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?
Specializes in Med/Surg, OR, Peds, Patient Education.
Excuse me this is the ED. You my dear, are not an emergency. We have attended to you. There are people in here that are emergencies. If you think being annoying is going to get you more attention, you are correct. I am calling security right now and you will get that attention. Probably not what you are really wanting but you are bringing this to yourself. So put a sock in it and sit back and relax.
This tactic will only increase the likelihood that the patient and husband's irrational behavior will escalate further.
Part of working in the ED is learning how to manage difficult people. Your mandate as a nurse is to care for the patient. Not feelings-wise, but action-wise.
I get not wanting to deal with jerks. I don't like doing it either.
But it is OUR JOB. I like calm and collected patients better than the screaming me-me's. But that's not what you get all of the time.
Just because your patient is a jerk doesn't mean they should be treated like a psych patient.
Honest communication, boundary setting, and consistency are the way to go. Not one-liners. They tend to escalate the problem.
Your ED should have some conflict resolution training. I suggest you make use of it, unless you LIKE beating your head against a wall. 'Cause expecting irrational people to act rationally is just going to give you a headache.
--> Honest communication, boundary setting, and consistency are the way to go.
Notice these three things you mentioned are ways to deal with psych patients. Just sayin'
Everybody needs #1 and #3, but especially psych patients, plus #2.
So how do mentally healthy people get emergency health care? If you have no money and need emergency health care and are not a drug seeker or a hypochondriac, then how to you receive emergency health care? This is the compelling question for the disabled and living on a fixed income.
I've had kidney stones and I can't even begin to describe the pain. I've never had to experience childbirth, but I've heard they are the closest thing to the pain of childbirth a man can go through. So I can understand the woman being out of her head. I can also understand the husband getting irate. He is seeing his wife in intense pain and what is being done doesn't seem to be helping or fast enough (most people don't understand that pain meds in the oral form take time to work and think that it should be instant relief). I don't care who you are if you're kidney stone is large enough that a stint was put in then it would be awful and no amount of pain med is going to make it go away.
That being said I guess to armchair quarterback it (yeah easy to say what I would have done when I am not being screamed at I know), I would have said to the woman, "miss I know you are intense pain and kidney stones are some of the most intense pain producing things we see. I have given you the doses of pain medicine I can currently give per the doctor's orders. They will take some time to take effect. I am going to track down the doctor as soon as I can and see if he can get you something for the breakthrough pain to make you more comfortable. The doctor is in with a critical patient and will be with you ASAP. Is there anything I can get you in the meantime?"
To the husband I would say, "Sir I know you are upset and it's difficult seeing your wife in this much pain, but I promise we are doing all we can do to manage her pain. Once the doctor is finished with his critical patient I will see what we can do about managing your wife's pain better"
Then if they continue to be belligerent that is when I simply step back, put my hands up, and say "sir I am going to step out and when you're more calm and willing to speak to me in a calm manner I will be more than happy to speak with you". Then I walk out. If they want to escalate further then security can be involved. I never threaten security. I find this is an empty threat. If I feel I truly need security I don't even mention it to the person being disruptive I simply call them.
Specializes in Education, Med-Surg, ED,Nursing Admin..
Patients experiencing pain may exhibit regressive behaviors, causing care personnel to label them as "drug-seeking", "unruly", or "borderline". This is especially prone to occur in Emergency Departments, where there may be several critical situations happening simultaneously.
Passing kidney stones is an excruciating experience, and patients are likely to be terrified, particularly if their nurse withholds medication, or is not supportive of their emotional needs. Their behaviors may escalate dramatically, as the pain continues.
The care provider must medicate adequately, and be present to emotional and behavioral cues, from the patient, and her significant other.
I would suggest that you take a course in pain management, to assist you in gaining knowledge, and coping strategies for managing pain. Having worked in ED for years, I know how hectic it can be...however, advocating for ample pain relief, and being emotionally available to patients who are experiencing acute pain can help patients to move through even very painful events more ably.
--> Honest communication, boundary setting, and consistency are the way to go.
Notice these three things you mentioned are ways to deal with psych patients. Just sayin'
Everybody needs #1 and #3, but especially psych patients, plus #2.
Those three things are ways to deal with ALL patients, psych or not. Not specific to psych at all, although certainly useful there as well. They are just plain healthy ways to manage your interactions with others - at work and also outside of it.
Those three things are ways to deal with ALL patients, psych or not. Not specific to psych at all, although certainly useful there as well. They are just plain healthy ways to manage your interactions with others - at work and also outside of it.
Ahhhh, should've finished the thread first before posting.
Those three things are ways to deal with ALL patients, psych or not. Not specific to psych at all, although certainly useful there as well. They are just plain healthy ways to manage your interactions with others - at work and also outside of it.
Ah yes Janey...BUT! In addition! You can also apply those rules to psych patients. Especially Rule #1, #3 and #2. IN THAT ORDER.
3 wks ago I had to do outpatient surgery lymph node biopsy after just finding out I have triple neg breast cancer with necrosis. (Let's just say bad wk). My daughter drove me after her much loved father in law passed during the night even though I wanted to cancel. My best behavior went out the window, feeling guilty, given timeframes for surgeon and support staff that didn't get close to happening and stuck 6 times by " jan and Cindy",(and told Marsha actually worked down the hall) before I reminded them of my port. then having a male nurse jerk shoot "Freeze" on my nipple w/o saying what it was or would do.
I have 30 yrs in as a psych nurse and will tell you if NOT for the anesthesiologist listening to me vent, and repeated back my concerns, then talking to Abt HIS part of my surg and a little humor injected in, i'd have written the whole department up probably including my dr! Just like on my job on psych ward he listened with care and compassion, repeated some, and stole my anger with laughter and offered hand of kinship. And yes even in pain most people can respond to some sm well placed laughs. One thing I always remember MH/MR patients is not only a Dx, BUT NOT THEIR CHOICE to have. And there is no education, license, or bloodline that makes one human any better than another, we are all One of a kind.
For people who replied to me that these three things psych or not, I would like you to look back at what I wrote at the end of the post which was a reply to canigraduate.
canigraduate said:
Honest communication, boundary setting, and consistency are the way to go.
Quote
Everybody needs #1 and #3 but especially psych patients, plus #2.
To translate what I wrote: Everybody needs honest communication and consistency, but especially psych patients, plus [they also need] boundary setting.
Meaning boundary setting may not be necessary for people who can set boundaries for themselves, but people in general psych or not need honest communication and consistency. I think these three things are especially important to psych patients. I do not have to set boundaries with every patient I meet. Many people are perfectly reasonable. However, those who visit the ER with acute psych conditions seem to need boundaries set for them so they do not escalate further.
CHESSIE
177 Posts
This tactic will only increase the likelihood that the patient and husband's irrational behavior will escalate further.