I recently had a patient in the ED who did have a lot of pain from her 1mm kidney stone. Understandable. However, the drama and borderline traits exhibited by her and her husband were highly disruptive to the staff and surrounding patients in the ED especially as we had a crashing patient who went into septic shock with a BP in the 50s before our eyes. The patient and husband were highly disruptive because of the perception that we were ignoring the patient and not taking care of her needs. I called security and the police who escorted the husband and another visitor out of the ED. I did not approach the husband as he was making a scene. We were all afraid he would come back with a gun. I did go back to the patient to give her more pain medication. This didn't stop the high drama from the patient. Besides for yelling about the pain, the patient was yelling that we didn't check her labs or urine (we did). She was also upset that we did not offer her a tampon or pad after we did her pelvic exam because she was bleeding. We never offer pads and I have never heard such an angry outburst over a pad.
Is there a one liner that you have in your back pocket that will help the patient and or visitors recognize their childish behavior and that we will not help them if they continue with this behavior.
Would something like this work? (Of course have security officer with you)
To the husband: Mr So and So, I can see that you are very upset. However, nobody deserves to be spoken to the way you are speaking. The other patients are disturbed by your outburst. If you want to be helped, you need to calm down and stop yelling. Yelling will not get you help faster. The doctor is with a critical patient at this time. I cannot give your wife a third dose of pain medication until there is an order from the doctor. I will have the doctor come check on your wife as soon as she is available. Is there anything else I can help you with?
To the patient: I can see you are very upset and would like more pain medication. As soon as the doctor puts in an order for more medicine I will bring it to you. The doctor is with a very sick patient at this time. Would you like and ice pack or some warm blankets to help manage your pain until we get an order? I will ask the doctor for some more medicine as soon as she is available. Is there anything else I can help you with?
From some of the descriptive comments I would query your attitude to some patients - I worked in A and E in England for ten years and admit i didnt always get it right i. How i responded to people i saw as challenging . But maybe a bit less judging and a bit more empathy would not go astray ? If you examined me pv because i was bleeding then didnt offer me a pad id be p,d off with you and if the pain controls not working id expect you to address it ( pain is what the patient says it is ) -
A patient does not have the right to curse, scream and harass a nurse over a fish sandwich, and a nurse does not have to stand there and take that crap from a patient or anybody else.
How to deal with this patient at the time: Let them talk and shout. Let them continue to do this. Listen and wait. Let them do this some more. They WILL slow down. You can agree with them about what they've said i.e.. there had been a mistake, however it happened, it shouldn't have happened- don't say much, just look (and feel) concerned. They will talk themselves out. The wife might join in- apply the same process.
Eventually (again 99 times out of 100) they will both stop. Then you can introduce a calm and suitable solution (i.e. we will fill the menu in together tomorrow to prevent repetition of events). Maybe ask if there is any additional action they would like taken? At some point in the next few minutes to few hours they will probably feel very ashamed/sheepish/embarrassed and come and apologise to you.
(This can work with Dr's too).
How to deal with your reaction internally: Remind yourself that you don't know the real cause of the over reaction. He could be really scared about his health and the menu represents a small bit of control. He's been trying to put a brave face on his fear for his wife and so has she- all the pent up feelings have burst out about this fish sandwich. I don't know, you don't know but it is NOTHING that you have done wrong. You are there for him, as his nurse, to support him through all that vulnerability and hopefully you feel like you are doing a good job :).
You can tell him once things have calmed that there will be no more cursing, however. I'm not advocating that we put up with everything all the time.
Thank you for your advice! This patient really has gotten under my skin and the whole situation has been bothering me for days. I'm determined to learn something from this situation because I certainly don't enjoy feeling like this.
Specializes in Cardiac/Transplant ICU, Critical Care.
You have very respectful and admirable responses, but I feel I do not have the patience for that any more. Long gone are the days of being being quite and passive when on the receiving end of any person's loud and obnoxious indignation.
If you say something like the following to a loud or verbally abusive patient or family member, it usually takes the wind out of their sails and brings them back to reality:
"The way you are speaking and acting is disrespectful and unacceptable, this is a hospital, and you are an adult, please act that way."
Nobody speaks to me with disrespect, when someone tries, I shut it down quickly.
These are NOT one-liners...never ever tell a patient or their relatives that another patient is more important than they are, critical or not. This patient was scared & so was her husband. The better thing to do is to ask what you could do to help, get a warm blanket, be kind...people who are in pain are not always rational...nor are the loved ones who see them in pain.
Is it not interesting you do NOT hear your septic crashing patient yelling that you save her live? Is it not interesting that you do NOT hear your septic crashing patient yelling because he fears of dying? Is it not interesting that you do NOT hear your septic crashing patient throwing a tantrum because of the anxiety she may never see her loved ones again? Is it not interesting you do NOT hear your septic crashing patient being belligerent because of his loss of control and powerlessness to staying alive?
But your septic crashing patient is YELLING, quietly, not in an inappropriate manner but CHEERING that you and your peers and colleagues are able to save her life. Actually, your septic crashing patient is doing an end zone dance, arms flaring, feet scooting and bootie shaking. But he does so quietly while laying there ROOTING you and your teammates allow him another day he can spend on the planet with loved ones.
There is not a shred of evidence, NOT ONE, that shows anyone has EVER died of pain, EVER.
Here is The Knitted Brow's one liner to diffusing escalating situations with patients—All of us are here to help. We are not here for you or anyone with you to be inappropriate to us. These are your choices (1) you remain appropriate and let us help you or (2) you're discharged.
That one liner without mention of other patients or that we are trying our best, are understaff, the computer crashed, that I was too short to play football or that there is a full moon outside. Nothing. I do not offer a single excuse as to why patients and/or families act inappropriate. Why? There is NOT a single reason, much less an excuse, for such behavior.
Those are the choices. Because neither I nor anyone on the shift with me is a punching bag to anyone. Not a verbal punching bag. Not a physical punching bag. We ARE NOT punching bags. Not to patients. Not to families. And not to administrators either.
Again, NO ONE HAS EVER DIED OF PAIN. NO ONE.
Nor have they died because it is too noisy at the nurses' station, the hospital food sucks or whatever favor of the week it is.
As long as healthcare continues to be a doormat not only will others walk all over you, they will wipe their feet on you as well.
Putting an inappropriate patient and/or family in their place is NOT a lack of compassion or caring either. It is purely NOT acceptable behavior, the operative word being NOT. And behavior we would not accept at home from our loved ones. So why should we accept such venomous behavior from those we are helping. NO!
Septic crashing patients NEVER complain, even if they succumb, not because they are unable to but because they appreciate us for the care we are giving them. The only ones who throw tantrums and complain are those with EXAGGERATED UNREALISTIC EMOTIONAL EXPECTATIONS.
And if after my one liner the patient continues to be inappropriate, as in this case because of a kidney stone, I return with a prescription of Percocet, Flomax and Zofran, kidney stone discharge instructions, a urology referral and tell the patient they are discharged.
I, then, without another word, go see the next patient. As most, like 99% of most, patients value, trust and appreciate us for the care we give. The 1%, or even less, who are rude, entitled, abusive, demanding and those with EXAGGERATED, UNREALISTIC, EMOTIONAL EXPECTIONS I dismiss. I dismiss outsiders (JACHO, Magnet Status, HCAPHS, etc.) who have taken healthcare down the wrong tracks as well.
That means I ONLY side with employees, coworkers and peers over petulant, unreasonable, angry and demanding patients or outsiders looking out for their own interest. This is not about us versus patients. This is about convincing patients we are looking out for their best interest and if they desire our help they must stand with us. If they decline they MUST leave. Because asking to be catered to until they get what they want is manipulative and not what we are here for as it only divides healthcare workers trying to help others.
On this, healthcare must stand in solidarity and not waiver otherwise those who annoy us will not change their behavior as long as they can find tolerance elsewhere.
I know. I know. Critic will suggest I find another career but the 99% who appreciate the care we provide disagree and it is because of them, the 99% who appreciate us, that I stay and now its been over 30-years. No one fatigues from compassion. What we fatigue about and are frustrated with are the eggshells we must walk on to keep our jobs of helping others. Don't be a punching bag. Don't! Just my two sense [sic].
The first thing I say to someone who is upset or acting out is something like, "That sounds so frustrating" (or disappointing or whatever.) Listening and validating feelings can help to de-escalate acting out behaviors. Whatever you decide to say in a situation like this, speak QUIETLY!! Just by speaking quietly, the acting out individual usually quiets down so that (s)he can hear what you are saying. If the individual continues to act out and/or yell, lower your voice even more! I work on an in-patient adult behavioral health unit, and we whisper quite a lot! It's effective and calming and can be done by anyone. Always call security and speak to your manager about CPI training! Good luck and stay safe!
did some of you nurses forget the whole therapeutic communication thing...
If my loved one is in the hospital, and they are being demanding/rude due to their environment, I would expect a nurse to understand their state of mind and work with them using the training they've been taught to handle it. And it certainly does not mean dishing it back to the patient. some of the responses here are just waiting for the right family member to go find their way to the DON, chew you up and spit you out.
These are your choices (1) you remain appropriate and let us help you or (2) you're discharged.
Unless you know for a fact that the physician(s) will back you up and discharge someone, regardless of her/his condition, because you don't like the way s/he is talking to you, this statement is just setting you up to be completely discredited in the client's eyes. Or are you the provider making those decisions and writing the scrips (and, in that case, is your employer and supervisor prepared to back you up and support you discharging people because you don't like the way they talked to you?)?
The doctor is mainly at fault. He needs to be educated.
Ummm, no. He was dealing with someone that was a higher priority at that time. I realize kidney stones are painful, as I've had one, but if my loved one were coding or in a crisis situation, and the MD left that for kidney stone pain (or other pain), I would educate the hospital with a massive complaint. The MD has to prioritize. If there's a complaint with the MD, the medical director or board of directors will "educate"
No one ever died of pain? What does that remotely have to do with appropriate pain mgmt?
There are plenty of things that never killed anyone, that in itself doesn't it make it right.
This ER business sure has darkened a lot of hearts it seems, not that anyone ever died of a black heart, as far as I know. But it sure sounds like s soul sucking place reading some of these posts.
BiniMc
4 Posts
From some of the descriptive comments I would query your attitude to some patients - I worked in A and E in England for ten years and admit i didnt always get it right i. How i responded to people i saw as challenging . But maybe a bit less judging and a bit more empathy would not go astray ? If you examined me pv because i was bleeding then didnt offer me a pad id be p,d off with you and if the pain controls not working id expect you to address it ( pain is what the patient says it is ) -