Inappropriate sexuality...where to draw the line?

[Kunzieo]

Hi. I was just wondering what you all would do in this situation.

We have a younger patient (52y/o) who came in last week with CVA who needed a craniotomy. During the craniotomy, he had some sort of cardiac episode (I'm sorry I don't really have the details, I'm just the CNA.)

Anyhoo...

At first he was really out of it, would barely respond to verbal stimuli, and didn't appear to have much purposeful movement of any of his extremities. However, whenever anyone stood by his right side, which is his good side, he would reach his arm up and wave it around, until he made contact with whomever was standing there, at which point he would stroke his hand up and down on whatever body part he landed on.

As the week went on, he regained ability to talk, and much voluntary movement of his right side. However, the groping continued. He would continue to caress whomever stood on his right side. As the week went on, it seemed more to me that he knew exactly what he was doing, and was aiming more for the butt and boobs.

He also began expressing some sexual thoughts...moaning whenever we put lotion on him, spreading his legs wide apart and shaking (as best he could) his midsection at us, and calling all of us honey, baby, etc.

This is where I am stuck. Half the nursing staff believes that he really doesn't have much control over himself, and that the behaviour is just a side effect of the CVA.

The other half has labled him a sexual harasser, and wants to call security on him any time he inappropriately touches the nursing staff.

So...what do you guys think? What would you do in this situation? Would you say something to the patient? I don't really want to be too hard on him...in case he can't help himself, but I don't really want to enable harassing behaviour, either.

[Tait, MSN, RN]

Man I don't know. It sounds pretty inappropriate and intentional to me. Hard to tell when you aren't in the situation but I would do my best to not let any of my "parts" get anywhere in the "grab and grope" range for starters.

As far as the "moan and wiggle" I would have to assess his mental capacity first hand to try and determine if it seemed within his scope of mental abilities to manipulate the situation in a sexual way.

Also does he do this when family is present? Might be worth having family help out for a day and see if he acts the same way. If there is no change chances are it might really be out of his control.

./shrug

Best of luck!

Tait

[Kunzieo]

Well, he answers most questions appropriately, yes or no, or one word answers. He knows he's in a hospital and that there are nurses in the room. He has a wife, who spends a lot of time there. But since I work nights, I don't know how he acts with her around, although the day and eve CNAs have complained of some inappropriateness. I don't know if it was in the presence of his wife or not.

[bill4745, RN]

Talk to his neurologist and see what she/he thinks. Personally, I've never heard of this type of behavior in a CVA, but it's worth asking neuro.

[casi, ASN, RN]

I'm another CNA so I really can't weigh in on the faking or not, but I can give you some advice for handling him.

Always point out his behavior to him, no need to be mean or call him a faker, but if his hands start roaming towards you try a "Please don't touch me."

I don't know how strong/weak he is, but these are a few things I found to work with dementia patients.

One thing I've found that works with combative patients other than staying on their weak side or staying an arms length away is to only uncover what you need. What this amounts to is when you are working on the patient, always keep his hands covered with a blanket, unless you need them out.

I'd also suggest that when you boost him in bed or reposition. Instead of telling him to cross his arms, as you tell him to cross his arms reach down and do it putting the weaker hand on top. Just makes him work a little harder to get the strong hand free.

[mauxtav8r]

Got any guy techs or CNAs or nurses who you could send in?

Just wondering if he would behave himself with a guy.

[txspadequeenRN, BSN, RN]

what a sneak???? lol sounds like he has a good thing going... has anyone told him to stop? if he can answer his name and respond to questioning appropriately then he can understand...."stop touching the nursing staff in a sexually inappropriate manner". i would also be telling his nurse so this can be documented.

[patwil73]

The CVA might have affected his impulse control - so he might know what he is doing but not be able to stop. The easiest test is to wash him with his wife out of the room and see if he tries to grab you, then have the wife come in and see if his behavior changes. If it doesn't either he is hoping his dx of CVA will get him a free pass or it has actually affected him.

A neurologist also should know if cases like this have been reported before.

Hope this helps,

Pat

[llg, PhD, RN]

You shouldn't be handling this "on your own." There should be a team discussion with the physicians, experienced nurses, etc. to develop a plan of care for this patient. That way, the expertise of the whole team is brought to bear on the situation and the issues are addressed in a consistent way. Each caregiver should not be addressing it in a different way.

[SharonH, RN]

Just because he appears to be alert and oriented to person and place does not mean that the part of his brain which controls impulses and tells him which behaviors are appropriate or not hasn't been damaged. Hasn't anyone consulted with his neurologist? llg is right; instead of everyone trying to figure out whether or not he "knows what he is doing", you should be developing a plan of care for how to uniformly respond to these actions or better yet, prevent them.

[TiredMD]

You shouldn't be handling this "on your own." There should be a team discussion with the physicians, experienced nurses, etc. to develop a plan of care for this patient. That way, the expertise of the whole team is brought to bear on the situation and the issues are addressed in a consistent way. Each caregiver should not be addressing it in a different way.

Agreed, the brain guys really have an obligation to weigh in on this. Your nursing supervisor should be pushing them to render an opinion.

[ktwlpn, LPN]

Just because he appears to be alert and oriented to person and place does not mean that the part of his brain which controls impulses and tells him which behaviors are appropriate or not hasn't been damaged. Hasn't anyone consulted with his neurologist? llg is right; instead of everyone trying to figure out whether or not he "knows what he is doing", you should be developing a plan of care for how to uniformly respond to these actions or better yet, prevent them.

I agree with Sharon- he is s/p CVA and a craniotomy.I'm betting the areas of the brain that were damaged are his impulse control and maybe an area that causes hypersexuality behaviors. We see these behaviors in LTC (other causes ) and often the most difficult aspect of care is making some of the staff understand that the patient really can't help it and needs to be treated with respect and patience...