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.
Specializes in psych, addictions, hospice, education.
In response to the most previous poster, I agree that a word such as combative can be used IF it is followed by a description of what gives you the idea the patient is combative (or lethargic, or confused, etc.). There's a reason under the combativeness and telling what gave you the idea is more helpful to someone reading your words, or hearing them, than just the label. Family might take offense to the label but understand better when you say what was going on. When I read "combative," I wonder exactly what was going on, what happened prior, what exactly the patient did, and so on.
I agree there's a difference. Sorry, but when a patient takes a swing at you(and I have had this happen), that's combative. I don't see how anyone could say otherwise..
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
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.
You don't say.
Obese = Increased BMI or Overabundant Adipose Tissue
Combative = Influenced by overstimulating environment.
"You can't call an obese person obese because it creates a stigma."
snort. Obese is the word the politically correct police came up with because it didn't have the stigma plain old fat had. Whatever words replace obese will pick up stigma just about as fast as they become accepted as the terms to use.
I think there are two different points being argued in this thread. I agree that "combative" is a term that is both accurate and useful enough to be used for charting, instead of muddying the waters trying to come up with a more PC description. However, I can also see that from the POV of a non-medical family member, it could be very distressing to hear the term applied to their loved one, which is what the OP's management was trying to point out. I'd categorize it with all the other clinical terminology that you wouldn't use for family members, and try instead explaining that the patient was, perhaps, "agitated" or "upset."
Specializes in med-surg, psych, ER, school nurse-CRNP.
"You can't call an obese person obese because it creates a stigma."
snort. Obese is the word the politically correct police came up with because it didn't have the stigma plain old fat had. Whatever words replace obese will pick up stigma just about as fast as they become accepted as the terms to use.
Combative can mean a lot of different things to some one who is not educated in the medical field. While it may carry clear connotations of a patients demeanor to you, when it comes to an average joe it's open to interpretation.
Example, some one with prior military experience would perceive combative as a seriously hostile gesture - nobody wants to hear that about their loved ones.
I guess it's a thin line, but I would think there are more constructive ways to describe the condition of a persons wife to them.
Specializes in Neuroscience/Neuro-surgery/Med-Surgical/.
I would document, ' pt became combative as evident by__________' (what ever behaviors that were displayed,; and who was present during this episode, as well as what was done (security called, restraints applied, etc...)
It would be less controversial to document the action:
Ms. X forcefully hit Nurse Y in the nose with her left fist. Nurse Y sustained a facial fracture and laceration. Ms. X was removed from the area kicking at staff and scratched 3 security officers on both forearms with the fingernails of both hands. Ms. X had ecchymosis 3 cm x 4 cm on the left dorsal hand after the incident, was examined by Dr. Z and admitted to behavioral health.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
I don't think they should have lectured you, though. It's not as if you came up with that word yourself. It's a common word used to describe behavior in psych nursing and as side effects to drugs, etc.
You are right! I don't think if someone smacks you in the mouth without any apparent provocation it is resistive. Best to learn more pc words to communicate with family members. I don't see anything wrong with nurses using the word with each other, though. Time constraints make it necessary to use the fewest words to convey an idea. We know it isn't a negative, but a descriptive term.
On a related note, does anyone know if SOB for shortness of breath is now forbidden? I have wanted to use it at times, but even though it would be nonsensical in most cases to think it was the bad thing, ie "pt. complains of son-of- a b*tch" but you never know. . .
Whispera, MSN, RN
3,458 Posts
In response to the most previous poster, I agree that a word such as combative can be used IF it is followed by a description of what gives you the idea the patient is combative (or lethargic, or confused, etc.). There's a reason under the combativeness and telling what gave you the idea is more helpful to someone reading your words, or hearing them, than just the label. Family might take offense to the label but understand better when you say what was going on. When I read "combative," I wonder exactly what was going on, what happened prior, what exactly the patient did, and so on.