Best strategies to deal with verbal abuse from patients?

mmjp77 · Jul 17, 2017

Thanks, everyone. I just went for orientation, and now am more afraid of being physically attacked than being yelled at! It will definitely be a learning experience, and empathy is definitely key, as many of you have mentioned!

Jacobyo · Jul 18, 2017

There is always a risk of being physically attacked. Always think safety first. Don't go in a room and be away from the door. If you see the pt getting agitated walk away, grab a partner or call security if needed. Always know the pt's that are AOB. I have worked in psych for 9 months now and have seen numerous nurses get hurt ex: kicked, punched, choked out, knocked into wall and receive stitches. I have been hit once by a 89 yr old dementia pt that thought he could take me out if he needed to. I watch my surroundings and try not to trust anyone but working in psych you see the same pts over and over and you build relationships with them which can lower your guard.

mmjp77 · Jul 18, 2017

I am nervous because I have never had anyone physically hurt me before, and I want to be empathic and caring....not looking like I don't trust people. But I definitely don't want to be in danger! It will be a balancing act I suppose, and a learning curve!

Scarlettz, BSN, RN · Jul 21, 2017

I find that just being polite and respectful will go a long way. I had a new patient who came up to the med window being loud and aggressive demanding this, this, and that right off that bat having just met. I asked her, "Why are you yelling at me - we just met? I will try and help you with that. But just give me a minute so I can look into it." I am a pretty quiet person and I don't like confrontation much so I was proud for standing up for myself. Turns out that she was just mad because the previous shift had been promising her medications that she did not receive for hours - which happened to be true. So, I can see why she was frustrated and realized she was just taking the frustration out on me. She quickly changed her attitude and apologized to me. However, I would have worded it differently in the future. I probably would not have said, "Why are you yelling at me?" as I remember in psych nursing that Why questions are not really therapeutic questions because it seems like an attack on her and can close communication. I would have said something like, "I can see that you are upset. Let me try to help you" Or, "I can see that you are upset. Do you want to talk about that?" But sometimes in those heated moments you don't always get the words out exactly how you want to say them. But, I think my willing to help her made her change her attitude. It was also a learning experience for me.

Sometimes being quiet and listening is a better option. I had this manic woman who got upset at another patient and then she started to be verbally loud at me when I tried to speak with her. She started rambling about something unrelated to the situation that made her upset. I tried to speak with her, but that seemed to set her off more. Instead I let her finish what she had to say and she just climbed right into bed and went to sleep. During all this, she was actually inching closer to me as she was screaming and I just kept taking steps backwards as she moved forward.

I have had a very small handful of patients say something about my appearance. It was actually not even to attack me directly. The couple people who mentioned my appearance were manic and just spurting things out. I just ignored their comment and changed the subject. One time I wanted to be say something, but I stopped myself because I knew the patient was sick.

One time I went in to a patient's room to give her medications. The room was somewhat dark and she screamed, "Well turn on the light!" in rude voice. I said, "Excuse me, I came in to you to give you your medications" and she said, "I'm sorry. Thank you." It is okay to stand up for yourself - because many times these patients need the help with certain social behaviors - it is all in your deliverance. You want to be strong and firm yet respectful, caring, and calm.

mmjp77 · Jul 21, 2017

Thanks, Scarlettz. I think it's easy to KNOW the "right" way to do things...but in a highly intense situation, how easily do those "right" responses flow? I guess i'll find out!! And think that with practice, it will become easier.

ChryssyD · Aug 1, 2017

You will find yourself experimenting with different methods, and different methods are necessary with different patients. I had to talk down a furious, screaming father in the ER whose only real problem turned out to be that he didn't understand what was going on with his child and no one would take the time to break it down for him in a way he could grasp. On the other hand, I've been called every name in the book (in several languages) by geriatric psych patients who were either completely demented or completely psychotic, so I didn't take it personally because they couldn't really control themselves; I wait for their meds to kick in before trying to modify their behavior. On the other hand, if the patient is borderline, anti-social, or just plain angry, I confront them by stating that I don't appreciate being called a whatever-they-called-me and I will not continue talking with them if they use abusive language; if they don't pipe down, I just walk away.

As far as physical aggression: Maintain a reasonable amount of personal space, watch your back, never allow yourself to be cornered (for example, in a patient's room with the patient between you and the door, since s/he could prevent you from leaving or shut you in with her/him), be cautious around patients who are acting out, never "sneak up on" a patient or touch them without their permission, and try to keep in mind that most psych patients are far more dangerous to themselves than they are to you.

Orca, ADN, ASN, RN · Aug 4, 2017

I worked with an LPN years ago who was a master at letting things roll off and getting on with business. We had a verbally abusive patient who had just arrived on the unit. He stunk to high heaven, and we were trying to get him into the shower. It would also give us a chance to wash and dry his clothes (what he had on was all that he came in with). He started cursing the LPN, called him the N word and everything that he could think of. The LPN looked at him and said, "I'm not impressed with that, and we are still going to the shower." The patient went with him.

psychnurse127 · Sep 25, 2017

I work on a geri-psych unit and my patients are mainly diagnosed with dementia. And sometimes I am shocked at the words that come out of my patients mouths. The only thing that I feel like I can do is not take anything personal. Because one minute my patients are throwing punches and spitting at me but the next minute they start calling me "honey".

allnurses Guide · Sep 27, 2017

So when you tell a patient "You will not talk to me that way"- I mean, what can you do?

"This interview is over for now" Document and chart Patient uncooperative - move on

allnurses Guide · Sep 27, 2017

I am nervous because I have never had anyone physically hurt me before, and I want to be empathic and caring....not looking like I don't trust people. But I definitely don't want to be in danger! It will be a balancing act I suppose, and a learning curve!

In the right environment with the right training you shouldn't be at high risk for getting hurt. In 17 years of Psych nursing I have only been seriously hurt 1 time and it was entirely my fault because I pointed my finger in a patients face and got hit in the eye for my trouble. Had migraines for a year after that but they eventually went away.

Never let them know you are afraid of them and always keep your cool. We have a great team at our facility and we work really hard to keep staff and patients safe.

I had a newer nurse tell a patient the other day that his actions made her feel "Uncomfortable" wrong wording as it let's him have control of how you feel. "You actions are inappropriate" would be better phrasing.

You'll get the hang of it.

Hppy

allnurses Guide · Sep 27, 2017

When I first meet a Patient, when they are brought up to the floor, I introduce myself and then ask them what they like to be called, after referring to them as Mr. or Ms. Then I ask them if they'd like a snack or refreshment. Patients are often in the ER for hours, and are tired and cranky.
If they are cranky enough to be verbally abusive, I will say something like, "I understand that this is your worse day. However, I am requesting that you not use profanity. Please give me as much respect as I give you.
Now- what can I do for you that will make you happy?"
Some Patients have mistook my pleasantness as weakness and have pushed the envelope. I have said to Patients, "Look- I can be your best friend or your biggest stumbling block to you getting what you want. The choice is yours: work with me and I'll do everything I can to help you. Work against me and my only responsibility toward you is your safety."
I've had pretty good results with these techniques.
Good luck to you, mmjp!

Davey - I think you and I could work very well together!

Hppy