What do you do if a patient strikes?

Long Term Care Columnist / Guide · Apr 30, 2005

Your teacher is wrong. Nurses can, and indeed must, defend themselves from harm........there is nothing in our code of ethics that says we have to just stand there and take a beating, or worse. There will be times in your career when you will have to use force to restrain someone and prevent him/her from injuring you, your co-workers, or even him/herself.........naturally, you have to use prudent judgment, and like every other citizen, you'll be expected to use the minimum amount of force necessary to bring the subject under control or to get out of harm's way. But you do have every right to protect yourself......I'd hate to see anyone not pursue a nursing career because they think they have to put up with being hurt.

GingerSue · Apr 30, 2005

there are courses in non-violent crisis intervention and these teach methods re:specific kinds of actions (eg. if a patient grabs your hair, wrist movements to weaken the grasps, postures, etc.) - the seminars explained about escalation, there wasn't suggestion about striking back.

Earlier another place of employment had offered self-defense courses - and the instructor said that if you're being attacked you might as well assume that the person will kill you, and he did teach various responses.

danu3 · Apr 30, 2005

Hi! I'm a pre-nursing student and I am in Intro to Health Care this semester. My teacher said that if a patient attacks you, you're not allowed to defend your self. I was kind of shocked at that and when I questioned it, she was very insistant that nurses are not allowed to physically do anything to the patient to get them away. I don't know much at all, but I know if a patient is biting me or grabbing me in such a way that I will get hurt, my first reaction would be to not hit them but to get them off of me in anyway that I can. Am I wrong in my thinking? What do you do when a patient gets violent? I'm a little confused.
Thanks in advance for your advice!
Emery

I agree with Mjlrn97, your teacher is flat wrong. Ask any ER or psych nurse where there is a high incident of violence. Think about it, if a patient is choking you, you are not allow to try to save yourself? Now in the case of choking, there are different techniques ranging from doing no harm or pain to the patient to causing some pain (but no pernmanent damage), to phsycially disabling or even killing the patient. Obviously you want to use the least amount of force to get away depending on how you are trained.

Or take another situation, a patient is choking the living daylight out of another patient. So, you are suppose to use nonphyscial (pure verbal) technique convince the choker to let go of the chokee? If you are trained right, you would be able to remove the choker fast with no damage (it will involve some pain), but it does involve phsycical contact.

Now if you use any kind of physical force, you always have the potential of being sued especially if it somehow "violate" your unit policy. So use minimal force is always the best but that assume you are properly trained.

Why don't you post the above two scenrio to the teacher and see what is the answer. It might clarify what the teacher meant.

-Dan

Emery · May 1, 2005

Thank you so much for clearing that up for me. I feel much better now. I will bring it up again in class on Monday. I realize that you do not want to harm the patient, if at all possible, but sometimes it just can't be helped. I don't know anyone personally who has been in the situation, but I can see how it would happen probably pretty regularly. I know that a lot of times adults are like kids and I work with kids all the time. 90% of the time you cannot get a child who is hurting another by simply asking him to stop. WEll, anyway, I'm just glad to know that I was right for a change (doesn't happen too often) hehe. Thanks guys!!!

Emery

danu3 · May 1, 2005

I'm just glad to know that I was right for a change (doesn't happen too often) hehe. Thanks guys!!!
Emery

Hey, you are using your critical thinking skill... :)

Sheri257 · May 1, 2005

Funny, I had a teacher who basically said the same thing. Patient hit the nurse, and the nurse hit her back. The nurse was fired, or that was what my teacher said.

Maybe it depends on the circumstances.

:coollook:

Emery · May 1, 2005

Do you know if those "self defense" classes you were talking about are required for nursing? I don't remember seeing it on my class list. If it isn't I'm sure it would be adventageous to take, eh?

hollyster · May 1, 2005

When I worked in PACU we had very combative pts. coming out of anesthesia. One day a child(10yrs oldand very big for his age) Bit down on one of the nurses arm, blood was dripping on the floor he bit in so hard. Two other nurses were trying to talk to him and pull him off. I walked over and pinched the childs' nose shut. He immediately let go. Can't breathe and bite when your nose is plugged. :)

Every nurse should defend themselves.

pfitz1079 · May 1, 2005

Good thread, Emery.

I'd never get fired from a place for trying to defend myself - I'd quit before they had the chance. The way I see it, I have one obligation when I come to work every day: come home in one piece. Irregardless of what your instructor has told you, you are responsible for your own safety.

The skill comes in learning how to read situations and getting a feel for using only the minimum force needed to ensure the safety of yourself, your team and the patient (in that order - always). A self-defense course is probably a good idea.

As to legality, remember - It's better to be tried by twelve than carried by six.

Be Safe,

Pete Fitzpatrick

RN, CCRN, CFRN, EMT-P

LPN1974, LPN · May 1, 2005

I work in MR/DDS and we are taught techniques to prevent and intervene in attacks from the people we take care of.

We cannot hit, or strike in any way, but use the techniques we are taught.

You can loosen someone's grip, get out of holds by twisting/turning a certain way,

get their hands out of your hair, loosen a bite, and ways to help other staff in trouble, also. There are also techniques to physically put someone down on the floor, but depending on your size and strength it might take more than you to do it. I know it would take more than myself to put a big, angry man down.

But you CAN do something to help yourself. Your teacher, obviously, is not aware of these techniques.

Where I work we have a code to be called over the intercomm, that notifies other staff on that team to respond, and they arrive there quickly, to intervene in the situation and help the staff without injuring the client. The client is placed into a "papoose" board, and strict monitoring by staff and nurses is then done for the duration of the restraint time.

So if you're going to be working where people can be violent, most likely there will be a program for prevention/intervention.

I feel ALL nurses need this kind of training. It sure might help you out of a nasty situation sometime.

flashpoint · May 1, 2005

We're always told that when the non-violent crisis intervention methods don't work, you can defend yourself to the point that you are safe, but no further. So...I guess you can slap someone's wrist or kick them in the shin to get away, but you can't beat the tar out of them.

I once had a patient grab my wrist with both hands and twist. I tried to pull away, but he had a really good grip. I screamed for help and finally slapped his wrist with my free hand when I heard a pop and felt the most horrible pain I had ever felt on the wrist he was twisting. It hurt so bad I almost passed out...six weeks later the cast came off and I was told I was fired for hitting a patient. Thank goodness for lawyers...:)