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??

[DenaLPN2010]

Recently I was put in a situation that made me very uncomfortable, I have a resident that is very racist and refused her bath because the aid was black, I chose to quote her word for word and was uncomfotable using the word tha she used to address the aid. I feel that we have to quote word for word to protect ourself and sometimes other people. My advise is to always follow your gut and do what you have to do to protect yourself and you license:nurse:

[Mudder]

I chart word for word, verbatum

[shiccy]

You CAN chart without using profanities.

I've done both types of charting. I personally cuss like a sailor when I'm not at work or with friends. If a person is cussing because they view you as an equal and not cussing to berate, I might not even mention it. I would, instead, state, "Patient states dissatisfaction with (x)" and what I said in response or actions I was taking (patient rep consult, dietary consult, etc).

This being said, if a person was going off the handle and screaming their lungs about about F*** this and F*** that and being verbally abusive, you have full right to put that into your charting. You ALSO have the right to place in your charting the 'gist' of what they're saying. For instance, "Patient states with multiple profanities and (insert description of patients combative, ect demeanor) that he/she is dissatisfied with meal selections during hospital stay." Therein again, charting what is done to placate the trouble maker. Sometimes charting, "Patient states with multiple profanities with aggressiveness, 'F*** this place and F*** you!' when informed of (x)." This is the best of both worlds because it describes that as the writer you didn't put in the cuss words yourself, but also points out if taken to court that you took exception to the profanities.

Please also note, that I allow the person to scream at me for as long as they desire. After they are done describing their disgust, I calmly bring out my therapeutic communication by saying, "I can see how that can upset somebody. Tell me what happened in more detail." Usually the asking for more details calms a person down and the cussing stops. If it doesn't a polite, yet firm, "Ok. Now. Can you please cut down the swearing a bit. I understand (x) is frustrating, but we have children visiting sick parents, too." If it continues, you can either get a supervisor or if you ARE the supervisor, telling them, "I'm going to give you a break for a few minutes so that you can calm down and I will be back in (x) minutes." This gives them a direct indication that cussing and verbal abuse is not tolerated.

I *have* told patients in my best fatherly voice that cussing is "unacceptable" and repeating it with the consequent cussing and reiterating, "What did I say about cussing?" Depending on the mentality of the person, sometimes that's what is needed as well.

[llerkl, ADN]

In a nonjudgemental, factual way, tell the story of what happened. NOT what YOU feel or think about what happened....just the facts! Facts: what the patient said, what the family said, what concrete behaviors they exhibited, what you did to remedy the situation or assist the patient, how the patient responded to what you did etc. When documenting about an unusual situation, what I REALLY focus on is:

If I was sitting in courtroom, and my documentation was posted for all to read, would others present in the room reading it understand what happened??

Also remember that you are right IN the situation and some of the details that may be clear to you, are not clear to an outsider reading your documentation. Might be good to read the note to another colleague, to see if it makes sense.

[nicenurselpn, LPN]

I have been in those situations before myself. I charted word for word.

NiceNurse LPN

[INLPN93]

I have worked at a couple of not for profit, faith based facilities.

It is in their policy that no profanity is in a residents chart, they offered one on one training for what amounted to using your English Comp coupled with good charting skills to avoid using profanity. As I was told in training, the behavior, what lead up to the behavior & nurse's response/intervention is far more important than a four letter word.

Since then, I have learned to chart without using them.

It is quite easy to get the point across of the residents combative/angry behavior without the language.

I have heard management and surveyors tear a chart apart over profanity and nonsense charting (their words, not mine).

I was also taught in LPN training not to use profanity when charting either.

I usually note something like; Res stated that 'I will not take this poison' and began to use explicitive language @ this time yelling @ writer in loud voice.

Reminded res @ this time he has right to refuse meds et also was made aware of implications of not taking meds. AEB, chance for increased BP r/t not taking evening meds containing Lisinopril 10 mg. Then I chart any & all further attempts to medicate or check BP in my shift and any further behaviors.

18 years of charting this way and I have never been told by surveyors or management they didn't get what the situation was about. Ever. Not one curse word in any of my charting either.

[nightengalegoddess]

It seems to me that every assessment needs to be followed up by 'as evidenced by'....which means....HOW was he verbally aggressive. It seems that a patient may be able, in a court of law, to accuse an RN of labeling and defamation without the exact portrayal of the event.

[CoffeeRTC, BSN, 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.

Charting verbally agressive is not good enough. You must put it into quotes. What is verbally agressive to one person, might not be to the next....or at least that is what someone reviewing the chart might say...I was told my upper management.

I on the other hand chart as a few posters above had mentioned...I would chart that they were using explicit language.

"Entered Mrs Jones room with 5 pm medication. Resident began yelling out profanities, threw water cup and yelled "get out" yada yada yada.......

[Flo., BSN, RN]

I chart word for word. I actually find it very therapeutic. When I am writing a stressful event for me like getting cursed at I always have another RN proof read it to make sure I am only stating facts.

It is also a great way to find out who really reads your notes! I have had docs come up to me and apologize for their pt and thank me for dealing with them.

[MassED, BSN, RN]

I chart word for word with quotations. Fact is fact.

[MassED, BSN, RN]

I have worked at a couple of not for profit, faith based facilities.

It is in their policy that no profanity is in a residents chart, they offered one on one training for what amounted to using your English Comp coupled with good charting skills to avoid using profanity. As I was told in training, the behavior, what lead up to the behavior & nurse's response/intervention is far more important than a four letter word.

Since then, I have learned to chart without using them.

It is quite easy to get the point across of the residents combative/angry behavior without the language.

I have heard management and surveyors tear a chart apart over profanity and nonsense charting (their words, not mine).

I was also taught in LPN training not to use profanity when charting either.

I usually note something like; Res stated that 'I will not take this poison' and began to use explicitive language @ this time yelling @ writer in loud voice.

Reminded res @ this time he has right to refuse meds et also was made aware of implications of not taking meds. AEB, chance for increased BP r/t not taking evening meds containing Lisinopril 10 mg. Then I chart any & all further attempts to medicate or check BP in my shift and any further behaviors.

18 years of charting this way and I have never been told by surveyors or management they didn't get what the situation was about. Ever. Not one curse word in any of my charting either.

depends where you work as to how you need to chart as well. In an ER, where often times you are charting quickly, moving through patients quickly, not having tons of time with patients/family/visitors, you need to be concise and move on. If you're being yelled at from many people in a crowded ER, then you chart and move on. Being concise means not coming up with fancy ways to chart. Don't make nurse charting PC - chart it as it occurs. Plain and simple. If you're being yelled at and you attempt to make amends or redirect a patient and they're still angry, yelling, threatening. Then chart it. No need to cover up their contempt. Why would you? It should never be tolerated to be mistreated, just because we're healthcare professionals. Does being a compassionate nurse also mean you turn a blind eye to verbal abuse by patients? And I'm not talking about mental health patients...

So I went back to the first line of your post... "faith based" facilities. That is why you have been told to edit the profanity from your charting. If a patient uses expletives, it has nothing to do with a faith based facility. It has nothing to do with your charting. It has nothing to do with religion. Charting is charting, without opinion, and without judgment. Charting fact. Period. We have to chart sometimes awful and horrific facts. Why would you feel the need to censor the facts?

I find it unreasonable and quite odd, really, that a "faith based" facility would have it in their policy to not chart a patient's wording, if using profanity. What else do they have in their policies?? How do their policies effect patient care? Do they hold grudges against patients of other faiths? Non believers? My mind is whirling thinking of the possibilities.....

[GM2RN]

I have worked at a couple of not for profit, faith based facilities.

It is in their policy that no profanity is in a residents chart, they offered one on one training for what amounted to using your English Comp coupled with good charting skills to avoid using profanity. As I was told in training, the behavior, what lead up to the behavior & nurse's response/intervention is far more important than a four letter word.

Since then, I have learned to chart without using them.

It is quite easy to get the point across of the residents combative/angry behavior without the language.

I have heard management and surveyors tear a chart apart over profanity and nonsense charting (their words, not mine).

I was also taught in LPN training not to use profanity when charting either.

I usually note something like; Res stated that 'I will not take this poison' and began to use explicitive language @ this time yelling @ writer in loud voice.

Reminded res @ this time he has right to refuse meds et also was made aware of implications of not taking meds. AEB, chance for increased BP r/t not taking evening meds containing Lisinopril 10 mg. Then I chart any & all further attempts to medicate or check BP in my shift and any further behaviors.

18 years of charting this way and I have never been told by surveyors or management they didn't get what the situation was about. Ever. Not one curse word in any of my charting either.

It's nice that you have been able to get away with charting like this, and maybe you will never have problems. But I have to disagree that charting without quoting word for word conveys the full impact of what actually took place.

Management and surveyors may not like profanity and "nonsense charting," but it's not their butts on the line if something about an incident is ever called into question.

You are fortunate that management has been supportive of your type of charting, but that isn't the case at all facilities.

I would prefer to chart without having to use quoted profanity, but I will chart the way I see fit in order to cover myself, regardless of the sensibilities or opinions of management or surveyors.