How do you deal with a patient slapping you?

[AmyRN1227]

Hi everyone,

Hope everyone is doing well. Work is going good. I will be off my orientation June 1st. I've already learned a ton. However, I was wondering how some of you would deal with a certain situation. We have a patient on our floor who's been there approx a few weeks. She came in with acute abdomen, they had an NG tube in her. They are trying to run tests but she refuses a lot of them. She's getting TPN for nutrition, and just recently we were able to take the NG out. They are thinking she has pancreatitis, gastritis. Well, she's 35, has a state guardian and is from a nursing home, has a history of schizophrenia. She has a very childlike manner about her. But, at times can just stare or not talk at all. She goes from hot to cold a lot. Well, the other day she was like in a manic phase and I was hanging a new IVPB on her and she came up to me and said "Hey, let me fix that." I thought she was talking about my hair because the previous shift had warned us she was playing with people's hair all day. Well, she outright slapped me across the face. And HARD. I was shocked, but held back of course like a good little nurse. I told her not to slap me. Then she apologized. One of the nurses said I should have filled out an incident report. I didn't because I don't think she even realized what she was doing and it's not like I got seriously hurt (maybe my feelings that's about it....") I had her again today and she was again trying to touch my face, saying it was pretty. When I told her not to slap me like she did the other day she said ---"I didn't do that!". So I know she's clueless. How would you guys have dealt with it???

Thanks,

Amy:kiss :kiss :kiss

[kaycee]

I also think you handled it well. There have been many times I have been pinched, hit grabbed and bitten by pt's that didn't know what they were doing. If I was actually hurt I would do an incident report. No matter what I always documented it in the nurses note.

In the ER though occasionally you get violent people that do know what they are doing. Those I report to the police and file charges.

Renee,forget armor, we kid all the time where I work about being armed to the teeth. If we all carried around our 357 magnums I don't think we'd have half the problems in the ED, and I think pt's would stay in their rooms when we told them.

[disher]

I complete incident reports for both physical and verbally abusive behavior. If the patient had slapped another patient you would you hesitate to fill out the incident report? You happened to the target that she doesn't remember hitting, whose next? The team needs to know about her potential for violance and make a treatment plan that addresses it. In my workplace an incident report ensures management and the physician are aware of the patient problems (since they have to sign under the follow-up section). Charting doesn't mean all staff concerned are informed.

[micro, RN]

tee it up tom

i haven't the battle scars that you do, but have had a broken finger, concussion various scratches and one human bit in the line of work.........

the other points you made, sad but well said

and you always keep it in the short grass

micro

[Cascadians]

Slapping? Punching, pinching, hitting, poking, stabbing, you name it, been there.

A calm firm statement that such behavior is not appropriate and cannot be allowed, immediately followed by:

If pt is ambulatory, a gait belt works wonders very temporarily slipped over arms at trunk and pt gently marched to nursing station for observation while incident report, charting and documentation quickly done.

The Dr notified, a psych nurse will talk to pt, a conference convened, meds possibly tweaked, and patient will learn in no uncertain terms that type of behavior is not allowed and will not help them in any way.

Workplace violence is rampant and must be curtailed or it will escalate. A patient who gets away with assault will do it again and do it to other patients too.

It must be stopped.

As much compassion as we have for Alz and dementia pts, we will not ever work in a Dementia Unit again. We salute those who are still able to take the risks.

[LasVegasRN]

ALWAYS ALWAYS ALWAYS fill out an incident report on any form of violence that happens to you in the workplace. It doesn't matter if you were hurt or not, it is an INCIDENT that needs to be documented. Like Disher said, the chart does not give the people who really need to keep track and know of these occurences the information. If your facility is OSHA compliant, which all of them have to be, those incident reports serve to establish critical data to prove the need for better security and safety for the staff.

[LasVegasRN]

Originally posted by teeituptom

Howdy yall

From deep in the heart of texas

And this is in a facility that has a policy prohibitng violence in the workplace, but has a security force that is strictly hands off. They will call for help while watching you get assaulted, Thats about all they are allowed to do. They do drive their little golf carts around the hospital and will give you a ride to your car.

Keep it in the short grass yall

Teeituptom

Unfortunately, this is a trend that happening all over. Don't get me wrong, I'm all for seniors being in the workplace, BUT for security - unless you are a retired Navy Seal or combat Vet, this is totally ineffective. We had a boyfriend of a nurse come in, walk past security and assault her in the cafeteria. He was in a total rage, scared the ca-ca out of all of us. The wonderful security guard called 911. By the time the guy had beat this girl up and left out to the parking lot, the wonderful security jumped in their golf cart and I surmised they were in "hot pursuit" to catch him. The guy was long gone by the time the police got there. The girl had a black eye, fractured jaw and collarbone.

.....oh yeah - they were back together eating lunch about a week later. But that's a whole 'nother subject!!

[SandyLV]

Since you all have more experience....

Is spitting considered violence and should it be reported??

[jevans]

Any inappropriate behaviour should be reported as an incident. These forms are to alert managers of what is really happening to nurses at ward level.

My work place has a no tolerance of aggression policy even when it is a patient who doesn't understand what they are doing.

At the end of the day we need to prevent any situation that will result in stress to our staff that will eventually lead to sickness

[RN-PA, RN]

At the LTC facility where I worked right out of nursing school, I was spat on by a resident with demntia who'd been eating chocolate right before I had to sneak up behind her to give an Ativan injection. (She was getting agitated and was known to hit other residents in that state.) Talk about "chocolate mess"! SandyLV, I don't necessarily consider spitting an act of violence, but I would document the behavior in my nurses notes.

At this same facility, I was slapped in the face a few times by confused patients, had Ensure thrown at me, and a few years later on a Med/Surg floor, a patient got a grip on my hair and wouldn't let go-- I had to call for help. (My hair was just below chin-length at that time.) I didn't take any of it personally and just admonished the resident/patient that the behavior was not acceptable or NICE!

On the Med/Surg floor where I work, I recently had a man in with gallstones and he was a brain-injured patient with problems controlling emotions, especially anger. He kicked one of the staff in the stomach and said to me at one point as I was applying restraints, "You look like you need a fist in your face" to which I sweetly replied, "You wouldn't hit a WOMAN with GLASSES, would you?" He replied in a most sinister voice: "Just try me..." We ended up getting a Psych Tech to do 1:1 with him, thankfully, and believe it or not, he'd actually been pleasant when I was first trying to assess him earlier that shift. He wouldn't let me near him, but laughed like mad when I joked with him asking, "Pretty please? May I listen to your heart?" I think he actually let me palpate pedal pulses and auscultate bowel sounds after my sickly-sweet requests. I just charted everything that happened with this man and never did find out if he had the chole since I was off then for a few days... YIKES! We need combat pay!

[micro, RN]

wear my patient attained bruises out for all to ask.....

what the hey.....

but they allow no restraints....

and the nurse takes and takes.....

from all around............ceo to patient below.........

at least majority of patients, they truly do not know......

what they do...........

counting the bruises

hehehehhehehehe

[NannaNurse]

Been in the same boat.....slapped, bit, slugged and even stabbed. Did I fill out incident reports???? YOU BET I DID, even if I "wasn't hurt" or "they didn't mean it". Incident report means just that.....an incident occurred and should be on record.

I'm sure this patient didn't mean to, but still doesn't excuse the fact that you were asulted at work.

...'Oh, I'm sorry my dog bit you...didn't even leave a mark...he didn't mean to.......' perhaps the next time will be different, somone could get hurt (patient or nurse or visitor)

You were smart and STRONG to not react and hit back. It's a natural thing to do, without even thinking, and I commend you.

continue your exceptioanl nursing care and keep your '3rd' eye open....

Good luck!!

[mattsmom81]

I believe many times the patient DOES mean to and been enabled to get away with the violence before, thus tries it again. Too many health care workers accept workplace violence as part of the job. This attitude assures it always will be.