Suggestions on Redirecting Pts

MrChicagoRN, RN · Mar 20, 2011

I try the usual, "I understand that you feel that way Mr.X and it is okay to feel the way that you do, however that comment/action was not appropriate, remember this time is to focus on you." but I feel like I should be doing something different.

That's a good answer, but a bit long for my taste. It's a rather long and complex statement to use with much of your patient population.

What works for me is something shorter and to the point.

In a warm, caring but firm tone: "It's normal to feel attracted to others, but it is not appropriate way to talk here."

Then leave the door open for additional discussion if needed.

Davey Do · Mar 20, 2011

First, Mashira, I want to reinterate MrChicagoRN's advice: Give statements which are to the point.

Sometimes merely ignoring inappropriate behavior is the best tact to take. No fuel to feed the flames, so to speak.

However, when behaviors require confrontation, I have found some successful methods for quelling inappropriate behavior.

Always consider your body language. Subtle clues can be immediately conveyed this way.

When I'm attemprting to quell a Patient's behavior, I hold my open-palmed hand next to me, facing the patient, slightly lower than shoulder height. This gives the subliminal message STOP.

Do not extend your arm in the least. To extend your open palm could be taken as, "talk to the hand" or "in your face", which could be interpretted as aggressive.

Next, I consciously lower the lids of my eyes. This gesture conveys assuredness and comfortability.

I face the Individual, allowing them their biological space- say three feet, and not much closer. I'm attempting to convey subtle, yet firm, confrontation. Being within another's biological space connotes aggression or intimacy.

Then, I speak in low tones, with a well-paced cadence. I choose each word very carefully and make my action apparent. This conveys seriousness. I've said many of these types of statements so many times, many of them are rote.

I give clear, concise directions. "You need to stop this behavior." I refrain from using the word "should". Should seems to echo many Individuals' Parent Tapes. And a lot of People are angry with their Parents. The word, should, can incite.

Then, I respond according to the Individual's statements. Always focus on the subject. Never allow the Individual to use Fallicies in Logic, or deterrents, to change the focus. An example of this would be an inappropriate compliment to deter your focus.

Stay focused. Under these circumstances, don't say, "Thank you, but..." If you thank the Patient , you've given him a stroke for his ego and some momentum for continued inappropriate behavior. You could even roll your eyes before you say, "Let's stay focused." Rolling your eyes subliminally puts a negative spin on the inappropriate behavior and your appropriate follow-up statement will reinforce the focus of the interaction.

"I am a Nurse and you are a Patient. You need to do as I request, or you will have to deal with the ramifications of your inappropriate behavior." A rather strong statement, but I'm relatively sure you understand what I'm attempting to convey: "Do as I request and no good will come of your inappropriate behavior".

If I'm making objective, factual statements about the Patient's inappropriate behavior, I am simultaneously shaking my head "no". This subliminally conveys negativity. If I'm speaking of appropriate behavior, or giving reinforcement for appropriate behavior, I'm similtaneously nodding my head, subliminally accentuating the postive.

There are SO many variables and comebacks that there is no way I can cover the whole enchilada.

I hope my basic framework gives you a general idea of how to deal with inappropriate comments from male Patients. You are doing the right thing in seeking data before applying actions to the specific situation. Continue to do this. Talk to your peers. Use good, sound general techniques in communicating with all.

And remember the old axiom: "Practise provides opportunity for possible improvement." Role play. Even if by yourself, with a mirror. Actors do that the same thing to assure they're conveying the correct expression.

PM me, if you wish. The best to you, Mashira.

Dave

Amayalu · Mar 20, 2011

Hi dave

if you are still there I am going to be starting a new job in med/psych and i am coming from one year MICU which is what I call psych on the side, and that came naturally to me . this I think is going to be quite different. can you give me any insight as to what to prepare for. I am also an attractive nurse but that never had a neg. effect on ICU pt or familys. I shadowed for four hours on the dif floors and mostly charting is what was done. surely there is a lot more to it.

Whispera, MSN, RN · Mar 20, 2011

How about a simple, "I feel what you said was inappropriate. Please don't say such things again." ?

Rui RN · Mar 20, 2011

I have been a psych nurse for 8 years and this is some of the best advice I have ever heard.. THank you!!!!

Rui RN · Mar 20, 2011

OH, at davey do...

ImThatGuy, BSN, RN · Mar 20, 2011

Not to sound full of myself, but I am a fairly attractive person. I often times get odd comments from pts that are outright inappropriate, or somehow tied to my looks, and I don't know how to respond to or redirect them correctly.
Examples:
"You're totally frick-worthy, not to be rude"
"Thank you for being so understanding, I swear I could kiss you right now babe"
"Wow, you do things for scrubs that no one has ever done before."

Is this what you tell guys at the bar too? lol

Just giving you a hard time.

Mashira · Mar 20, 2011

Thanks so much for the advice. I definitely agree I need to shorten my little speech and make it more to the point, especially considering the pts. memory and attention span tend to be very short. Great tips guys, especially DaveyDo! I greatly appreciate it!

I'mThatGuy, you really are THAT guy aren't you?

But no, at the bar I usually go with, "I don't know how to put this but, I'm kind of a big deal."

(If you didn't see Anchorman, ignore the last bit lol)

ImThatGuy, BSN, RN · Mar 21, 2011

I'mThatGuy, you really are THAT guy aren't you?
But no, at the bar I usually go with, "I don't know how to put this but, I'm kind of a big deal."
(If you didn't see Anchorman, ignore the last bit lol)

LOL. My kinda woman.