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When Dianne Rallis-Peterson, RN, CEN, an ED charge nurse at Community Medical Center in Missoula, MT, was treating a patient with a head injury, the irate man grabbed the ends of her stethoscope and tried to strangle her by crossing it around her neck and pulling it tight.
The man falls frequently due to a head injury and often comes to the ED for suturing, she said. "On this particular day, he received a nasty laceration to his forehead and was in an angry mood when he arrived," she recalls. "Everything we did to help him was making him more irritable. Even washing the blood off of his face, neck, and hands didn’t appease his bad mood."
The nurse found herself getting irritable. "When the man said there was something wrong with the bandage on his head, I told him that it was fine and needed to stay on," she recounts. "The wrap was perfect, the bleeding was controlled, and his ears where pinned flat against his head and not folded over. It looked fine to me."
In response, Rallis-Peterson raised her voice and told the man to leave the bandage on. "I stood in front of him with my hand on my hip, made a loud sigh, and looked annoyed," she says. "He knew I was getting exasperated. I’m sure my body language and tone of voice spoke volumes."
Suddenly, the man reached for the ends of the stethoscope and wrapped them around her neck. "He got my attention — 100% of it! He told me what I needed to hear through his clenched teeth," she recalls. "I began to choke and grabbed his hands. He let go."
Here, Rallis-Peterson analyzes what she could have done to prevent this assault: First, she failed to address the reality that she was losing her patience. Rallis-Peterson says if she had acknowledged her increasing tension, she would have requested a co-worker to assist or take over the patient’s care. "We do this a lot for each other when we have a patient that we just can’t take anymore,’" she says.
Some patients react well to some nurses but not with others, notes Rallis-Peterson. "The same goes for the staff. There are a few patients that I simply have a terrible time tolerating," she admits. "They frustrate me to no end. In those cases, I’ll purchase a double latte or soft drink of the nurse’s choice if they take over the care. The offer is reciprocal, too."
Secondly, Rallis-Peterson didn’t pay attention when the man complained about the dressing being too tight. "He had just sustained a good bump to his head, there was swelling and tenderness, plus he had a whopper of a headache," she notes. "In my enthusiasm to control all bleeding, which actually was not a problem at the time, I applied a nice tight dressing, unaware at how painful it was for him."
Rallis-Peterson left the bedside shaken, and a co-worker loosened the dressing and gave him a couple of Tylenol. When she returned and apologized to the patient for the dressing problem, the man also apologized and thanked her for taking care of him. "I always take off my stethoscope and roll it up in my pocket when I have this person in the department. I encourage others to do the same," she says.
To prevent future violence, staff should be encouraged to report all incidents, even minor ones, urges Tracy G. Sanson, MD, FACEP, assistant medical director for the department of emergency medicine at Brandon (FL) Regional Medical Center. "This includes intentional verbal or physical behavior that threatens, intimidates, or results in injury, as well as acts of violence against a person or property," she adds. (For a sample incident report, click here.)
Nurses are more likely to report incidents if they know the form used is confidential and it identifies its destination, such as the hospital’s risk management department or safety committee, says Sanson. "Credibility is dependent upon whether reports are handled quickly and effectively." she adds. Word spreads quickly and damages the whole process when a report is made and nothing is done, when a report is handled improperly, or when the allegations are not treated confidentially, stresses Sanson.
Avoid these problems by maintaining an internal tracking system of all threats and incidents of violence, Sanson urges. "Either staff experiencing or observing the behavior may file a report," she says. "Consider starting a hotline for staff to report these incidents."
Most violent and aggressive behavior is criminal in nature, says Sanson. She recommends calling the police immediately if a patient does any of the following:
Do not try to negotiate with a person displaying this level of aggression, says Sanson. "Allow the police to come and evaluate the situation, even if the situation calms down," she advises.
For more information about prevention of assaults, contact:
• Dianne Rallis-Peterson, RN, CEN, Emergency Department, Community Medical Center, 2827 Fort Missoula Road, Missoula, MT 59801. Telephone: (406) 728-4100. Fax: (406) 327-4505. E-mail: Dpetson@aol.com.
• Tracy G. Sanson, MD, FACEP, Department of Emergency Medicine, Team Health Affiliate, Brandon Regional Medical Center, 119 Oakfield Drive, Brandon, FL 33511. Telephone: (813) 681-0503. Fax: (813) 948-8477. E-mail: firstname.lastname@example.org.