Dealing with combative patients

  1. i dealt with a situation today where i was posted on constant observation to a "combative and aggressive" patient (i'm working as a health care aide during the summer). basically, without going into too much detail, it was my worst shift ever. the patient was restrained using a magnetic belt, but the problem was that the patient hit, bit, kicked, scratched, pulled hair, etc. so needless to say, i left the shift with a rather large scratch along my arm (no blood was drawn, but the patient's nails were long and sharp...and it still hurt like hell.) as well as having been hit at (i managed to duck when she struck out) and verbally abused.

    so my question is: how do ppl deal with patient's like this? and how do you deal with their family (part of the problem is that the family refuses to consent to wrist restraints and bc our hospital has a least-restraint policy, there's nothing we can do about it).

    any advice would be helpful so i know how to deal with ti in the future.

    ps- the nurse assigned to this pt. was careful to chart EVERYTHING.
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    About nursesarah

    Joined: Apr '04; Posts: 115; Likes: 7
    Specialty: Acute Med, Pediatric Hematology-Oncology


  3. by   traumaRUs
    In Illinois - we don't need family consent for restraints for our safety or that of the pt. If the pt is combative, we have security (not an aide) who are specially trained and we put pts in 4 point restraints. People that spit - get a mask that is clear and see through (in order to accurately assess airway, anchors around the shoulders and secures on top of the head. You should never tolerate this situation. Hopefully, you filled out an incident report regarding your injury???
  4. by   Dixiedi
    I have also seen situations where family was required to stay with the pt round the clock. If they refused, the pt would have been discharged to a university hosp. Generally a place where a lot of people do not want to go, they fear substandard care for what ever uneducated reason. So, it generally worked, family stayed.
    I've never heard of a staff member being set aside to babysit, even if the pt were on the wane side of A/O X3.
  5. by   LisaG21
    This is a problem in my hospital. We have one on one...which means someone who can physically hurt themselves has a person sit with them until the doctor feels that it is unneccesary for them to have a babysitter. Usually its people going through withdrawl, of some kind of drug, or has too much confusion.

    Usually what we do is we use restraints, or let them yell or do whatever until they calm down, yelling will never hurt anyone sooner or later they will calm down. We call security a lot!lol they help calm the patient sometimes they bring their k9 dog and the patient calms while playing with it.

    My suggestion is just to stay out of the patients way and put off doing stuff until it is safe. If restaints can't be used it isn't worth your saftey to make someone take their medicine.

    We had a lady who would spit, scratch, even try and hit us with her cane (she was about 80 lbs and she used to kick the crap out of me lolol) One time she hit the wall so hard when she tried to hit me in the head with her cane that she made a hole. lol But we would just let her be as long as she wasn't in any danger of hurting herslef (falling) and she was fine after an hour or two.
  6. by   Farkinott
    i did one on one (specialing) of a speed addled young female once. She was on a general ward but in a single room (with a large window). This girl was the psycho ***** from hell. She even accused me of rape at one stage. My boss then came in (after I told her) and tore strips off this crazy *****.
    Surprisingly, the psycho patient became very quiet after being "told off".
  7. by   teeituptom
    Haldol or Geodon works wonders also