Educated professional, articulate 30 something female p'ts who have been made comfortable ( pain/nausea relieved etc) ....behaving like morons just because they feel they can.
Becoming all over-wrought and throwing an absolute wobbly because they are annoyed at being in hospital ...annoyed because they can't go home yet ... because their husband has to go home / the dog is by himself / they are bored / dr is taking too long to discharge ...and so on.
I've had the most silly unreasonable behaviour lately. These people know they can get away with this ... as long as they are not verbally or physically abusive.
Anytime you feel that the patient may be acting in a manner that is unsafe to herself or others, you should immediately ask her if this is the case and remind her that the "nursing process" requires you to seek a psych hold if she can not maintain her own safety.
Anytime I have a wild patient who decides to act out despite all interventions performed, my last card is that I tell them that if they can't be safe then I'll have to ask the doctor to consider transferring them to the intensive care (read: actively psychotic) unit, because I can't put their safety or the safety of others at risk due to their own behavior.
That gets 95% of them to improve. The other 5% get the transfer.
Anytime I have a wild patient who decides to act out despite all interventions performed, my last card is that I tell them that if they can't be safe then I'll have to ask the doctor to consider transferring them to the intensive care (read: actively psychotic) unit, because I can't put their safety or the safety of others at risk due to their own behavior.
That gets 95% of them to improve. The other 5% get the transfer.
LOL
Wish I could do that.
I am tired of these ones taking up so much resource ... just because their reason for admission (minor) is about the worst thing that ever happened to them, therefore haven't developed coping skills....and the poor things feel so entilted to act out in this way.
I have way sicker p'ts who need my time
I work with a nurse from Sth Africa and she said this sort of thing is not tolerated there ...the p't is placed outside until they agree to behave
I once had one of my family members in the hospital and they started acting like a spoiled brat. When the poor nurse left the room I had a not so nice talk with them. They were only in the hospital a couple of days and probably could have managed at home but just wanted someone to wait on them. Once their nurse mother got ahold of them they were more than happy to behave.
I disagree on one point .... it is about being a brat, with loss of control coming in at second place.
Voicing their dissent etc doesn't always work. These people don't like to be managed
Actually, a lot of the "why" for their behavior is the feeling of a loss of control. Though there are certainly more than enough entitled, bratty patients in the pool to go around.
At least you guys and gals in the ED are lucky: they may be trying your patience, but at least you can get them out of there after several hours, whether you admit them, send them home...or send them to me :) I usually have to keep my patients for quite a while.
if someone were attempting to "manage" me, i would be royally ticked off! DONT ever treat me like a child, and try to manipulate me like that! Not theraputic at all!
I work with a difficult population (SCI), most of which are young males from the 'streets' who were never taught any manners and do not know how to communicate well with others. I try to take the same approach: strictly business, state the rules of our unit and THEIR responsibilities as a pt from the day of admission. I have also noticied that staff which does not take a similar approach get manipulated and treated badly.
I work with a difficult population (SCI), most of which are young males from the 'streets' who were never taught any manners and do not know how to communicate well with others. I try to take the same approach: strictly business, state the rules of our unit and THEIR responsibilities as a pt from the day of admission. I have also noticied that staff which does not take a similar approach get manipulated and treated badly.
I have no probs with them. Plus the next night they ask for a female nurse instead.
Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Well ...yes...theoretically so.
However these p'ts don't like to be managed ...and if they pick this up they esculate....because it's the 'contol' issue LOL
They are intelligent and educated ...and a lot of the techniques we use on other p'ts don't work here because they understand what we are doing. We as nurses, often don't have enough authority to circumvent the process so we don't have the tools to deal with these ones - I find this frustrating. A docotr would simply walk in and refuse to take any nonsense and have them sign a AMA form
Because they understand our nurse processes ....they get worse because they feel patronised when we try and manage them
So I am pulling out my hair here ...
Wait--when a patient starts that AMA thing, I have that paper in my pocket.
I don't make time for their nonsense, and they can usually tell by my aloof "really?" demeanor.
Sometimes, I just stare at them as they throw their hissy fit--just like a child--and then I say, "You feel better?"
and then walk away...sometimes, just saying nothing--and doing nothing, but just looking at them, makes them realize that they are acting like children.
They have all the right to throw hissy fits. Let them. YOU have the right to not let it get to you. YOU are in control of YOUR reaction. If you realize how much you really don't have to let them get to you, your life will be much easier.
Meriwhen, ASN, BSN, MSN, RN
4 Articles; 7,907 Posts
Anytime I have a wild patient who decides to act out despite all interventions performed, my last card is that I tell them that if they can't be safe then I'll have to ask the doctor to consider transferring them to the intensive care (read: actively psychotic) unit, because I can't put their safety or the safety of others at risk due to their own behavior.
That gets 95% of them to improve. The other 5% get the transfer.