Pt threw a bedpan...

SubSippi · Mar 10, 2015

Honestly, once a patient starts doing things like hurling poop, my top concern would be how to stop them from doing it again (or from doing something similar or worse), and their feelings about how that happened would be at the bottom of my list.

I have a hard time finding much compassion for someone who is A/O and would act this way...if a policy was formed stating that by a patient knowingly committing a violent act would result in an immediate discharge and permanent ban from the hospital, I wouldn't protest.

When my patients feel like being mean, that's fine, we don't have to be friends. But the second my physical safety is threatened I am DONE.

Additionally, someone who committed a crime might be traumatized by being put in handcuffs, but nobody faults police and tells them they should have used other methods first to coax them into the back of a police car.

I acknowledge that I would make an AWFUL psych nurse.

withouttheH3 · Mar 10, 2015

My first question would be if this person is able enough to pick up and throw a bed pan then why are they using one, instead of a bedside commode? Secondly, why was the bed pan in a place that would be accessible to the pt...

allnurses Guide · Mar 10, 2015

My first question would be if this person is able enough to pick up and throw a bed pan then why are they using one, instead of a bedside commode? Secondly, why was the bed pan in a place that would be accessible to the pt...

Just because the arms work doesn't mean the legs do. I believe the OP said the patient was unhappy with a call light response time...presumably the patient was ON the bedpan and wanted help getting off it and so chose to throw it at the tech when they were able to get there. That is my summation of the situation anyway.

Red Kryptonite · Mar 10, 2015

You are supposed to show them and say "NO"! but NOT actually rub their noses in it.... that's animal abuse.....
Cat's don't learn from negative reinforcement,

Jeez, as I said, it takes once or twice. It's not animal abuse. And all sentient creatures learn from both positive and negative reinforcement.

klgteamnurses · Mar 10, 2015

This is one of the unfortunate occurrence's in this industry. I would certainly make my Charge Nurse aware of the incident and file any reports/paperwork that need to be completed. I would also have the patient evaluated because there could me a number of reasons for the tantrums in addition to the bipolar disorder.

Emergent, RN · Mar 10, 2015

I don't understand why these patients aren't charged with assault and battery. Let the court system sort out whether or not they are legally culpable. A barroom brawl is treated more seriously by our justice system.

Pangea Reunited, ASN, RN · Mar 10, 2015

Jeez, as I said, it takes once or twice. It's not animal abuse. And all sentient creatures learn from both positive and negative reinforcement.

It is abusive. I hope you'll look for a better way to "teach" in the future. You could learn a lot by being kicked hard in the stomach every time you did something undesirable, but is it right? And I know you wouldn't want to be potty-trained like one of your unfortunate pets...

Red Kryptonite · Mar 10, 2015

It is abusive. I hope you'll look for a better way to "teach" in the future. You could learn a lot by being kicked hard in the stomach every time you did something undesirable, but is it right? And I know you wouldn't want to be potty-trained like one of your unfortunate pets...

I knew this equivocation was coming. People > animals. Animal intellectual capacity

I refuse to engage in this ridiculous conversation any further.

Anna Flaxis, BSN, RN · Mar 10, 2015

Jeez, as I said, it takes once or twice. It's not animal abuse. And all sentient creatures learn from both positive and negative reinforcement.

Okay, we're going off topic here, but I couldn't help but comment. Yes, it is abusive, and clearly you lack an understanding of reinforcement theory. "Positive" and "Negative" do not refer to good or bad. They simply refer to the presence of or absence of a stimulus. So technically, rubbing the dog's nose in poop would be "positive" reinforcement because you are applying a stimulus. But I guarantee, the dog will never connect this to the physical act of pooping, let alone pooping in the house vs. pooping outside. The same goes for showing the dog the poop and saying "No". Any behavior changes (i.e. the dog learning to poop outside) are a result of other factors, not these outmoded/outdated "training" methods that are, thank God, starting to fall by the wayside.

To bring this back around to the subject at hand, this is one of the reasons I suggested that if I were present when the patient threw the bedpan at the tech, my most immediate response in the presence of the patient would be to ignore the patient and focus on taking care of the tech. Imagine little Jimmy and little Bobby are playing in the sand box. Little Jimmy kicks sand into little Bobby's face, making him cry. Many people would focus on little Jimmy, scolding him and punishing him for what he did. Unfortunately, this is positive reinforcement. Little Jimmy is getting attention- even if it is negative attention, it is attention nevertheless.

Now, imagine if, instead, you completely ignore little Jimmy at the moment, and focus on little Bobby, showing concern for his well being, making sure his needs are met. Little Jimmy receives no attention for his behavior (negative reinforcement), and little Bobby's sense of safety and security is reinforced by the concern of the caregiver for his well being.

This does not mean that little Jimmy does not have consequences for his behavior. Absolutely, this needs to be followed up with appropriate consequences- just not in the immediate heat of the moment. Little Bobby's well being should be the most immediate concern.

In the instance of the patient acting out by throwing a bedpan, the tech's safety should be the very first concern. Ignore the patient. They get zero attention for their behavior in the immediate time span. Once the tech has been taken care of, then the patient is subject to appropriate consequences such as verbal correction, pressing charges if applicable, etc.

But no, you cannot hit the patient, slap them in restraints, use chemical sedation, yell or scream at the patient, etc. just to punish them for their wrongdoing.

Anna Flaxis, BSN, RN · Mar 10, 2015

I knew this equivocation was coming. People > animals. Animal intellectual capacity
I refuse to engage in this ridiculous conversation any further.

Actually, operant conditioning is very powerful and works both with humans and non-human animals.

enkwanta · Mar 10, 2015

I had one threw a metal roller desk at me because he requested his medication and it was not time. He came to the nurses station and that was what he did. I had to call security. However, he had history of addiction.

Worse, another one who was HIV positive threw the full urinal at me, and he was not confused. I am still in nursing but I do school nursing now, which also has its own challenges. I guess we do what we do because we love the challenge of caring and not so much for what we get out of it. This is called answering the call to serve.

Red Kryptonite · Mar 10, 2015

Actually, operant conditioning is very powerful and works both with humans and non-human animals.

What Is Operant Conditioning?
Operant conditioning (sometimes referred to as instrumental conditioning) is a method of learning that occurs through rewards and punishments for behavior. Through operant conditioning, an association is made between a behavior and a consequence for that behavior. For example, when a lab rat presses a blue button, he receives a food pellet as a reward, but when he presses the red button he receives a mild electric shock. As a result, he learns to press the blue button but avoid the red button.

Which is exactly why my dog training method works.

And now it's really time for me to go sleep off my night shift.