Pressing charges on a psych patient?

[Little_Mouse]

I was just wondering if it is possible (or silly/ right/wrong) to press assault charges on a psych patient on a psych unit?

I work on a gero-psych unit and have been assaulted some time ago and not too long ago a coworker got a broken nose from getting punched by that same pt...

I am just curious if it's possible to press charges on the pt or because the pt is being evaluated and treated in a psych unit that it would be pointless or deemed silly since that's the reason the pt was admitted in the first place...?

And btw, although my unit is technically "psych" we are not stricly psych-- we allow IV poles and call lights w/wires (which has been used as potential weapons several times), although we don't allow knives, we do allow forks and don't count utensils post meal, etc.

[kids]

If one human being assaults and injures another human being in a health care setting IMHO the correct thing would be to call 911. Once things get to that point it is obvious that the patient cannot be cared for in the current setting and needs to go to an ER with a 72 hour hold for evaluation. After that I would hope that the unit would not re-admit someone like that. My guess is that law enforcement would decide if the person committed a crime and needed to be arrested. Jails have psych wards for these types of people.

Jails around here certainly don't have psych ward.

[ImThatGuy, BSN, RN]

I only said I felt that as a nurse it would be wrong to hurt your patient even if they hurt you.

Even if they hurt you? If it wasn't your patient and someone else's would it matter? If it were someone assaulting you outside the grocery store would it matter? Where did you get indoctrinated into that mindless dogma? I've heard other young nurses mention this before, and they heard it from instructors much like you. I'm actually pursuing my second degree (nursing-BSN), and the day this comes up in lecture, if ever, is going to go south for the instructor. I can't stand by for trash like this to be spread.

As a nurse, or not, no one has a right to hurt you, but You have the right to let whoever you want hurt and walk all over you. Kudos. You've foolishly chosen that path, and you can live with it. I, and many others here, choose not to.

I'm not suggesting someone uses the full scope of their MMA skills or gets into an all out boxing match, but fend that person off, and get the heck out of there until a group of people can go in and take back the environment and get the patient under control.

I'm steamed. There have been a few threads lately that have really irked me, and this one tops the list.

[ImThatGuy, BSN, RN]

It depends on the diagnosis and situation.

What penalty is going to be imposed on an actively psychotic patient who assaults someone in a psych unit? Or an elderly dementia patient?

Neither is likely to be deemed competent to be prosecuted and they sure as heck aren't going to put them in jail, any 'penalty' is going to involve shipping them right back to the psych unit they came from.

A cognitively intact patient? You bet I'm filing a police complaint and letting the system sort it out. A cognitively impaired individual I'm not likely to make a report, there isn't any point and it's a waste of resources, I just ask that my employer support me in any workers comp claim (which they have).

I've had my bell rung by a gentleman who was actively hallucinating as a result of an adverse reaction to MS. I've had my back broken by a man who was profoundly demented due to Lewy body disease (who had just come from the geri-psych unit). "Justice" would not have been served by making a complaint to the police against either.

It doesn't matter if the psychotic is penalized. You still need to go through the process. If nothing else perhaps the person that broke your back would be forcibly transferred to a more secured facility (not jail) in which the staff is more able to handle those kinds of patients.

[linearthinker, DNP, RN]

Somehow I don't think sniper is a fan of Jonathan Swift.

Snort. I got it, even if no one else did. ^5

[Belle Epoque]

It depends on the diagnosis and situation.

What penalty is going to be imposed on an actively psychotic patient who assaults someone in a psych unit? Or an elderly dementia patient?

Neither is likely to be deemed competent to be prosecuted and they sure as heck aren't going to put them in jail, any 'penalty' is going to involve shipping them right back to the psych unit they came from.

A cognitively intact patient? You bet I'm filing a police complaint and letting the system sort it out. A cognitively impaired individual I'm not likely to make a report, there isn't any point and it's a waste of resources, I just ask that my employer support me in any workers comp claim (which they have).

I've had my bell rung by a gentleman who was actively hallucinating as a result of an adverse reaction to MS. I've had my back broken by a man who was profoundly demented due to Lewy body disease (who had just come from the geri-psych unit). "Justice" would not have been served by making a complaint to the police against either.

Back broken, eh? And you never filed the appropriate charges? What a shame. You've just sent the message that nurses are expected to take that crap as part of the job. Congratulations.

Sometimes justice comes in the form of your healthcare facility hiring more staff or assigning more security personnel or development of new policies to protect/support staff. It isn't your job to worry about prosecution. Leave that to the cops. But each and every situation of physical assault needs to follow the proper reporting channels. What happens after that is not your concern. Stop being the victim, you're ruining it for all of us.

[diane227, LPN, RN]

You can try but I will tell you that from my experience, you won't get anywhere. It is very common to have cases like this thrown out.

A better option, and in fact one that is required under the law, is to have the care team address this patients behavior. This team should include direct care givers, physicians, social services, OT, PT and in some cases, administrative staff. A pharmacist should be included in this discussion so that the patient can have all medications evaluated and to assure that the pt. is not having a drug reaction or drug-drug interaction. It is the responsibility of the facility to come up with a plan of corrective action to keep the employees as well as the resident safe from harm. A complete evaluation of this patient should be made along with a full assessment of his/ him her needs. Attention should be paid to having the pt in a home like environment with personal items near. Also, be sure that you assess pain, food preferences and bowel issues. Often, patients act out because they cannot express their needs in a more appropriate manner. It is also important to keep the patient occupied by distracting activities if possible and to have consistent care staff. It also might be appropriate to consider short term administration of a psychiatric medication that might assist with the behavior. But with sedative and antipsychotic medications, they should be evaluated for efficacy and cannot be used specifically to control behavior as that is considered a restraint device. Also, it is mandatory that you have evaluations of these medications on a regular basis to assure that they are still required and are part of the residents required therapy to treat the underlying cause (depression, active psychosis). It is critical to include family members who know the patient and his/ her preferences when devising a plan of care. You goal should be to keep change to a minimum for these patients.

Once a plan has been established, it must be followed by all staff. The plan of care should be evaluated on a regular basis to see if it has been effective. If the patient continues to be disruptive and no actions taken have helped to control the patients actions, the institution can request that the family move the patient to another facility.

The minimum care standards for caring for these patients can be found at the CMS web site and are outlined in the government regulations for care of patients in nursing homes, hospitals etc. Your state probably has their own regulations as well. In my experience, once you address the simple need issues of the resident often the aggressive behavior can be contained.

[Sniper RN]

Even if they hurt you? If it wasn't your patient and someone else's would it matter? If it were someone assaulting you outside the grocery store would it matter? Where did you get indoctrinated into that mindless dogma? I've heard other young nurses mention this before, and they heard it from instructors much like you. I'm actually pursuing my second degree (nursing-BSN), and the day this comes up in lecture, if ever, is going to go south for the instructor. I can't stand by for trash like this to be spread.

As a nurse, or not, no one has a right to hurt you, but You have the right to let whoever you want hurt and walk all over you. Kudos. You've foolishly chosen that path, and you can live with it. I, and many others here, choose not to.

I'm not suggesting someone uses the full scope of their MMA skills or gets into an all out boxing match, but fend that person off, and get the heck out of there until a group of people can go in and take back the environment and get the patient under control.

I'm steamed. There have been a few threads lately that have really irked me, and this one tops the list.

I never said not to defend yourself. My comment was directed at the comment that suggested taking a chair to the patients head while they were sleeping. You are illiterate if you can not see what I have posted. I look forward to your post on, "Should I be in jail getting sued?" And NO it would not matter if it was my patient or another nurses I would NOT take a chair to their hear. I would defend myself from harm but not with a chair to a sleeping patients head. You will make a fine inmate one day if you choose that route. You are twisting my post around to try and make it look like I said "Stand their and take a beating." Point that out for me.

I am glad you are steamed. You get worked up pretty easy huh? I hope your instructor brings it up in your class and when you act like a jerk she kicks you out of class.

BTW I may be new to nursing but I am in no way new to the world.

Take your time and read through my posts real slow so you can understand what I write before putting words in my mouth there tough guy.

[linearthinker, DNP, RN]

Ah, new to nursing. That explains a lot, lol.

Mean, Demented or bat **** crazy makes no difference to me. I will press charges and let the legal system sort out the issue of competency and responsibility.

[ImThatGuy, BSN, RN]

I never said not to defend yourself. My comment was directed at the comment that suggested taking a chair to the patients head while they were sleeping. You are illiterate if you can not see what I have posted. I look forward to your post on, "Should I be in jail getting sued?" And NO it would not matter if it was my patient or another nurses I would NOT take a chair to their hear. I would defend myself from harm but not with a chair to a sleeping patients head. You will make a fine inmate one day if you choose that route. You are twisting my post around to try and make it look like I said "Stand their and take a beating." Point that out for me.

I am glad you are steamed. You get worked up pretty easy huh? I hope your instructor brings it up in your class and when you act like a jerk she kicks you out of class.

BTW I may be new to nursing but I am in no way new to the world.

Take your time and read through my posts real slow so you can understand what I write before putting words in my mouth there tough guy.

Yep, steamed. You like literal meanings don't you, but yeah I think most here have taken from your post that yes we should just stand there and take it.

If you'll reread my posts you'll find the following statement:

If so, then they are lawfully entitled to defend themselves as reasonable under the circumstances be they nurses or not.

That "reasonable under the circumstances" may be involve anything from shoving the patient away to taking that chair upside the head if you're in a locked room and can't escape. It's just common sense really. This is the point I'm trying to make in addition to you do not have to be abused by a patient. You can do something about it later, and you can defend yourself.

Hope that makes it clear for you.

Btw, I'm not a nurse either. I'm a cop.

[Sniper RN]

Yep, steamed. You like literal meanings don't you, but yeah I think most here have taken from your post that yes we should just stand there and take it.

If you'll reread my posts you'll find the following statement:

If so, then they are lawfully entitled to defend themselves as reasonable under the circumstances be they nurses or not.

That "reasonable under the circumstances" may be involve anything from shoving the patient away to taking that chair upside the head if you're in a locked room and can't escape. It's just common sense really. This is the point I'm trying to make in addition to you do not have to be abused by a patient. You can do something about it later, and you can defend yourself.

Hope that makes it clear for you.

Btw, I'm not a nurse either. I'm a cop.

Surprise, surprise on being a cop. LOL I guess that makes your opinion more valuable huh? Not in my book. As far as "taking a chair upside the head if your in a locked room and can't escape" Here you go twisting things around to suit you. No one on here said "in a locked room and can't escape." They said, "Hit them in the head with a chair while they are asleep." But I guess that is ok for you. You could always lie and say they were attacking you. You know, just twist things around a little to suit you.

BTW you keep bringing up your post. I never said anything about your original post, you just felt like chiming in on mine.

[leslie :-D]

Surprise, surprise on being a cop. LOL I guess that makes your opinion more valuable huh? Not in my book. As far as "taking a chair upside the head if your in a locked room and can't escape" Here you go twisting things around to suit you. No one on here said "in a locked room and can't escape." They said, "Hit them in the head with a chair while they are asleep." But I guess that is ok for you. You could always lie and say they were attacking you. You know, just twist things around a little to suit you.

BTW you keep bringing up your post. I never said anything about your original post, you just felt like chiming in on mine.

sniper, perhaps you'd feel better directing your angst at the one-and-only-poster, who suggested a chair to the head (even though he was using his warped humor....surprise! some of us (nurses) enjoy that type, time to time.).

it seems that imthatguy isn't the only one who's getting excessively worked up.

leslie

[ImThatGuy, BSN, RN]

Surprise, surprise on being a cop. LOL I guess that makes your opinion more valuable huh? Not in my book. As far as "taking a chair upside the head if your in a locked room and can't escape" Here you go twisting things around to suit you. No one on here said "in a locked room and can't escape." They said, "Hit them in the head with a chair while they are asleep." But I guess that is ok for you. You could always lie and say they were attacking you. You know, just twist things around a little to suit you.

BTW you keep bringing up your post. I never said anything about your original post, you just felt like chiming in on mine.

I keep chiming in on your's because it's an open forum, and your post is the one that needs replying to.

No, I didn't spin the scenario in my favor. I am merely pointing out something that makes sense beyond what you keep stating as in there is a time when it would be reasonable to hurt a patient. The point is moot anyway. A person can defend himself. Whether one chooses to or not is on his conscience. My point is clear to others just not you, and I'm fine with that.

Yes, I realize you're trying to be sarcastic about being a cop, but I'm proud of it. That role does in fact lend a bit of credit to the topic of this thread: pressing charges on a psych patient.