I Don't Think He Meant To Hurt Me

[SunnyPupRN]

I'm writing this mainly because I just want to vent a little. I have a peds pt who is an adolescent, but BIG and strong. He's a big developmentally delayed and watches lots of cartoons. You know how in cartoons you see these exaggerated actions, like bouncing into the clouds or the feet moving at supersonic speed before the character even takes off? Well, this pt copied something he saw...one character going to another and throttling them at the throat swinging the head violently back and forth. One minute I was sitting, charting, and the next minute my head was whipping and my throat was in a vice grip. Once I realized what was happening, I was able to take his hands off, but I was rattled.

I am sure he didn't mean to hurt me. My throat is still tender, but there is no bruising. This is home health, so nobody was around, but I was firmly explaining to him that what he did was not ok when the parent walked in and heard. The parent was angry, because apparently they had told him before not to do this.

I did have a few minutes where I maybe I had a touch of PTSD from some domestic violence, and I felt sort of unreal and a bit tearful, but I was able to shake it off. The bottom line is that I am ok. I guess I just needed to write it down.

[Been there,done that, ASN, RN]

Maybe this kid should not be watching violent TV shows.

Exactly. The kid has been noted to have violent outbursts." The parent was angry, because apparently they had told him before not to do this."

Yet.. he is allowed to be stimulated by violent .. so called "cartoons". The parents, the agency , and the provider are missing the boat regarding his diagnoses.. but leaving OP ALONE with a mentally unstable patient.

[JustBeachyNurse, LPN]

You need to report this. Now. You need to be checked out.

The agency needs to take action the next nurse can be hurt especially if they are more petite

[BadwomanM]

Is this child by any chance on Depo shots? I don't know that much about it, but I've heard in elderly men with dementia they can lessen aggressive behavior. Maybe that would be a good option for him?

Just my pennies' worth... :)

[pixierose, BSN, RN]

Quazar -You are a special mom

I might have mis-characterized his actions; I don't think they were malicious/aggressive. I think he acted spontaneously, and he truly doesn't know his strength. To be fair, I'm not in and out for quick assessments - I'm there for long stretches of time for the express purpose to give the family relief. I've had him for about three months as a patient, and he can be grabby, affectionate [sort of reminds me of Angelman's syndrome although that's not his diagnosis] but I've never seen him hostile or threatening. I don't think there's any blame, really. I'm just feeling sore and surprised and wondering if I could have done something differently.

Thank you for your concern!

I agree with the (most likely) intent of his actions.

And hence lies the problem ....

You *will* be attacked again. This type of behavior -- imitating television shows of aggressive content -- has not been corrected formally. His mother knew of the behaviors, yet did not inform you -- how is she addressing it? If the answer is unclear, or if you are uncertain, it's time to strongly consider leaving this assignment.

It's not the kiddos fault but those that supervise him: it's all about antecedent-behavior-consequence.

Could you have done something differently? NO! No one informed you.

When I was still teaching, I had a 12 year old do something similar -- he bopped me on the head, attempting to see how far I would fly. Turns out, pretty far. Mild concussion, 6 stitches from the hair pull (still don't like thinking about that; it was like I was scalped). Luckily I had other staff around me at the time.

((Hugs))

[Kitiger, RN]

1) Report to your supervisor, not only for this time, but in case it happens again. You need to be able to show that you have kept your supervisor informed. Also, your supervisor must know in order to prepare any other nurse who might be assigned.

2) Get checked out by the company doctor. If you have problems from a hidden injury down the road, you need to be able to show that you followed company policy.

3) Find a way to debrief. Talking it over with your supervisor may be enough, but if you need help to process this, then get help.

4) Take a class in deescalating violent behavior. Your company should pay for it. This class will also teach you how to protect yourself, things like not sitting in a corner ...

5) Consider whether this child's size along with the fact that you are alone with him is an acceptable situation.

[JennaRae]

This made my heart break for you. I'm soo sorry! *hugs*

[NurseLiliRN]

Oh my goodness, I'm sorry this happened to you! You need to report the incident to your employer, and I think they should get a male nurse to take over the case, since the patient didn't understand that shaking and strangling his nurse is very serious. Since he likely will repeat these behaviors in the future, when he is even bigger and stronger, it may take a strong man to restrain him during those times to prevent harm to himself and to others. Otherwise the mom needs to be present in the room at all times. I'm glad you're okay!

[Red398]

I am so sorry this happened to you. As in agreement with previous posters, I would not be taking that assignment again. Your health is more important. Fortunately, I have not been in this situation before, but I can only imagine how terrifying it must have been for you. Please take care of yourself.

[SunnyPupRN]

It doesn't matter if he meant to hurt you or not, he DID. Do not see this patient again, he is only going to get bigger and stronger since he's still so young. No one is going to have your back in this besides yourself, decline all future assignments involving your attacker. Mentally disabled or not, that's just what he is; your attacker.

Thank you for this input. While I respect and understand what you are saying, if I treated everyone who is developmentally delayed, strong, and has boundary issues as a potential attacker, I would be making interaction with patients a big problem for myself. "Attack" implies malice...there was none. He needs boundaries set and reset. I have seen him since that night, and indeed he did pull my arm, but I was prepared, and firmly reminded him again that it's not ok, and he stopped. I think this is a subjective experience, and another nurse would be completely justified in feeling attacked and refusing to go back. For me, I'm trying to learn and work with the situation.

[SunnyPupRN]

Hi, my name is Purplespider and I live in Virginia. I am so sorry that this happened to you. I have had incidents where clients hit me and I had one client who molested me as well. When these incidents happened, I told my supervisor about it immediately. She took care of the situation, but it was hard at first though telling her and revealing it over and over again. My advice to you would be to tell your supervisor immediately. You did a great job in standing up for yourself. I understand that the boy may have a disability which may cause the violence or the hitting, but it is absolutely not OK for any child even if they have a disability to hit or make fun of an adult for any reason. You did the right thing in telling him that was not a good action. You can also tell him and show him a good action instead of the action that he did so that he learns positive behavior versus negative behavior. You also should report this to your home health agency so that they know about it and perhaps get some therapy for yourself or talk to someone about the experience because the more you let your feelings out in the open, the better. I wish you the best. Purplespider, CNA

I'm so sorry for your experience! It sounds like you were able to heal, or maybe get some good perspective. Thank you for understanding.

[Panful, LPN]

I learned not to turn my back for to long. Years ago I had a pt that would punch me between the shoulder blades twice. She was smiling and said hi. I quickly turned my cart around. Hence no further issue. Some pts do not realize the strength they have. Different cartoons??

[oldpsychnurse]

You say you can't treat every case like a potential attacker. That is true. But this patient is not a potential attacker anymore. He IS an attacker. You should report his behavior and refuse to continue working with him. He needs care that is beyond what you are capable of giving him, IMO (and I mean no disrespect to you or your abilities). I hope you don't wind up being seriously injured or killed, because this kid sounds more than capable of just that. And the fact that he's only playing and copying his tv heroes won't leave you any less hurt or any less dead.