Hi all, has anyone made a police report against an assaultive patient? Yesterday my coworker was assaulted by an alert and oriented male patient, punched in the face and thrown on the ground. One of our male coworkers helped her up and then the patient destroyed the room, ripped out chunks of the walls, etc. It took 3 deputies to restrain him. He spit all over the deputies.
The deputies encouraged my friend to report to police. The patient is 18 and has a diagnosis of oppositional defiant disorder. Originally came in for overdose, medically cleared for 2 days, but no psych beds available. The psychiatrist kept telling management it wasn't safe for him to be on a medical floor. We often have these strong male patients, and a lot of female staff get injured. Our male coworkers are wonderful and come to the rescue, but sometimes it still happens. Is this just what it means to be an inpatient nurse? Does anyone's hospital have a good way of preventing these incidents?
I didn't know when I signed up for the job that the description included defending myself against large, violent men. I stay in shape, but I will never have a chance against a huge angry man. I am still researching what exactly "oppositional defiant disorder" is. Deputies said we should also report him for property crime. I am usually against sending people to jail, but this pt seems like an actual danger. Everyone constantly de-escalating, we treated him nicely but often had to restrain him, and his behaviors just couldn't be controlled. He tried to attack anyone who went near him. What is the solution for these kinds of patients?
What a stupid facility . Bad enough staff being assaulted ( and I am so sorry :((. ) but doesnt risk management know there was little holding this animal ( yes, animal) back from walking into pts rooms and tearing them apart too ? Maybe they need to be informed of this incident too. Hope the injured nurse heals OK
Specializes in ER/School/Rural Nursing/Health Department.
On 8/27/2020 at 12:29 PM, Rill said:
I wouldn't try sending him to jail, especially if you have no experience (personal, meaning yourself, not family members, not friends' kids, not your kids, yourself only) with neurodivergency. However, you need to start something to get your facility onboard with better means of handling neurodivergent patients and caring for their own employees. Hell, learn how to start a union (and keep it quiet in the beginning stages) and start one focused on just that.
Prison isn't the only option. The nurse could talk with the prosecutor and ask that a plea with suspended sentence is attempted with a therapy requirement, anger management classes, etc.
I don't think giving people who are alert and oriented a "free pass" helps them or their behavioral issues. Escalating to the point of violence with nursing staff means that this patient would have no issues becoming violent with any members of the community either. The outcome of this act of violence was apparently minor-the nurse was able to get up, mildly injured. But what if next time he strikes a pregnant nurse and she falls? Or he hits an aide who falls into the counter and ends up with a concussion and stitches? If this behavior is deemed okay where is the line drawn for him to take responsibility for his actions?
I know I'm late to reply, but I wanted to address a couple thing for those who stumble upon this post later as I did. I am a PMHNP-BC, the odds of an adult having Oppositional Defiant Disorder is slim. First, this is predominantly a childhood disorder and symptoms have to emerge before 12, though usually do by 8. If untreated ODD can lead to more serious mental health conditions in children most often Dysruptive Mood Dysregulation Disorder (and in 10% or less Conduct disorder). When not treated in childhood it can cause personality disorders in adults.
Explosive temper and violence is NOT a symptom a ODD. Those with ODD are Defiant towards authority figures, vindictive, don't like to be told no, can be argumentative, anger outburst. Explosive temper and violence is actually more rare in mental illness than most people think, but would be found in someone with intermittent Explosive disorder or someone in an active psychotic episode (psychosis is not limited to disorders like schizophrenia or schizotypical disorder but also MDD with psychotic features).
Assault on nurses is unacceptable and needs to end. I don't know any other career/job where it would be considered acceptable for this to happen yet it happens in nursing all the time. I have been hit in the face, spit on, threatened by a patient 2.5x my size who had me cornered and was refusing to let me leave the building (ironically bc they were mad I was no longer the one taking care of them), and had by breast fondled while doing a tube feed or my butt grabbed while at the med cart by geri patients who where cognitively aware of what they were doing, but thought their age made it OK.
This being said, I want to note that most nurses who work outside the mental health field are not as trained in working with mentally ill patients as they should be. Why is this important? Because if you know on intake the risk you have the tools to protect yourself (because alot of hospitals are not going to step in and protect the nursing staff for them), also you need to know their is a difference between cognition and thought process/content/perceptions. About 80% of my patients who experience hallucinations know they are not real, but if you are in a scary situation or a situation you are not comfortable with, one it can make hallucinations worse, and two you are more likely to react to them. Also hallucinations can come on suddenly and can be precipitated by stress or anxiety. Now delusions are another matter, people don't normally know they are delusions. But unless you talk to them about the subject surrounding the delusions neither do you. It is possible this individual was having paranoid thoughts the entire time then finally acted on them. But they are perfectly capable of being oriented to person place and time. In psych we also have them assess situation, but that doesn't always rule our disorder thinking or altered perceptions either.
So let me ask you, if your co-worker developed an illness from a blood borne pathogen from not using appropriate PPE would you blame the patient? No of course not. Because the patient had an illness they can't control and your co-worker have the training to know how to protect themselves. But if a nurse gets injured by a psych patient when not using the appropriate protection (adequate assessment of psych symptoms) we immediately blame the patient. Because one, psych disorders are still not seen as real as physical and two nurses don't receive adequate education in it.
You mentioned you didn't even know what ODD was, despite the fact that it can affect up to 11.4% of children compared to the 7.5% of children affected by asthma, but I know everyone on this thread has heard of asthma.
martymoose, BSN, RN
1,946 Posts
What a stupid facility . Bad enough staff being assaulted ( and I am so sorry :((. ) but doesnt risk management know there was little holding this animal ( yes, animal) back from walking into pts rooms and tearing them apart too ? Maybe they need to be informed of this incident too. Hope the injured nurse heals OK