Violent patient outburst

[Dr.Nurse2b]

not certain where this belongs...

i recently encountered a patient, aged and seemingly harmless. the patient was situated in a wheel chair in the doorway of a room - half in - half out ...a cna was attempting to wheel the patient into the bathroom for a potty break.

the altercation happened quickly...i was close enough to hear the patient mumbling racial obscenities and suddenly the patient stood up - at first i thought the patient was getting up to move into the bathroom. i moved closer as i was shocked the patient stood up to begin with - at this time the patient lunged at the cna and attempted to grab the aid with one hand has he drew back to strike with the other hand. the cna look shocked and terrified and cried out "please, please mr. ... i am just trying to help you". i was shocked...i quickly move the wheelchair forward and stopped just behind the patient. i gently placed my hand on the patient's shoulder...i whispered softly - "sir, please have a seat right here" in an attempt to back him away from the aid. well it was my turn...the patient turned right around grabbed me and took a swing. i don't remember if i was actually struck or if i was grazed but i can tell you this patient was very strong and i was completely shocked and caught off guard. i jumped back several feet and the patient attempted to move toward me...leering at me and continuing to mumble. other staff members intervened and i walked away.

i find out this patient has a history of violence and apparently has a problem with males and black people. the patient allegedly attacked a male employee just a week ago and supposedly knocked teeth out....elbow to the mouth! so i am lucky i did not get my butt handed to me. again, i was totally shocked...my peers tell me i present in a "non-confrontational manner"...i do not appear threatening at all...kinda funny because my partners would make fun of me because i am a little "girly". j but i walked away from this thinking... "was this me?" and "i should have handled this better".

so my problem/concern for the group...

let me preface with my experience is primarily in ems. i currently work critical care so my patients for the most part are pretty sedate. this event occurred during a clinical rotation. i have never had someone in an institutional setting attack me...sure i have been bounced around in the back of an ambulance but you come to expect that from patients who have been shot, stabbed, or perhaps on drugs...these events are easily dealt with. this event however took me by surprise and my concern is my response to all of this...i obviously came unglued and this was apparent to my colleges...i think i may have scared some people. :imbar

i was told "every vein in your head and neck was popping out"..."you were obviously upset". from my experience "veins popping out of your head" translates to "dude you looked like a madman!" i understand this is a natural reaction but i was truly angry...has anyone ever experienced this feeling? i was furious! the racial slurs and the attack on the aid...and what made it personal - swinging at me.

after the event i consulted a psych nurse who stated "if it were me i would want to swing back too. we are human"... ok...so i am human...and now i am embarrassed because i looked like a madman on the floor. i would like to grow from this experience...i have witnessed cases like this from afar where a 5'2" er nurse walks up to a 6'6" tall man who is threatening to kill all the staff...the nurse single handedly diffuses the whole scene without breaking a sweat.

how does one develop the skills to maintain control and clarity in situations such as what i have experienced? i need to know...i need to grow...

[Ruby Vee, BSN]

martial arts. i worked with a 5'1" redheaded nurse who happened to see a visitor lifting a co-worker's wallet. she politely told him to drop the wallet and leave. he pulled a knife on her. the altercation ended with him flying through the air in one direction, the knife in another, and the wallet returned from whence it came. then she sat on him until security showed up!

seriously, martial arts helps with maintaining calm, and with blocking punches. or so the redhead claims. i've never tried it. i've found that these sorts of events are few and far between, but they really do shake you up when they happen!

[iluvivt, BSN, RN]

Once you had a clue that you had an angry patient that was already lashing out...proceed carefully in helping your co-worker....but immediately call other staff to assist. You need strength in numbers. Yes I still get angry when patients try to hit me...as a matter of fact the degree of my anger shocks me. I can excuse a lot when there is a physiologic cause...but when patients know what they are doing...that is when when you protect yourself and realize they have the problem...stay cool...set limits. This guy had a lot of issues and a case conference is in order. If he returns to this facility his records should be flagged to alert everyone. Also there are some courses that can instruct you on dealing with difficult patients,including assaultive behavior....check it out

[gentlegiver, ASN, LPN, RN]

It happens, I've gotten black eyes from sweet LOL and whip-lash from a jerk who believed it was his right to beat women. Sec 12 them out and document the heck about what happened. Hopefully some-one out there will refuse to allow them back into the facility.

[TakeTwoAspirin, MSN, RN, APRN]

I really don't know why we are expected to react to personal attacks against us any differently than if we were attacked on the street. Why are we expected to just suck it up and maintain our "nursing composure" and just act like nothing happened? You were attacked, and you have every right to react the way any human being would if they were attacked unjustly - angry and confused.

I suspect that your colleagues were just concerned about you and doing their best to open the door for your to talk about it when they made the vein popping remark.

Honestly though, I would be even more angry if the situation with this patient was as you describe. If a patient had hurt a colleage as bad as you describe just the week before, and nobody had warned me about his violent and unexpected outbursts, then I would be REALLY angry. Had you known, I suspect that both you and the CNA might have reacted differently once this old guy started up. As things stood, I don't think any one of us would have done anything too differently, you just have to go with your instincts if you have nothing else to go on (and the hospital/staff gave you no reason to have any other perception of the situation). Poor judgment on their part - not yours.

[Jo Dirt]

...i have witnessed cases like this from afar where a 5'2" er nurse walks up to a 6'6" tall man who is threatening to kill all the staff...the nurse single handedly diffuses the whole scene without breaking a sweat.

how does one develop the skills to maintain control and clarity in situations such as what i have experienced? i need to know...i need to grow...

i don't know, because i would have decked this creep.

the only thing i can't tolerate is mean-spirited, evil people.

[mpccrn, BSN, RN]

the guys chart should be flagged as history of violence. no one should approach the guy alone. security should be placed 24/7 at the guys bedside and criminal charges should be filed for his attacks. in a word, consequences.

[SEENIT]

I'm a float nurse, I observed that violent patient behavior is handled very differently on medical floors vs psych floors. On the medical floor the nurses are blamed for the patients behavior, "What did the staff do to upset the patient" On the psych floors limits are set and patients are told violent behavior will not be tolerated.

Patients with psych historys are admitted to hospital units other than psych. Often time residents are unfamiliar with their medications and do not order medications that would help stabilize their behavior. I've also seen psych patients taken off their meds completely because the doctor feels their behavior is a result of over medication.

A show of strength were every available staff member and security come in to back up the patients primary nurse. The primary nurse explains to the patient that they are there to help them, but violent abusive behavior will not be tolerated.

You should not blame yourself for the patients behavior. The patient was frustrated about his physical condition and lack of control. This does not make it OK to abuse those who are trying to help hime.

[mruss]

It may be that you actually handled the situation pretty well by backing off, in spite of the "fight or flight" response you experienced. It also sounds like you didn't leave the patient unattended and vulnerable to injury, seeing co-workers intervene before you walked away.

Unexpected violent behavior can throw anyone off their routine interactions. Sometimes there's a personality clash, or the patient doesn't like you for some unknown reason (or irrationality), or you're having a bad day and not handling the situation at your best. It's good that there's other people to step in and help.

[Dr.Nurse2b]

I don't know, because I would have decked this creep.

The only thing I can't tolerate is mean-spirited, evil people.

Thats how I felt!

I backed up and said "I'll tell you what Mister"... This old coger looked at me and sneared and said "I'll tell you what..." waving his fist...I figured it was best to walk away because this guy wanted to hurt someone.

I found out this guy is an ex-military career guy...just mean and obviously very angry for whatever reason. Good thing I backed off...I probably would have had my butt handed to me by an old guy in a wheel chair! I'm chalking this up to this guy proably saw one too many wars or lost a buddy or is just lost.