Pt threw a bedpan...

[NanikRN]

What would be your response if a pt threw a bedpan with feces in it at the tech working with you? Pt has bipolar disease but takes medicine. Alert and oriented. Seems to be able to control her actions at other times apologetic afterwards --/- just wondering

[AJJKRN]

Sounds like attention-seeking behavior. Boundaries need to be set and charges brought against the patient. Absolutely not acceptable period.

[kungpoopanda]

It's assault and the patient should be charged.

[Angeljho, MSN, NP]

It's assault and the patient should be charged.

Really? The patient is mentally ill.

I've had tables thrown at me, juice thrown at me (my favorite scrubs were stained), been spit at, spit on, and almost punched (luckily it didn't connect). If the patient continues to escalate, then you have a behavioral emergency on your hands. Usually these problems can be solved with very good verbal intervention.

[Angeljho, MSN, NP]

Wow, some of these comments are just really out there. It just goes to show how unprepared acute care nurses are at dealing with mental health patients or behavioral emergencies. "She threw a bed pan! Grab the Geodon and the restraints." Restraints and IM medication against the patient's will are considered the most restrictive interventions. Both the nurse and the MD's license can be at risk for using such interventions without approaching the patient with less restrictive interventions first. I urge some of you to get some in-service because YOU will have psych patients on your floors, and you are expected to know how to deal with these situations accordingly. Restraints? Yeah ok, go ahead and put yourself at risk.

[icuRNmaggie, BSN, RN]

I doubt that therapeutic communication techniques like silence, reflecting and validating are going to be very effective with an out of control pt who is throwing fecal matter at the staff.

[Angeljho, MSN, NP]

There are techniques beyond therapeutic communication that we use in psych; you can use redirection, focusing, modeling, distraction technique, etc. I know acute care nurses aren't psych nurses, but I really believe learning some techniques that are used in psych can help in the acute care setting.

[heron, ASN, RN]

@newboy: an alternative to heaping scorn on the heads of us lesser mortals might be to describe some of the techniques you think might be effective in this situation.

In my view, once the patient has progressed to the point of physical assault, viable options for ensuring the safety of the staff are pretty limited. Keep in mind, we have little to no information as to the history of the patient or the specific situation. All we know is a dx of bipolar, 2 staff present, and a feces filled bedpan.

True, acute care nurses get little training in de-escalation techniques. On the other hand, those who never worked acute care have no clue just how fast a medical situation can go sideways. Even if staff had experience in psych techniques, they may not have had the luxury of time to use them.

Sometimes, a tantrum is just a deliberate and calculated attempt at bullying and needs to be dealt with accordingly. In this case, what was "modeled" was some of the real-world consequences of an assault.

[Tenebrae, BSN, RN]

There are very few mental illnesses that impair a persons ability to know right from wrong. To infer that this sort of behavior is somehow ok because the person has a mental illness, is enabling which is far from helpful.

Any visitor to any emergency department in the country will see signs stating that verbal/and or physical aggression may well result in criminal charges being filed and so it well should. No member of the hospital staff should have to cop violence in the work place.

Really? The patient is mentally ill.

I've had tables thrown at me, juice thrown at me (my favorite scrubs were stained), been spit at, spit on, and almost punched (luckily it didn't connect). If the patient continues to escalate, then you have a behavioral emergency on your hands. Usually these problems can be solved with very good verbal intervention.

[Angeljho, MSN, NP]

The best thing to do in this situation is to remain calm and have a minimum of two people approach the patient from a distance. I would try to distract the patient by focusing on something else, such as her health. "You seem upset, can I check your B/P to make sure it isn't elevated?" I'm always taking note of presentation or appearance - clenched fists, raised arms, vocal tone and volume. If distraction isn't working and the patient is maintaining a hostile presentation, then it's time to medicate. I know time is everything in acute care, but you have to slow down and try not to over react to the patient's behavior. If you keep a calm and relaxed demeanor, the patient will de-escalate to your level - that's modeling. It's not always picture perfect, but when these patients are dealt with in a harsh manner, it becomes a traumatic experience for them. Safety of the staff is important, but most of the time a psych patient starts to de-escalate after they've done something like throw a bed pan. It's the staff's reaction to the behavior which causes the further escalation (everyone rushing the patient, shouting, etc). I'm not saying this to throw blame at nursing staff btw; my intent is for acute care nurses to just be aware.

[Angeljho, MSN, NP]

There are very few mental illnesses that impair a persons ability to know right from wrong. To infer that this sort of behavior is somehow ok because the person has a mental illness, is enabling which is far from helpful.

Any visitor to any emergency department in the country will see signs stating that verbal/and or physical aggression may well result in criminal charges being filed and so it well should. No member of the hospital staff should have to cop violence in the work place.

I never said the behavior was okay. I don't know where you got that from. I said there are protocols when addressing a psych patient. Hospitals are now starting to implement behavioral emergency response teams which consists of psych nurses and - depending on the time and hospital resources - social workers or psychologists. This prevents events where staff are quick to grab restraints and IM antipsychotics - experiences that further traumatizes these patients. And determining whether the patient knows right from wrong is not your job, because I'm pretty sure you're not qualified to do psych evaluations. Just saying.

[Nurse SMS, MSN, RN]

To be honest, if a patient is throwing objects and biohazards at me, I am not too concerned with whether the situation is traumatic for them. The OP stated the patient was definitely A&O. This is assault. Having a mental illness does not negate the reality of the situation or that it is traumatic for the caregiver, who is, in fact, a victim at this point.

I do agree with keeping calm and modeling calm behavior and staying at a safe distance. I tend to take a "mom" approach. I know my gut reaction would have been to frown at the patient, say "That is NOT okay!" and get the tech and myself out of the room, then rally the troops to go in together, clean things up, discuss acceptable behaviors with the patient and go from there. If the patient continues to be agitated then a code for agitated persons would be called. In acute care, de-escalating by mental health protocols is ideal, but unfortunately we are rarely tossed into an ideal situation and often times the quickest route to safety involves restraints and meds.

[macawake, MSN]

And determining whether the patient knows right from wrong is not your job, because I'm pretty sure you're not qualified to do psych evaluations. Just saying.

Be that as it may but I was reasonably adept at distinguishing between a person throwing something vile at me with a glint of highly aware, deliberate mean satisfaction in their eyes and a person fighting me tooth and nails because they genuinely thought that I was a three-headed monster, long before I entered the healthcare arena (previous law enforcement). The former was messing with me,

the latter was fighting for their survival.