Friday, July 15, 2016

Physical Safety in Nursing

Awhile back, I had a patient who was a bit of a handful. Which isn’t saying much, because I feel like a lot of them are. One night, while I was changing one of his dressings, he was watching a particularly violent show on TV. He turned to me and asked a question I don’t think I’ve ever been asked before.

Have you ever been hit?

I was surprised, and without thinking, I told him yes.

He was shocked and asked if it was my boyfriend or husband that did it.

Of course I told him no. When he pressed, I told him that I’d been hit by one of my patients.

He became very invested in the conversation, asking, “Have you ever been choked?”

Ironically, yes, I have.

I work in geriatrics, and more often than not, there’s not just physical ailments that I’m treating. I treat many patients who suffer with mental illnesses as well. Dementia, bipolar, depression are incredibly common among the geriatric population. (I should say the ones in skilled nursing.)
I learned about it in nursing school, but the one thing I didn’t learn was how to be safe while taking care of patients who are unpredictable. 

When I was a brand new nurse, I had a patient who I liked very much. He and I got along and seemed to understand each other. He also had dementia. One night, while doing my rounds, I checked on him and noticed that his shoes were still on. Without really thinking about it, I went in to take them off. I’d done this dozens of times before, and usually he would wake up just a little bit, and I would tell him I was taking off his shoes and he would go right back to sleep.

Unfortunately, that night, that was not what happened. He woke up and grabbed me by the throat, trying to find something to choke me with. One of my personal decisions, when I became a nurse, was that I wouldn’t wear anything around my neck. At that point, I was grateful I’d done that, or he might have strangled me with my stethoscope right there.

I’d put myself into a dangerous situation, and I didn’t know how to get out of it. I’d gone around his bed, and now I couldn’t reach his call light. The door was on the other side of the room, and my CNAs didn’t know which room I would be in. They would have expected me to be gone for a while anyway, since I was doing rounds. I struggled with him until I could get free and then I got out of that room as fast as I could. I had the presence of mind not to run, since I knew that would aggravate him further, but when I glanced over my shoulder, he came running after me.

He grabbed me and threw me against the wall before pinning me there with his arm. Fortunately, at that point, I had gone far enough that I could call for help and my CNAs came and pulled him off me. I ended up giving him a shot of Ativan, and then I had to stay locked in the nurses’ station for over two hours until he finally calmed down. Even locked back there, he still came and tried to climb over the desk.

Nursing is a stressful job, and I wish that someone had told me to pay attention to my surroundings when I became a nurse. I walked into a dark room, placed myself where I couldn’t reach the door or the call light, and assumed I would be same. No matter what the patient, we never know when they could snap, or when something could trigger a violent reaction.

So pay attention to your surroundings, and always prepare for the worst.