Managing Disruptive Patients _ ________________________________________________________________
Jackie wakes Erik at about 6:00 a.m. and administers his pre- operative medications. Erik is taken to surgery at 7:00 a.m. The surgery goes well, with no complications. Erik has an uneventful recovery and is returned to his unit at 2:00 p.m. His daughter and son-in-law are waiting to see him. Although he appears somewhat sleepy, Erik is mumbling to himself and gesturing with his hands. Neither his daughter nor his son-in- law can understand what he is saying. They try to visit with him briefly but finally leave, telling him to get some rest and they will return later. Erik dozes off, but when he awakes, the unusual behaviors seem to increase. Erik’s voice becomes louder. He then begins to appear very tense, grimacing and clenching his fists. When Jackie approaches him, he seems angry with her, and she is confused as to why. The nurse reports her concerns to her unit manager: “I’m not sure what’s going on with Erik, but I feel somewhat frightened of him.”
The correct answer is A. Rationale : Although all actions are needed, the priority is the safety of Erik and the staff. Getting other staff to the room to help calm Erik would most quickly accomplish that goal.
Self-Assessment Quiz Question 5
Which of the following would be the best response to Erik following his behavior? A) “You know this kind of behavior cannot be tolerated here.” B) “No one here is deserving of your violent actions.” C) “You seem to have lost control. We are going to help you calm down.” D) “Now why would you do something like that?” The correct answer is C. Rationale : Stating the facts about the situation first followed by letting Erik know the staff are there to help calm him will not come across as accusatory or belittling to Erik. Staff arrive on the scene ready to assist in restraining Erik. In the meantime, a Swedish-language interpreter has come to the unit. After the interpreter is introduced, Erik seems to calm down considerably.
Self-Assessment Quiz Question 3
What is the best action for the nurse manager to take at this time? A) Instruct Jackie to pass information on to the next shift regarding Erik’s behavior. B) Remind Jackie that she is expected to act independently, not rely on her supervisor. C) Go with Jackie to visit Erik and see if together they can figure out what is going on. D) Make sure that Jackie did nothing to anger Erik while caring for him. The correct answer is C. Rationale : This is a situation that needs attending to as soon as possible and it may take more than one person to handle it. Jackie and the nurse manager decide that they both will go to Erik’s room together to conduct a postoperative assessment. As they approach Erik’s bedside, he begins shouting, trying to pull out his intravenous line and catheter, and attempting to leap out of the bed. He picks up a water bottle that was on his over-the-bed tray and throws it at the unit manager. It hits her on the arm, stunning her but not hurting her.
Self-Assessment Quiz Question 6
The nurse manager asks the interpreter to convey to Erik which of the following? A) “You seem to be upset. Tell us what’s bothering you.” B) “Why are you behaving so poorly?” C) “What are you thinking? Throwing things is not allowed here.” D) Were you really trying to hurt someone?” The correct answer is A. Rationale : This approach provides Erik with an opportunity to tell the staff in his own words what is bothering him. The on-call healthcare practitioner responsible for Erik’s care arrives and, after reviewing the situation, orders medication to calm Erik. The interpreter tells Erik, in his own language, about the medication and why he is receiving it. Erik responds favorably to this and accepts the medication. A staff member is assigned to remain at Erik’s bedside until he falls asleep. Soft restraints are made available at the bedside in case they are needed. After this incident is under control, the unit manager, Jackie, and the other staff involved go to a conference room to review the episode. A plan is made to confer with the family about Erik’s reported “mood swings,” request a psychiatric evaluation, use Swedish-speaking personnel when available, and maintain close observation of the patient. Jackie asks the team why Erik behaved in this way.
Self-Assessment Quiz Question 4
Of the following, which is the best choice for the nurse man- ager to do first?
A) Initiate a call for help from the rest of the staff. B) Ask for an interpreter to be sent to the unit. C) Have someone call Erik’s surgeon. D) Call Erik’s family.
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