long nails as "sharps"?

[greenbeanio]

If you had a patient with a personality disorder who is not psychotic but has an aversion to rules of any kind and of limits being set .... and if this patient had assaulted staff 3 times in one week, scratching them with long nails and drawing blood every time ... would it be expected that their nails would be clipped and filed for the safety of staff and possibly other patients? Even if they had to be restrained in order to do it, if they refused to let their nails be clipped voluntarily? Or would you have to let this patient keep their long, jagged and filthy nails? Even though they are not allowed to keep any other weapons or sharps with them.

I'm sure the laws regarding this kind of thing vary from state to state. Although I am not sure that there are laws specific to nails, which are the only part of the human body that can be removed without pain and which grow back (other than hair, which cannot be used as a weapon). So I am not asking about the laws of your state, so much as the common sense/ethical perspective on this.

[SubSippi]

What about those mitten things? I don't know if clipping the nails is the only solution but something should be done to keep the patient from attacking staff. One day that patient might get someone's eyeball!

[Whispera, MSN, RN]

She could still bite or punch or grab hair.

I think it's logical to sit with her (with other staff present as a show of strength) and explain that her nails need to be cut, and why, and see if she does it herself, before doing it forcefully. If she's hurting people purposefully, she needs to have charges filed against her. If it's in the heat of the moment, maybe not so much. Her reaction to the statement that they need to be cut will give you an idea of her motivation in this.

[ScotTropRN]

I think I would still check with your state board of nursing because in the end if you were to cut the patients nails without their permission or without a physicians order you would not want to be potentially charged with assault. This might sound extreme but with today's lawyers who knows.

[nurse lala, BSN, RN]

I agree that assault charges are a consideration. But ethically, I find it hard to believe any court would support a suit under the circumstances as outlined. The fact that the client has used her nails as weapons supports the cutting of her nails with a Dr orders. The greater good of keeping staff and peers safe is a stronger argument against the individuals right to have long nails.