Verbal abuse ... what are my rights?

[KHT]

So, I work in a facility where it's not uncommon to have patients who are confused and aggressive - out of psych issues or other diagnoses where aggression is an expected stage of their disease process. Sometimes, they're cranky or aggressive because they're seekers and you're not getting them their much needed "pain" med.

However, this latest patient is a whole new ballgame for many of us on the unit. Quadriplegic - so completely dependent for all activities of daily care. BUT, he is verbally abusive ... you F'n nurse, hurry your F'n ass in here when I call, F you! (racial slur here and there), and he goes on for 45 minutes that he eats up of your time "fixing" his position because he dictates every minute detail. I'm at a loss as to how to deal with this .. if it's coming from a confused patient, that's one thing but this is draining when it is coming from someone who is completely oriented and knows exactly what he is doing! 45 minutes each time repositioning is required is also a problem because it takes me away from my other patients who can go downhill very quickly but I wouldn't know it.

The charges, nurse manager, supervisors, head nursing office, all know about this patient because he calls them incessantly when things don't go his way. BUT he is allowed to continue this behavior. I'm dreading the next time I go in and find that I'm assigned to him!

[Have Nurse, ADN, RN]

Just because he has a disability, it does not give him license to verbally abuse you, and it's perfectly fine to tell him that. He needs some limits to be set. Get the doctor involved and your legal advisor to see what recourse you may have.

Verbal assault is not ok and he needs to know that.

[Davey Do]

it is common maladaptive coping. Its about control.

He wants control because he feels he has none. He is not coping well with his dependence on you.

Control and power. We all like to believe and feel we have some control over our environment.

We use techniques we know work. They may not be good or healthy, or as FBT said "maladaptive".

We respond to situations which have their basis in two basic emotions: Love and fear. This patient has a lot of fear and is lashing out inappropriately like some cornered animal fearing for its life.

Here's a technique to consider that comes with a much less than 100% success rate: Put the focus on the person and not the behavior. For example, "I know you are in discomfort and pain. I realize and can appreciate the validity of your situation. We want to do everything we can to help you be as happy as you can possibly be."

Ask him questions, again, putting the focus on him. See if you can get him to focus on the reason for his psyche pain. Use verbal listening. Be understanding and supportive.

As I said before, this technique has a low success rate. But every now and then, I've had a breakthrough. And the breakthroughs have not always been illuminating revelations that resulted in a total change of conscious and behavior. The breakthroughs are usually short-lived and require consistent reinforcement from caring individuals that can act objectively.

Again, as I said, "something to consider".

Good luck and the best to you, bratty.

[Davey Do]

Something else: Is he on any meds for behavior, like anti-psychotics, anti-anxieties, or antidepressants?

These meds go a long way in controlling behavior.

A psych consult could be warranted.

[BeckyESRN]

This guy has absolutely no control over anything in his life and he hates it. The only thing he can work independently is his mouth and it makes him feel powerful to see the reaction he can get out of people. Try to remember it's just verbiage and he can't exactly back it up with anything.

Try to give him control over as much as possible "Do you want to start with the soup or eat dessert first?" but do tell him he's not helping himself with the attitude. Good advice to leave the room every time the abuse gets cranked up. If he has any moments of acting human, try to use the opportunity to develop rapport. He wants to feel like a person even though he's going about it the absolute wrong way.

Good luck.

Wise words. I think you've absolutely hit the nail on the head.

Also, haldol blow darts...

[Davey Do]

Also, haldol blow darts...

Ha ha ha ha ha!

[ATTACH=CONFIG]26293[/ATTACH]

[Elfriede]

Other way :

What would you do to get accepted and not be treated as a workpeace?

[MrsMRN]

I didnt read through everyone's posts so forgive me if this has already been said: I used to work on a geriatric alzheimers/IV drug user unit (i know, whaaa?) where a LOT of the patients were verbally abusive due to their diagnoses or background. What worked for us was a written care plan displayed in the room for all to see (if its not a private room, somewhere in the room where all STAFF could see). Whether the patient agreed or not, we would ask them to sign it. (very few would of course, but we made sure they understood that it didnt matter if they signed it or not) Every day at huddle we made sure EVERY STAFF MEMBER on the floor knew the plan. the patient would have ONE RN and ONE CNA assigned who were responsible for their needs. We made sure the patient knew that no one else would be responding to their needs. They were allowed one call light call per hour that would be responded to, and at any point they became aggressive (verbally or otherwise) of their behavior was outside of the expected behavior in the care plan, it was an immediate walk out (once the patient was deemed safe of course). We made it THEIR choice whether they received the care they wanted or not based on THEIR behavior. Medication administration was done quickly and efficiently and if the patient began their bad behavior or foul language, medications were withheld until the behavior stopped (as long as these were PRN and not life saving medications). Politeness and treating staff with the dignity and respect they were demanding was of upmost importance to reinforce. Of course, everyone needs to be on board with this plan or it falls apart quickly. Hope this helps!

[Horseshoe, BSN, RN]

I didnt read through everyone's posts so forgive me if this has already been said: I used to work on a geriatric alzheimers/IV drug user unit (i know, whaaa?) where a LOT of the patients were verbally abusive due to their diagnoses or background. What worked for us was a written care plan displayed in the room for all to see (if its not a private room, somewhere in the room where all STAFF could see). Whether the patient agreed or not, we would ask them to sign it. (very few would of course, but we made sure they understood that it didnt matter if they signed it or not) Every day at huddle we made sure EVERY STAFF MEMBER on the floor knew the plan. the patient would have ONE RN and ONE CNA assigned who were responsible for their needs. We made sure the patient knew that no one else would be responding to their needs. They were allowed one call light call per hour that would be responded to, and at any point they became aggressive (verbally or otherwise) of their behavior was outside of the expected behavior in the care plan, it was an immediate walk out (once the patient was deemed safe of course). We made it THEIR choice whether they received the care they wanted or not based on THEIR behavior. Medication administration was done quickly and efficiently and if the patient began their bad behavior or foul language, medications were withheld until the behavior stopped (as long as these were PRN and not life saving medications). Politeness and treating staff with the dignity and respect they were demanding was of upmost importance to reinforce. Of course, everyone needs to be on board with this plan or it falls apart quickly. Hope this helps!

That sounds perfectly reasonable with patients who are A and O, but I don't see how that works for someone with Alzheimer's.

[Neats, BSN]

I am not sure if this patient is in a SNF but I can tell you this

I had a quad patient , the facility had to buy a special bed costing $25,000.00, I inherited this patient when I was a LNHA and took over a facility he was admitted about 45 days before I got there. He turned that facility upside down, made an impact (negative) on not only the staff but the residents too. He would spit, bite, anything he could do to make our lives as miserable as he felt.

We care planed down to the last min. We each shift had specific instructions to whom ever was taking care of this patient and for anyone who answered a call bell light. I had everyone document what they heard, saw, what they did and he did.

This patient made so much ruckus he was in a private room because he disrupted others. One night I had to place a new admit in this patients room until the next day. I promise the staff I would stay the night.

From the get go, I could see this patient's behavior change to a real mean spirit he revealed to all each night. He would yell just as the new admit would doze off just to torment the new admit. I documented everything I saw and had to move the new patient...ugh!!!

The next day I called this mean patient's provider, the health department, the ombudsman, and patient family, I set up a meeting with all in attendance-that same day, after we discussed this patient, we had the patient come into the room and just informed the patient the care plan, treatment plan and if he did anything staff would call the police for assault on a health care worker. After 3 days the patient bit a staff member, we did call the police to press charges, they took him away first to the hospital then to jail. Last I heard they had to place this real hard to love patient 100 miles form his home of record.

[MrsMRN]

Yeah that did sound confusing. This was used for our very demanding IV drug users who were very much alert and oriented :)

[Decisions7]

I'm not a nurse yet but maybe you should put on some dance music and dance in front of him show him moves he will never be capable of.

(don't do this :))

[brownbook]

I am slightly hard of hearing. Way too often I just smile and nod as if I did understand what someone said to me and go about my business. I always joke to myself or to others...I hope that nurse didn't just say that a code red or code blue was called!

I'd love to see a nurse/CNA giving the patient a note saying I am hard of hearing, I am going to give you a bed bath, then just going about their business. They can put tiny ear plugs in their ears.

Or a nurse/CNA going in the room, saying I am going to give you a bed bath then putting on huge head phones with the music blaring and going about their business, pointing to their head phone when the patient is talking, the nurse shaking their heads, as in "I can't hear you"!

It would probably just escalate the situation, but I'd love to see it.