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

[Red Kryptonite]

I have no idea why another poster's name is showing up on a quote I took from a website.

[Angeljho, MSN, NP]

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.

So the guy who's HIV positive and threw urine at you is worse than a roller desk being tossed at you? Fair enough, it's your experiences so I get it. But why the need to mention he's HIV positive if he only threw urine at you?

I really don't see how that's worse.

[Anna Flaxis, BSN, RN]

I am very familiar with operant conditioning. I am a former dog trainer. I don't think it means what you think it means.

A pile of poop in the living room is not a behavior. It is a pile of poop in the living room. By rubbing the dog's nose in a pile of poop in the living room, you are not rewarding or punishing a behavior. You are simply rubbing his face in a pile of poop in the living room. This is not operant conditioning.

[Red Kryptonite]

I am very familiar with operant conditioning. I am a former dog trainer. I don't think it means what you think it means.

Go argue with BF Skinner about it then. While he may have agreed that appetitive reinforcements were more effective than aversive ones (there, used correct terminology), he never said aversive ones weren't effective at all, which is what you're trying to claim.

[macawake, MSN]

Red Kryptonite said:

If an A&O patient threw that at me or a coworker I'd have trouble not reacting like I do with a dog who poops in the house. I'm a great believer in rubbing their noses in it to prevent repeats.

I realize that several posters have already pointed this out to you, but really this isn't a good way to teach puppies. I feel rather strongly about this or I wouldn't have bothered to add yet another post on this topic.

House Training Your Puppy | ASPCA

Quote

What NOT to Do

• Do not rub your puppy's nose in his waste.
• Do not scold your dog for eliminating indoors. Instead, if you catch him in the act, make a noise to startle him and stop him from urinating or defecating. Then immediately show your dog where you want him to go by running with him outside, waiting until he goes, and then praising and rewarding him.
• Do not physically punish your puppy for accidents (hitting with newspaper, spanking, etc.). Realize that if your puppy has accidents in the house, you failed to adequately supervise him, you did not take him outside frequently enough, or you ignored or were unaware of his signals that he needed to go outside.

How to Housetrain Your Dog or Puppy : The Humane Society of the United States

Quote

Oops! Take mistakes in stride

Expect your puppy to have a few accidents in the house—it's a normal part of housetraining. Here's what to do when that happens:

• Interrupt your puppy when you catch him in the act of eliminating in the house.
• Make a startling noise (be careful not to scare him) or say "OUTSIDE!" Immediately take him to his bathroom spot, praise him, and give him a treat if he finishes eliminating there.
• Don't punish your puppy for eliminating in the house. If you find a soiled area, it's too late to administer a correction. Just clean it up. Rubbing your puppy's nose in it, taking him to the spot and scolding him, or any other punishment will only make him afraid of you or afraid to eliminate in your presence. In fact, punishment will often do more harm than good.

I've previously had this discussion with a few friends who thought this was an appropriate way to treat a puppy. It's not. It upsets me to see misinformed individuals use this as a "training" technique.

Something I find rather ironic is that this is a punishment that only a human would come up with. We think that feces are rather gross, hence rubbing someone's nose in it seems like a suitable punishment/behavior modifying technique. Dogs however aren't that averse to feces, I'm sure you've noticed that left to their own devices on a walk in nature they'll chew on pretty much anything, including feces. I think that the fact that your pets have become housetrained has more to do with the fact that they matured and developed bladder and bowel control and got used to the routine of "going" outdoors, rather than the nose-rubbing.

I wish you'd reconsider your strategy.

[Anna Flaxis, BSN, RN]

Go argue with BF Skinner about it then. While he may have agreed that appetitive reinforcements were more effective than aversive ones (there, used correct terminology), he never said aversive ones weren't effective at all, which is what you're trying to claim.

I'm not trying to claim that at all. Aversives do work. But unfortunately, they can be very damaging, particularly when applied imprecisely or with a poor understanding or execution of timing, among other things.

[NurseOnAMotorcycle, ASN, RN]

Take the animal training conversation somewhere else!!

[Anna Flaxis, BSN, RN]

Take the animal training conversation somewhere else!!

But it relates! To immediately focus attention on the thrower of the bedpan is giving reinforcement to the behavior (keep in mind, we're not talking about an agitated disoriented/psychotic person here- they are alert and oriented and not psychotic). By withholding attention and showing concern for the victim instead, we are sending the message that throwing bedpans will not get your needs met.

Unfortunately, I'd bet anything this person has received lots of attention for acting out for a significant amount of their lifespan, and as a result, this pattern of behavior will be nearly impossible to extinguish. However, if the caregivers are consistent in their approach to acting out behaviors, then the patient can maybe contextualize the information and understand that in *this* particular situation, the behavior will not work to their advantage. Sadly, consistency among caregivers is nearly impossible to achieve in today's healthcare environment.

[Angeljho, MSN, NP]

Whether or not the patient was psychotic at the time of the behavior cannot be determined without more information. I just wish people would stop equating alert/oriented with the absence of psychosis.

[Anna Flaxis, BSN, RN]

^ Good point. I was assuming.

[VivaLasViejas, ASN, RN]

Of course an alert and oriented person can be psychotic, and vice-versa. But the behavior in this case sounds like a tantrum over not having his/her needs met in what he/she thought was a timely manner. The mental illness is incidental and shouldn't be the reason for the bedpan-tossing IMHO. You can't blame it for all bad behavior.

[its_meee]

actually...that's a turdnado