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.

[Toremeup2]

Please take it serious and report to your manager. PTSD, is difficult.

[RNfaster]

I agree with others that you should report it to your management. They will then be able to protect subsequent caregivers (and even you and your patient) better. What if you are out sick one day, and another nurse covers you that does not know the dynamics as you have described them? Imagine if the kid hurts the nurse very badly...even though it was not meant with malice.--By reporting, you can help protect other caregivers, your patient, and yourself.

[qrnh, BSN, RN]

This patient has behavior and safety needs. In Oregon he would be able to have a behavioral analysis by a psychologist who would work with the county developmental disability social workers to create a behavior plan for him that would address his safety needs. This plan would include specifics about how everyone on his care team (and that includes you) can stay safe while with him. I won't list all the likely components of a good behavior plan because it has to be based on his individual assessment, needs, and triggers.

This is a team problem that needs a team solution in order to best meet the patient's needs and provide for safety. Providing individualized supports to people with developmental disabilities is the backbone of successful services that create the greatest amount of self determination and life satisfaction for the patient.

You can't keep this to yourself because it is not in the best interest of the patient (or your own safety). This difficult event is an opportunity for your patient to receive better care through a more realistic behavioral support plan.

I agree with those who have said that you will see this behavior again. It may be possible to resolve it (over time and with team effort), but right now this behavior is the current reality.

You need to speak with your manager. Is it possible for you to involve his developmental disability caseworker?

Peace.

[Mhays]

I had a situation where I was walking with a client up the stairs and all of the sudden she went down on the first level of the stairs. I made sure that she was in recovery position and OK, then I got the nurse in charge director of the adult day care center that I was working in, and she helped me get her up and she was safely put into a chair. In nursing, it is always a good idea to know the protocols of the facility and to always get help when needed.

[OrganizedChaos, LVN]

I had a situation where I was walking with a client up the stairs and all of the sudden she went down on the first level of the stairs. I made sure that she was in recovery position and OK, then I got the nurse in charge director of the adult day care center that I was working in, and she helped me get her up and she was safely put into a chair. In nursing, it is always a good idea to know the protocols of the facility and to always get help when needed.

?

This is private duty. The nurse works 1:1 with a patient in their home. There may or may not be anyone in the house with us. But definitely not any other nurses.

[JustBeachyNurse, LPN]

I had a situation where I was walking with a client up the stairs and all of the sudden she went down on the first level of the stairs. I made sure that she was in recovery position and OK, then I got the nurse in charge director of the adult day care center that I was working in, and she helped me get her up and she was safely put into a chair. In nursing, it is always a good idea to know the protocols of the facility and to always get help when needed.

Group home/facility is very different from 1:1 PDN. There are no facility protocols in homes. There is no help if the nurse is there alone because the parents are at work or are out.

Very different. In PDN the nurse is it. No backup

[Mhays]

When children do act out and either hit, kick, or throw things, that usually is an indicator that something is going on either at home or at school that the child would possibly need help to verbalize. A nurses job is to teach the student how to verbalize their concerns instead of acting out on them. For example, when a child starts to hit a nurse, the nurse needs to look at the child's eyes and tell them that they do not like it when they are being hit on their back and you can say to them instead of hitting me, you can show me what is bothering you by drawing a picture about it. You can also show them that hitting does hurt a person by demonstrating on a doll when they hit the nurse and the nurse cries and cries. By doing these steps, that would introduce more of a positive approach to more of a positive behavioral manner.

[JustBeachyNurse, LPN]

When children do act out and either hit, kick, or throw things, that usually is an indicator that something is going on either at home or at school that the child would possibly need help to verbalize. A nurses job is to teach the student how to verbalize their concerns instead of acting out on them. For example, when a child starts to hit a nurse, the nurse needs to look at the child's eyes and tell them that they do not like it when they are being hit on their back and you can say to them instead of hitting me, you can show me what is bothering you by drawing a picture about it. You can also show them that hitting does hurt a person by demonstrating on a doll when they hit the nurse and the nurse cries and cries. By doing these steps, that would introduce more of a positive approach to more of a positive behavioral manner.

Behavior modification is not a nursing responsibility. We can implement a behavior program designed by a BCBA, psychologist or LCSW. If you have a child that can't grip a pencil telling him to draw is unrealistic. Beating a doll and crying is not recommended to redirect or substitute harmful behavior. You need to be careful implementing plans without the credentials to do so. A behaviorist would do a functional behavioral assessment (FBA) seeking (ABC) antecedent, behavior and consequence to determine the best intervention. Most nurses are not familiar with positive behavioral support plans.

By doing the wrong intervention you can cause more harm than good.

All behavior has a reason. In a nonverbal child it's a form of communication.

[PHorvath]

Oh you poor thing! I couldn't imagine what I would do in that situation with one of my private duty patients but you handled it so well. Good job in maintaining your composure. I am so sorry this happened to you. {{{{{{{{HUGS!}}}}}}}}}}}

[Mhays]

When I was the school nurse, I had to assess my students based on their healthcare needs and behavioral needs. If the student that I was assessing was OK and willing for me to help them, then they were OK for me to take care of them. If they were crying, angry, or throwing things, then I waited for about ten to fifteen minutes and then reassess to see if they are ready for me to take care of them. Sometimes, just giving people time to relax is just enough for them to get to feeling better and calmer as well. Time is also a student and person's best friend as well.