is there something wrong with using the word combative?

[NurseLoveJoy88, ASN, RN]

Last week we got a new admit on 7 -3 shift, and my ED wanted me to call the residents POA. On My 3-11 shift to let the poa jnow how she doing. The resident was combative with me and the cnas. She was kicking and trying to bite us. She would not eat and also would sleep on the very edge of the bed which was a saftey issue.

So when I called the poa to update him on how his wife is doing, I very politely advised him that his wife was a little combative. I also focused on how we will continue to reassure. Redirect, provide safety and etc. I told the poa that will do everything we can to keep her safe and give her the best quality care.

Well the next day I get lectured by my boss and the ED. They both said I should NEVER use the combative to a family member to describe violent behovior, instead I should say " RESISTIVE" . I apologized for my wrong doing and took it as a learning lesson. I still deep down inside don't understand why combative is so terrible to describe a behavior of a family member. I have some residents that are RESISTIVE but are never combative. I do believe there is a difference.

Please help me understand.

[caroladybelle, BSN, RN]

Some hospitals prefer to stay away from words that have disagreeable connotations to them, either in the legal record or to a S/O. In some places, this means quoting the patient's words or making a description of what they did, vs using terms like combative or hostile or violent.

If a chart goes to court, they worry that using terms like hostile or combative will make the jury think the nurse was angry or slanted against the pt. If the language is more "sterile", there is less for the lawyers to pick at.

It is somewhat like using the term client vs patient, or saying the pt declined a medication vs refused. In some places that "cater" to patients, they use very careful language. Of course, I ocassionally slip in an "adamantly refused".

[AngelfireRN, MSN, RN, APRN]

I use the terms that fit the incident. If the facility wants to pretty it up, fine, but I will chart what happened. It's like the PC bug has gone pandemic. You can't call an obese person obese because it creates a stigma. You can't call a spade a spade anymore because you might hurt its feelings. Craziest thing I've ever seen.

[MAISY, RN-ER, BSN, RN]

I call it as I see it in my charting-a resistant patient is not the same as a combative patient. Resistant gives you the idea that the person can be reasoned with-combative is just that and truly speaks to the possibility of staff injury and physical violence.

There is nothing wrong with the word at all....I don't know I would use it when speaking to a family member but it would definitely be in my charting.

M

[Meraki]

In healthcare we generally just combative to mean aggressive behaviour, however by definiton it implies that someone is eager to fight, that there is a level to intention to it, a belligerence. I'm working under the assumption that this was a patient with an altered mental status (e.g. dementia). It may have come across to the family who knows and loves the patient as harsh to describe her as having an eagerness to fight.

I have no problem with the word and would use it in charting but would probably reframe it for a family by describing the behaviours instead of labeling them as combative or hostile or violent or even resistive.

[NurseLoveJoy88, ASN, RN]

Thank you all. What should I use with families when the res. Are combative?

[Whispera, MSN, RN]

I'd say avoid words that attach a patient intention to them. Just tell them (and chart) what the patient did, without any judgement about what it means. One person's definition for combative would not necessarily match another person's. Telling what the person said (with quotes, if it's on the chart) or did, provides a much clearer picture.

[NurseLoveJoy88, ASN, RN]

Thanks whispera. I get it now, reading your post just made a light bulb go off in my head. Thanks to everyone.

[steelcityrn, RN]

Maybe this was already said here, but my feelings are when you called a pateint combative, you have labelled them as such by your definition. In other words, it would be proper to chart this as patient swigging arms at staff with care , or, patient is resisting urinary catheter at this time, Dr So and So aware. Patients states "eveyone leave me alone". To me, this paints a picture of the behaviour, makes it clear but not defined by your definition.

[sibelian]

I'd say avoid words that attach a patient intention to them. Just tell them (and chart) what the patient did, without any judgement about what it means. One person's definition for combative would not necessarily match another person's. Telling what the person said (with quotes, if it's on the chart) or did, provides a much clearer picture.

Ah ... I thoroughly disagree. There is no room for relativism here; "combative" has a clear and unambiguous meaning, and has been commonly used in medical charting for eons. It means "inclined to fight". Here, the OP described the patient as "kicking and trying to bite us". So the patient was not only inclined to fight; she WAS fighting. The OP could have said "the patient was fighting staff". But using "combative" .... either orally or in the chart note .... along with "kicking and trying to bite us" is perfectly appropriate.

Advice to the OP: don't get in the habit of sanitizing your language. If the patient in question ever injures herself in the future due to combative behavior, a charted prior history of combative behavior may be important in the defense of the facility and nurses. It's wonderful to be sensitive to family feelings, but not at the expense of the truth.

[RNperdiem, RN]

I wonder if the lecture was a result of the patient's husband complaining to management after he spoke on the phone to you, otherwise, how would they know that you used the word "combative" in a conversation?

I think this is at least one part workplace politics.

I would use the word combative in a nurse-to-nurse report. I like to forewarn others about a kicking or spitting patient. I describe the actions.

To families, the medical jargon might be misunderstood.

[MAISY, RN-ER, BSN, RN]

Sorry, but if a patient is likely to injure someone they are combative and staff needs to be aware so that no one is injured. You must always be on your guard and be prepared. In the ER if a patients ends up being taken down-a "resistant" patient charting just looks like they were being difficult-"combative" says it all.

M