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 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.
It's important to point out that you are in psych unit/hospital. In a regular hospital the Intensive care unit is where they would LOVE to go because they get more attention and one on one nursing care but is not really the solution to their problem. Boundries need to be set.
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 therapeutic at all!
I agree with morte. While we all empathize with the situation and understand how frustrating it can be, the nurses job is to help manage the patient's care, not manage the patient - there is a difference. Patients should be encouraged to take control of and responsibility for those things they can. That said, we should not roll over to accommodate unreasonable or unsafe requests or demands - you simply explain to them why you can not do what they request (policy, safety, etc.). The reality is, no matter how much you try to educate, some patients are still going to be a PITA. I'd have no problem in telling them point blank what the options are, and if they don't like it they are free to leave AMA.
As to making decisions or doing things that you think are not in their best interest, at least in the US that is their legal right, assuming they have the "capacity" to make their own decisions (which the patients you describe would) - and courts have held that such a decision may not be used as grounds to question their capacity. All you can do is try to educate & document, document, document.......
I find the ones who are dramatic are going to be dramatic regardless of what is done or not done. I point out that they have had x,y,z for a,b,c and there is simply nothing more to be done but wait. Of course in a firm (yet caring) voice. They are the ones behaving poorly, my reaction does not have to engage that. I am not supposed to control my pts, but educate them.
We forget; No one comes in to the health care system except for a doctors order or by way of an ER visit. No one ever HAS to be admitted unless they are the victims of trauma. So why should I have to put up with crap from someone who CHOSE to come to my ER, and then does not the treatment they get there?
We forget; No one comes in to the health care system except for a doctors order or by way of an ER visit. No one ever HAS to be admitted unless they are the victims of trauma. So why should I have to put up with crap from someone who CHOSE to come to my ER, and then does not the treatment they get there?
Agree
I discussed this situation with a couple of our senior docs.
Given this patient's behaviour worsened after my therapeutic management of the situation ( NB The situation was being managed, not the p't) .... next time a similar situation occurs, these two options would be feasible:
1. Present AMA form promptly and p't leaves
or ......
2. Given she was threatening action that would result in harm to self despite reasonable explaination and education ..... psych evaluation. The docs are happy to step in promptly and do this. Meanwhile she would be located to the 'bad' room where she would pose less risk to self and others.
Harm to other p'ts could also result due to the temporary relocation of staff resource to manage the situation.
The episode wasted a large amount of staff resource and threatened risk to the hospital. She does not have the right to impose this cost ( just because she is experiencing loss of control and coping issues) on either the organisation or myself.
If I had not opposed her big want (the thing she was having a hissy wobble fit about) I would be fighting for my job and my license now.
I'm not sure what degree of "drama" we are talking about here, but I'm of the opinion that many nurses forget just how traumatic and stressful an ER visit/hospitalization can be. I've always given wide latitute re:behavior because I think the loss of control and fear related to being in the hospital is easily forgotten by nurses who see it every day.
I've developed a 'zen' response to this. In our ER bay I just stand there and listen to them yell until they wind down and tire themselves. I don't wait on them hand and foot, though. Just my approach.
IMHO,any pt. in hospital for an ELECTIVE procedure, should know what they are in for. Any pt.who tells me that they don't want to get out of bed after a hip replacement "because it hurts", is no candidate for sympathy. WTH did they think it would feel like?
mmutk, BSN, RN, EMT-I
482 Posts
It's important to point out that you are in psych unit/hospital. In a regular hospital the Intensive care unit is where they would LOVE to go because they get more attention and one on one nursing care but is not really the solution to their problem. Boundries need to be set.