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 PICU, NICU, L&D, Public Health, Hospice.
I have a tendency to use words like "combative" when speaking with peers and colleagues and use more generally descriptive terms when documenting or speaking with family.
As has been mentioned before, the documentation should have a lean toward actually describing the behavior or quoting the patient rather than summarizing with a term, IMHO. Of course, this opinion is largely based upon my nursing education (sat right next to Flo), my personal observations of other charting in many settings, and my long term friendship with a Risk Manager/MSN. This is the practice that I observe in pt records the majority of the time. This is the type of charting that will be most helpful to the patient should the record need to be reviewed...and most useful for you in the case of litigation and deposition.
However, in our professional voice to ear interactions, it makes sense to use verbage which gives your colleague a quick and meaningful picture of the situation. You can always provide more info if they ask. This is also what I observe to be the most common practice across the nursing practice setting. We talk like professionals when speaking to other professionals, using all our $10 words.
So, in essence...we all agree, and I think, most paint a pretty good picture in the record of combative, fighting, kicking, biting, resistive, violent patients. And when we speak to one another we can be pretty certain our peer has more than a 6th grade understading of the words we use.
Hmm I wonder sometimes what politically correct charting looks like....
The 489 lb patient required a seven person EMS and 5 members of the team to hoist them into the ambulance?
Patient swung arms at staff connecting in nose and eye. Team member has 7x7 red ecchymosis and nose bled for 10 minutes. Resident rights and safety assured. Family notified of resistance to cares. Patient stated property was damaged with all that bright red liquid stuff on carpet from team member.
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.
A little bit of tweaking needed in order to properly inform Ms.X's family of the incident
Would this pass PC?
"(Your loved one) moved her left fist rapidly in the direction of a nurses nose where it made contact with great force. The nurse sustained a facial fracture and laceration. As (your loved one) was removed from the area, her legs were thrusting outwardly in the direction of staff and the fingernails of both of her hands were dragging along the surface of the skin of the forearms of 3 security officers"
erroridiot
266 Posts
Finally did somethin' rite!
Golly, thanks for the whoop-@ss compliment!
So that means that my charting is a better choice than the word combative?