. I chart not only for the patient, but also for myself.

[ShannonRN2010, BSN, RN]

Word. for. Word.

[Nascar nurse, ASN, RN]

We all have a different tolerance for what is actually aggressive behavior. I don't even bother to use the words because maybe you, a state agency, a lawyer, etc may view aggression differently than I do.

I write word for word & if that means a whole string of F-words than that is what I will document. It leaves absolutely no doubt about what was really happening in the room.

The same applies for if physically combative..I don't bother to write resident was physically combative. I spell out the patient/resident "hit CNA, scratched nurses arm to the point of drawing blood, spit in staffs face, etc".

write the facts and let the reader draw their own conclusion.