Staff attacked by resident

[nurseguy213, LVN]

At the facility I work in, we have residents that have been through strokes or heart attacks with varying degrees of alertness. One of our residents attacks the staff when being changed or fed. Having brought this up to supervisors, we've been told the resident does this because they are soiled or simply in a bad mood and we should wait. But the truth is, the resident does this even when they are clean. But to blame the staff for being slow to get to the resident because they took longer with the last 10.or so residents they are assigned to is not an excuse to get punched, slapped, kicked or bitten. What are we to do?

[NurseCard, ADN]

I wish I knew what to tell you other than, I also once had a resident like this.

She was AWFUL. She would scream, hit, kick... you name it. She was

mostly alert and oriented too, with occasional confusion. I remember she

finally ended up going to a geripsych unit for about 3 weeks, then came

back. Honestly don't remember if she got any better after that or not,

it's been a long time ago.

So this resident is fully alert and oriented? I mean, it sounds like

there are definite psych issues that need to be addressed by the

MD.

No one should ever go in the room alone.

When possible, tend to this resident first. No, you shouldn't

have to do that, but at the same time, it may make your

life a little easier. If what is making them the most angry

and violent, is having to wait.

Good luck.

[Tenebrae, BSN, RN]

I would say clear boundaries are needed

If the patient is with it, advise them "if you choose to assault our staff, you will be criminally charged with assault every time"

If your managers are too limp wristed to stand up for their staff and back you, use two staff for all cares.

If the patient tries to be assaultive, ensure that they are safe eg bed rails up, fully covered, dignity maintained, advise the patient you will come back in 30 minutes when they have calmed down

No one should have to deal with violence in the work place from alert and orientated patients. Its hard enough when its coming from a lovely little dementted lady who kicks like a mule

[Davey Do]

A psych consult could be in order, and harm to others goes as far as to meet criteria for an involuntary inpatient psych admission.

Our geriatric psych unit regularly gets admissions for LTC residents who are physically aggressive with staff. Typically, the aggressive patients are medicated with an antipsychotic and perhaps an antianxiety and/or antidepressant.

The atypical dopamine antagonists, such as olanzapine, resperidone, or quetiapine, are great at decreasing aggression and have significantly fewer side effects than the older typical dopamine antagonists such as haloperidol or chloropromazine.

[Chrispy11, ASN, RN]

I've had to deal with similar behaviors from residents. Were always sent out for psych evaluations. One came back on medications, others were sent to a facility better equipped to handle the behaviors. In the mean time, you're going to need back up and should always take help with you.

Good luck.

[FolksBtrippin, BSN, RN]

You may need a prn for agitation, Davey mentioned a few choices. You could also go the benzo route. Time it so that it's peaking when you intend to bathe, change him etc.

Is it possible that pain is a factor in this behavior?

[marable]

In my experience a lot of these angry patients know exactly what they are doing...On the unit I worked on we had an HIV pos . patient who liked to spit on the staff...One day I could tell he was getting ready to spit on me...I told him that he did not want to spit on me as I was not going to be like the other nurses whom he had spat upon before that when he spit on me I was going to clock out and go to the sherriffs office and have a warrant for his arrest made for attempted murder because he was HIV positive....I meant that , I would have gotten an attorney and would have done anything that I possibly could legally....He never spit on me , he knew exactly what he was doing....

[Glycerine82, LPN]

Identify which staff members are the best with her and figure out what they do differently. Sometimes its the approach, sometimes its the face or even the skin color (dementia patients don't know any better). I've had patients in the past where I've had to delegate certain people to care for them. (or not care for them as the case may be). It's also best to make sure two people who are skilled go in and get it done as fast as they can and that the amount of times is limited to as few as possible.

[Daisy Joyce]

I get where you're coming from, but I would be very dis-incentivized to learn social skills if what it earned me was the crappy assignment day after day.