Dealing with Combative Patients

by Howard Gerber on December 7, 2017

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combative patient
As a nurse, you probably deal with all types of patients. Unfortunately, not all patients are easy to work with. Occasionally, patients become out of control. Sometimes patients don’t want help or even become aggressive.

It’s best to de-escalate a situation before it becomes physical, but that’s not always possible. Despite your best intentions, some patients may become combative. Depending on where you work, dealing with combative patients may come with the territory. Understanding how to efficiently deal with an aggressive patient helps keep both you and the patient safe.

Understand the Underlying Cause

Patients may be combative for a variety of reasons. Certain medical conditions, such as a stroke, head injury, and dementia, can lead to personality changes, including anger. Medication side effects can also affect people differently, including combative behavior.

Understanding the possible underlying cause of combative behavior can be useful to provide a solution. If medication may be causing unwanted side effects, changing meds or switching to a lower dose may decrease aggression. Also, understanding the cause may help you avoid taking things personally.

Although it can be challenging, there are strategies, that can help nurses and physicians work effectively with aggressive patients.  Remember, there is not a one size fits all approach to handing combative patients, but there are some common tips to help you feel prepared.

Remain Calm

When a patient is becoming hostile and aggressive, it can be difficult to remain calm. Taking your irritation out on the patient only makes the situation worse. In many cases, patients are not intentionally disruptive. They are often combative due to a cognitive impairment, neurological problem, or psychiatric issue.

Remaining calm helps you keep the situation from becoming worse. Remember, once a patient is already combative, your main job is to keep the patient from hurting anyone including themselves. If you remain calm, you’re more likely to defuse the situation before anyone gets hurt.

Call for Help

If a patient becomes physically combative, call for help immediately. Hospitals have security in place to respond to aggressive patients. Follow your facilities protocols for getting assistance with combative patients. Hospitals often have a “code gray” system in place to call for assistance with a combative patient. In other cases, you may call security directly. Ideally, you should seek assistance before the situation becomes physical. As you see a patient’s behavior escalating and becoming more threatening, get help. Watch for signs your patient is become aggressive, such as pacing, clenched fists, and a change in tone.

Keep Personal Safety in Mind

Patients exhibit combative behavior in different ways. Some patients may become verbally abusive. Others may kick, punch, or spit. Keeping your safety in mind is essential. Put some distance between yourself and the patient. Don’t allow yourself to become cornered in the room. Stay close to the door and don’t turn your back to the patient. In some cases, restraints may need to be used on the patient for their safety. Follow hospital policies regarding placing restraints.

Do you have a suggestion or tip that has helped you in the past deal with a combative patient? Share with us in the comment section below!

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