Workplace violence and safe staffing

[mruss]

We had a combative patient this past weekend. She was 92, weight around 100 lbs, in for a hip fracture repair, history of Alzheimer's disease, having only a few teeth, no dentures, and plenty to say. It took a lot of time to get the gist of what she was ranting about, and then figure out what to offer that would give some relief. On a typical day, I would have had five or six patients, and there wouldn't be much time to spend this way. Luckily, the hospital census was down, so she was one of three patients I was assigned to look after. She was prone to hit and scratch unless the caregiver took the time to first develop some rapport, and then proceed in a very slow and deliberate manner. As a testament to reasonable nurse to patient staffing ratios, it did help to be able to take the extra time with this patient. Physical therapy (PT) and respiratory therapy (RT) did not want to work with her a second time because she hit and clawed at them. I think this was mostly due to the way they tend (or need) to do their work: "get in there, get the job done, get out, and go on to the next one, or you'll never see everyone on your list today". Of course, despite my best efforts, and the time I did have to spend, she wasn't all sweetness with me either. According to her, sometimes over the course of just a few minutes, I went from being "a good boy" and "my sweet doctor", to "I'm gonna kill you" and "I'll slap the **** outta you", which she tried a few times, but her blows were easily deflected. At one point, while a tech and I were bathing her, she put up her dukes in a boxing fashion, started hitting, saying, "I'm gonna slap the **** outta you", and we burst out laughing. This connected with the humor in the patient, who began repeating the phrase, feigning some hits, then laughing herself (albeit a wicked sort of laugh, but that made it even funnier to us).

While I suppose this was case of violence towards healthcare workers, to me, it didn't amount to much. She couldn't hit hard enough to hurt, and it was pretty easy to avoid being scratched by her fingernails. She was usually calmed by a gentle approach. Other caregivers seemed more concerned. After all, she did manage to knock the glasses off the orthopedic surgeon, intimidate the PT team, upset the RT person by scratching and cussing, and convince the nurse tech that the blood transfusion she received must have contained some "devil blood". Even though I'm making it sound like it didn't get to me, I was glad when my shift was over.

[ktwlpn, LPN]

We had a combative patient this past weekend. She was 92, weight around 100 lbs, in for a hip fracture repair, history of Alzheimer's disease, having only a few teeth, no dentures, and plenty to say. It took a lot of time to get the gist of what she was ranting about, and then figure out what to offer that would give some relief. On a typical day, I would have had five or six patients, and there wouldn't be much time to spend this way. Luckily, the hospital census was down, so she was one of three patients I was assigned to look after. .

This is my major pet peeve-we have pediatric, neo -natal,cardiac,post cardiac,and intensive care units etc-why no geriatric unit? They have special needs and are as deserving of the best care we can provide as anyone else...A patient like that does NOT belong on a med surg unit but there is no alternative. It sounds like some of your co-workers could use a little education regarding dementia care,too-in your dept. and others. Why don't you suggest a little "lunch and learn?'