intentional or falls

LadyFree28, BSN, LPN, RN · Aug 21, 2014

Where to start...

Anyone who is exhibiting behaviors such as falling or splitting staff or any other um "attention seeking behaviors" then they need to be documented and care planned, period.

As for do people fall intentionally? Maybe it's a coincidence that one falls after being redirected when they have been using challenging behaviors...on a weekly, monthly, or quarterly occurrence. *shrug*

Regardless, we have to treat each fall, regardless of origin, as the real deal; moving forward, knowing that this individual has behaviors that cause safety issues, then there should be an interdisciplinary approach to this patient; also brush up on those mental health therapeutic communication skills; also Google "managing challenging behaviors"; there are some good resources out there.

martymoose, BSN, RN · Aug 21, 2014

absolutely have had this happen. usually the type you describe.

have even had 1:1 supervision for their safety and our liability!!!

even had one as you describe fall 0n the poor tech- literally!!!! she was screaming help from underneath the pt!! we had to roll the pt off her..she was ok but it's the pt.

Thing is these still count as falls. even if we lower someone to the ground it still counts as a ding.

might as well not get hurt.

I thing we should have the place set up like a playground

with the gym mats.

and no, don't feel guilty.

dudette10, MSN, RN · Aug 21, 2014

The answer: fainting couches. Stylish AND functional!

LadyFree28, BSN, LPN, RN · Aug 21, 2014

The answer: fainting couches. Stylish AND functional!

Hope it's in the budget.... :nailbiting:

duskyjewel · Aug 21, 2014

Since I've had patients purposely urinate and defecate on the floor, I can believe someone would fall on purpose. There are bitter, mean, nasty people out there who will resort to all sorts of behaviors when they aren't catered to. You're not evil or burnt for thinking this.

Has a psych consult been considered? I mean, falling on purpose is self-harming behavior.

Roman1 · Aug 21, 2014

When I was working as a PCA, had a patient walk down the hall to me and the nurse, and then start to faint. I grab her under the arms, the nurse gets a chair and we get her back to her room. Half hour later patient walks back down the hall with her belongings and leaves AMA.

I'm like ok she just fainted and now she's going AMA. The nurse tells me she was admitted for having a seizure in the ER last night, but no one in the ER actually believed it was a real seizure. The doc still had to admit her for observation and of course...... Pain meds, because her seizure caused debilitating pain. Anyway after her fainting spell the doc wanted tests done and I guess would not increase what ever pain med dose until she had these tests done. So patient gets mad because she doesn't want any testing and leaves AMA.

morte, LPN, LVN · Aug 21, 2014

yes, patients do It, and no you shouldn't feel the least bit bad about feeling that way.

psu_213, BSN, RN · Aug 21, 2014

yes, patients do It, and no you shouldn't feel the least bit bad about feeling that way.

I agree. Obviously you can't chart anything that suggests that your opinion is the pt fell on purpose...unless of course, the pt tells you "I fell on purpose." I have seen circumstances where I am 99.9% certain the patient fell on purpose. Not put themselves into a situation where they knew they could fall. I talking they intentionally threw themselves onto the floor. As someone else said, people can be jerks. Just be sure to chart which safety measures are in place to prevent a fall and chart what is done to help prevent future falls.

Lvuv · Aug 21, 2014

No! But yea I stayed very objective in my fall note a happened then b, despite c, I called x,y,z.... We did... E,f,g.... We will do x for c. Etc.... however, in my hospt event reporting still I didn't say p the it fell on purpose but I strongly suggested it.... Again not in the chart!

So glad to hear these responses. I did suggest a psych eval in my care plan for escalating emotional responses r/t emotional support interventions set forth in care plan that previously worked well but seemed to fall apart this shift. I felt bad for suggesting that but feel it is the problem. All safety things I charted also but in hind site could have added much more! in my fall note also. Thing is I don't work on a psych floor and this pt could use one for histrionic's. This worse part is I work on am intermediate floor and did have 3 others with legitimate illness. One of whom I was anxious to give care to despite all the darn charting. OMG THANKS for the responses is totally helpful specially the story about the fall Roman! Love the fainting couches idea... If I ever make it up the ladder I am totally pushing for this! Thanks!

Roman1 · Aug 22, 2014

Your welcome! Yes some people are just unbelievable in what they do, or get away with. You are right to listen to your gut feeling it usually does not steer you wrong. I'm a new grad nurse but an older new grad, so I have had quite a few experiences in life so far dealing with drama queens and kings! :)

kbrn2002, ADN, RN · Aug 22, 2014

Short answer...no, you're not evil or burnt. I've dealt with this more than once. It's not all that uncommon for an attention seeker to either intentionally fall, or place themselves on the floor [unwitnessed] and yell for help after doing so. Unfortunately it is difficult to objectively chart this as definite proof of this behavior is almost impossible to obtain.

The best solution our team has come up with is documenting each incident [which I am sure you do anyway], determining a pattern of behavior and possible interventions, obtaining a psych consult and documenting the outcome of that consult and care plan it as a known behavior. I know it's frustrating. Good luck!