'Difficult Patient': A Reflective Essay

called the security team to put them on standby. Patient 1 had gotten up and left the room without my knowledge while I was still with patient 2. This was the perfect time to move patient 2 out of the room. Another nurse and I positioned the patient to move her out of the room and to safety. We did this successfully without patient 1’s knowledge, and patient 2 was placed in a private room on the other side of the unit. During that time, the other healthcare providers who had come to assist us found patient 1’s Facebook account and confirmed that the patient did, in fact, “go-live” on Facebook. After watching the many live sessions, we were led to believe that this patient was on the verge of a psychotic episode. The staff that gathered to help ended up calling the medical physician that was on duty and in the hospital. It was important to ethically and legally decide what to do with this patient because of her behavior toward the staff and patient 2. The incident occurred during the off-shift, and most physicians and higher administration were not on-site. The patient needed to be evaluated by a psychiatric physician, but there wasn’t one on call that night. We had to call and wake the administrator on call. The patient had not become violent, which made things more difficult because we have standard protocols for violent or physically abusive patients. The physician assessed the patient and confirmed that she was unable to logically and safely understand her medical condition. The patient disagreed with the physician’s diagnosis and became belligerent. She began to hurl degrading insults at every staff member that was present in her room. For whatever reason, she became most upset with me, and began to threaten me and other staff members on the unit. Our hospital had recently initiated a “code violet” protocol for threatening or violent patients. Once the patient voiced that she wanted to kill me, a code violet was called overhead, and the patient was immediately pink-slipped. When a code violet is called, a team of care providers responds to the location of the escalated patient or family member. Once the team arrives, the situation is assessed and a decision is made on how to handle the occurrence. In this case, the patient was considered homicidal, so the patient’s belongings were confiscated, which sent the patient into a state of hysteria. She became combative and had to be put in restraints. Both arms and legs were restrained. She was given a sedative, and was transferred to the psychiatric unit. While going through the patient’s belongings, I found a very large butcher’s knife in the patient’s purse. There were so many different emotions that flooded my mind and body. It is horrifying to think that the patient had that weapon in her possession the entire time. Somehow it had gotten through the metal detectors and security despite hospital protocol. This experience was grueling because it challenged me to use years of experience, a combination of tactics, learned techniques, and an unnatural amount of patience. The outcome could have been worse for any of the people involved. Someone could have been seriously hurt or even killed. I am thankful that everyone worked together in this case and the outcome was favorable on our part. In healthcare, we constantly put ourselves at risk with the different types of patients we take care of. It is a difficult task, but in order to fulfill our commitment, we must effectively take care of those in need.