When I worked in a long-term care facility, I was sitting at the desk, doing my charting, minding my own business.
One of our confused patients was in an independent walking device, which allowed her to ambulate with the use of the walker and sit as necessary.
I don’t know who left the stapler on the counter. Maybe it had never been a problem before.
Quicker than any healthy person could, the resident snatched up the heavy, metal device, reached over the counter, and took several good swings at my head.
I ducked and managed to wrestle the stapler from her fortunately weak grip.
It wasn’t the first run-in I had with a confused, violent patient, and it wasn’t the last in my nursing career.
Most nurses have handled situations like this, but when does the aggression rise to the use of deadly force?
A 95-year-old World War II veteran was killed recently when his aggression became too much for staff and police to handle.
The confused man threatened staff with his cane, then with an assistive shoehorn. Allegedly, he also managed to get hold of a knife, and at this point, the police were called to the scene.
First, they tasered him. Nevertheless, he still presented enough of a threat to the police that they shot him in the belly with beanbag bullets.
Although these rounds are generally non-lethal, they caused internal bleeding, and he wasn’t able to recover from the shots.
This tragic scene begs the question: why weren’t all of these professionals able to control this situation before using force?
Dealing with aggressive patients is one of the most difficult problems to face nurses at any level.
Fortunately, several methods are available to calm aggressive patients, and the use of these techniques can eliminate the need for force in treating patients.
Most nurses and other staff have learned redirection techniques as part of dealing with confused patients. This approach focuses on shifting the patient’s focus on whatever is agitating them at the moment.
For instance, a patient who is desperate to catch the bus from thirty years ago could be redirected with questions about where they are going, who they need to meet, or what bus they want to catch. Remain open, warm, and friendly when talking to the patient, and try to understand what they are feeling in their world that has prompted so much anxiety
This technique is closely related to validation therapy. It takes into account that some confused patients are working through issues from their past by confronting them in hallucinations.
Validation therapy is related to redirection in that it focuses the patient on something else. However, it also seeks to reassure the patient that you recognize what the underlying feelings are that have them so worked up.
For aggressive patients that may or may not be confused, the third party technique may help to talk them down. Often, aggression arises as a conflict between the patient and a specific staff member who is attempting to give them care.
The patient may see this staff member as the aggressor, and no matter how carefully the nurse attempts to redirect them, the mere sight of them sets the patient off. In this case, a neutral third party can help to defuse the situation.
Whether it is a charge nurse, supervisor, or manager, having someone enter the discussion that does not have a “side” can be enough to calm the patient. Although the third party doesn’t necessarily have to be neutral, they can hear the patient out, and this has a calming effect.
Often, this technique is used in hostage situations, where the criminal feels persecuted by the police. By employing a negotiator, the third party can be a sounding board, a voice of reason, and possibly someone to soothe the angry person’s ego.
In the end, nurses should not have to call the police to deal with patients. While it is true that many of our charges can get violently aggressive, nurses need to know how to deal with this situation as much as they know how to pass meds.
Excessive force may be required in some cases, but police do not have the disease perspective that nurses have. Although they may have some compassion, it isn’t exactly a trained skill for them to understand the behavior of a demented patient.
As with practices such as restraints, nurses need to find a different way to handle this all too common problem. It just may mean the patient’s life.