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

[Teshiee]

Spitting on you is considered assault. Gosh!!!!! I can really understand mentally disabled people they aren't together but some but hole coming there and beat his girl friend down, that is pathetic. What is more sad she back with them. Domestic violence is a bytch!!!!!

[Brownms46]

I agree with reporting any incident of violence whether you "think" you're hurt or not! Never let an incident like this go undocumented...for your protection as well as others. I have been hit, kicked in the stomach, had a urinal full of urine thrown at me,(back when they were metal) spat at and more. One old vet hit me so fast in the chest, I didn't even realized I was hit, until he drew his hand back. Some of these folks can be very fast, and everyone needs to be aware of them! One pysch pt. called our locked unit, and told us he was on his way with a shotgun for the male nurse I was working with. Talk about scaring you know whatless! Document, document, document...everywhere!

[TaraER-RN]

working in the ER i get paranoid every day that something will happen...been a year and so far I've been lucky enough to be ok. We have quite a few guy nurses and guy EMT"s there and paramedics will help, so if we have a psych guy needing restraints the guys won't let the girls come near them. people have bene kicked, bitten, hit etc. in my facility and we have the no tolerance no matter what the situation. We have to fill out what we call unusual occurence reports for everything! You should fill out something beyond the nurses notes, so it starts a pattern if needed. As for the spitting thing, depending upin the situation I would fill it out, especially if it got in the eye etc. (which did happen to a nurse in my ER)

[OrthoNutter]

You know, if you slap 'em back in under two seconds then it's classed as an involuntary reaction and they can't sue you. :roll

Seriously, you did well to control your temper. If that had been me, I'm not sure I would have been able to hold back and I would have been putting in my under two second slap.

I don't care if they're clueless, demented, psychopathic etc. I don't go to work to get beat up. It's the notion that we should accept workplace violence as part of our job that gets me.

[jayna, RN]

I was slapped by a ***** of a drunken woman. Not a patient but patient's relative.

She hit her husband (woman abuser) and he had abrasions and few minor lacerations. Vitals all normal. Other examinations all normal. This is 4 am in the morning. She insisted for doctor to see her husband which i said told her the doctor is around he will come and she him. Doctor busy. She keeps on insiting and I told her, the doctor will be coming we'll wait. Then out in the blue a big hand comes around and slapped me on the cheeks and head.

I left the department, and the doctor arrives arguing with the drunken woman and told her to leave or else he will call the police to arrest her.

We filed a report against her and I never saw her for 4 til last year, she came in the hospital (emergency unit) with her baby who was having a dysentry. Poor baby poor her. I attended them . Probably she didn't recognised me but she looks guilty.

[biscuit_007]

Originally posted by MollyJ

Wow! sounds like you handled it well and did some good limit setting.

My only thought is--does your hospital have a psych mental health CNS or experienced psych nurse that could consult on helping you guys deal with her and discretely evaluate her meds? with the GI intolerance, you probably cannot give her some of her routine meds, but she seems to be acting out alot and being in the hospital environment is probably pretty frightening for her.

Good luck.

I love this idea. I would have never thought of it myself since i rarely deal with violent patients in PICU but use any and all resources available to you and you will be fine.

[Nurse Hag]

Call 911 and fill out the incident report. This gets the attention of the pt/res and his or her family. The administration and Doctor also have to deal with it and you can always drop the charges later. We had a resident try to walk into traffic after leaving the facility, (really confused patient) he wanted to know if we ever thought about getting hit by a truck. The facility was on a highway, he tried to throw a staff member in front of a truck. After the cops came suddenly the Doctor, Administration and Family agreed with the "floor staff" that he needed to be in the locked dementia unit. The staff had been trying to get this done for about 3 months. I have used the technique on 3 other patients and its amazing how fast things move. PS the other residents tend to take note that you are not going to tolerate abuse.

[mario_ragucci]

Next time she slaps you give her a combination, right-left-right, with an open palm. Try to go for the body. Make sure you are up front, and hit her with everything you got.

If a person pops you one, it's okay for you to pop them one back. You can't deny what needs to be done

(humor :-)

[momrn50]

Have had chunks of hair pulled out, a black eye, a busted lip, grabbed from behind in a choke hold, kicked, scratched , bitten, gummed....reports filled out on all incidents, nothing done by administration because they couldn't afford to lose any residents. I don't work there anymore.

[MHN]

I work in a psych unit attached to a general hospital there is a special psych liaison nurse whose duty is to assist staff on the general wards deal with psych patients.The liaison nurse also helps the pts with the mental health diagnosis.So its a win win situation.

As far as documentation goes all such incidents should be reported verbally to team leader,incidents forms completed and in the pts notes .

[sandstormsdust]

I didn't read all the posts on this thread but, felt compelled to write something here.

The other day I was reading an article in the newspaper.

Although the situation in the paper was different than the facts here I feel are the same... and in my eyes EXTREMELY CONCERNING

A woman called the police do to a domestic. A woman officer showed up and want into the house to 'rescue' the ladys daughter. The abusive partner then attacked the officer causing an on floor wrestle. The officer unable to protect herself used one hand to ward off the partners fist and the other to protect her gun.

She sustened minor injury's. With bleeding in the mouth, bruises and other small scrapes. She was treated at hospital and released.

A few months later she went to her GP for a physical and was 'diagnosed' with Hep C. The only thing she could pin the Hep C on was the incident from a few months before... the "partiner" consented to having tests done and was proven to be the primary person whom she had got infected from.

I would find that any profession that deals with people who are in anyway slightly altered upstairs or in the fit of rage... there would be a mandatory rule or a rule thumb that would make the employees sign documents or write the 'incedent' down even if only for future purpose.

~it is late but I just wanted to get this off before I lost track of the thread....

[Jenny P]

PLEASE EVERYBODY! Document ANY violence on an incident report! I was punched twice in one week back in 1980; then 10 years later (after years of repeated ear infections, etc.) was found to have inoperable TMJ (the "hook" of the joint is totally missing and can't be rebuilt) from the 2nd punch. I did fill out an incident report on the 1st punch, and also on the 2nd one: the guy in 4 point leather restraints (having a reaction to his angio dye) kicked a pregnant nurse across the room and caught me in the jaw so hard that the docs thought he'd broken it! I was sent to the Childrens hosp. for special x-rays (which proved my jaw wasn't broken) and also went to see my own dentist who documented that ANY FUTURE root canals, bridges, etc. on that side of my face would be directly due to that injury. Well, 10 yrs. later, when the TMJ was diagnosed, the x-rays were gone, but the incident reports in my file and the note from the dentist carried weight and the hospital has to pay for my appliances and PT when it gets bad again. Of course, the hospital tried to say I had had braces (true) when I was young and the TMJ was due to that-- I (luckily) was able to contact my former orthodontist from 25-30 years before, and HE REMEMBERED ME!!! (because I was his 1st pt. with such a mess of teeth). Anyway, he was able to tell the hosp. that I did not have TMJ from that. So, for the rest of my life the hospital has to pay for this injury to me (I just have to deal with the pain when it flares!).

Document both in the chart notes (objectively and what was said), and FILE THOSE INCIDENT REPORTS! It's for your safety and health, not just to get back at the patient!

BTW, we, as nurses, are now legally able to file assault charges against pts. that do hit or injure us. This is a fairly new ruling (witin the past 3-5 yrs), and effects all of the US, I believe. The ANA lobbied for that and it was passed by congress!:)