Violent Patient Issues

[Lynx25, LPN]

I work in a LTC, and last week we had an issue where a very large, tall resident attacked a CNA, grabbing and twisting her arms causing a muscle injury, scratching her face, and actually would not let her go for several minutes. His reasoning was that she would adjust his roommates TV to suit him. This man has some short term memory issues, but IS alert and oriented.

The nurse present didn't know what to do, and apparently just stood in the corner of the room screaming at the top of her lungs while the CNA got mauled.

They sent the guy out to the behavioral health unit.... but he's BACK!

What are you supposed to do with someone like this? If it was me, my reasoning is that you lose all of your "Right to do whatever the heck you want because it's your hommmmeeeeee" nonsense, and I not letting you attack anyone. I don't think they should have people here like this, because the staff does not have the cajones to deal with it. They would literally rather let someone beat staff and other patients, than 1013 them out, because- "Well what if it was you?"

So, I suppose my question is, what are you SUPPOSED to do with this sort of person- because apparently here we placate or ignore them until something serious happens.

[traumaRUs, MSN, APRN]

We had an incident several years ago locally and the pt went to prison. That's my solution.

Nurse in Critical Condition After Workplace Attack

[Hygiene Queen]

I work in a LTC, and last week we had an issue where a very large, tall resident attacked a CNA, grabbing and twisting her arms causing a muscle injury, scratching her face, and actually would not let her go for several minutes. His reasoning was that she would adjust his roommates TV to suit him. This man has some short term memory issues, but IS alert and oriented. The nurse present didn't know what to do, and apparently just stood in the corner of the room screaming at the top of her lungs while the CNA got mauled. They sent the guy out to the behavioral health unit.... but he's BACK!What are you supposed to do with someone like this? If it was me, my reasoning is that you lose all of your "Right to do whatever the heck you want because it's your hommmmeeeeee" nonsense, and I not letting you attack anyone. I don't think they should have people here like this, because the staff does not have the cajones to deal with it. They would literally rather let someone beat staff and other patients, than 1013 them out, because- "Well what if it was you?"So, I suppose my question is, what are you SUPPOSED to do with this sort of person- because apparently here we placate or ignore them until something serious happens.

Back in the day, these pts were "snowed" and could be restrained.

There is no place for these pts.

Everyday, we (I work in geri-psych) receive pts such as yours.

Imagine a whole unit of these types of pts!

Once we get them, we cannot get rid of them.

No facility will take them.

We have had many who will stay months at a time, even if we have managed to stabilize their behaviors with the right med combo, because they are "marked".

It is appalling to me that any staff would stand there, with their thumb up their butt, and just watch another person get the crap beat out of them.

Where is the back-bone?!!

We have half-seriously joked about creating a special home for these pts.

Where are they to go?

No home will take them... and they can't stay with us at the hospital.

If anyone thinks it was cruel to sedate or restrain a pt, then they need to see what some of these pts are capable of.

It is very frustrating.

[K+MgSO4, BSN]

Call the cops to take the pt down. I can't blame the other nurse for standing by. You don't know is she pregnant? Is she recovering from surgery? Is she scared and froze? Is she a slight nurse that weighs about 40kg?

anyhow, yeah I would send them to geri psych services I have so much respect for those nurses. I couldn't do their job! Get Geri psych to assess him and speak with the family. This is not safe. You need to set limits. and olazapine!

[Rob72, ASN, RN]

We pay a great deal of lip service to, "critical thinking", in Nursing, but it is really rarely evident. Preventing a critical incident is no different whether discussing hemodynamic or metabolic balance, or anticipating/preventing a patient assault.

I highly recommend Craig (SNarc). His group works with "plain" folks, nurses, cops, fire/EMS, military, and Craig's special teaching ability is to put the concept he's demonstrating in your context. Here's a link to a general concept he teaches. It applies whether in the hallway of your hospital, a LTC, the ED, or (as demonstrated) in a parking lot.

http://www.safeism.com/pdfs/SNContacts.pdf

Don't get wrapped up in, "That doesn't apply to me..."

In context, were the gentleman described on my floor, I believe I would have been attempting to remove his grasp from the CNA, when the resident lost his footing... Being able to validate your perception of threat, and a measured response to the threat, along with your reasonable anticipation of sequelae is key to resolving these issues safely and legally.