1. Salladay, Susan A. RN, PhD

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One of my patients yells when her call light isn't answered instantly and terrorizes the interns. Today she screamed at the respiratory therapist and threw a cup against the wall. Her roommate is upset and nurses try to steer clear of her. Is this an ethical issue?-A.B., WIS.


I think it's always an ethical issue if one person's actions are damaging to others.

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Several factors may explain your patient's behavior. Maybe she has a history of psychiatric problems. Or she may be fearful and respond angrily under stress.


Whatever the reason, the safety of staff and other patients must be your first concern. Take these steps:


* File adverse event reports for any disruptive behavior you witness, according to facility policy.


* Inform your nurse-manager about the problem and ask her to help. She can handle administrative details, such as finding a private room for the patient so her roommate isn't unfairly subjected to her behavior.


* Also inform the patient's health care provider about the patient's behavior. He needs to evaluate her to rule out or treat any physiologic reasons for the behavior. He should also call for a psychiatric consult if indicated.


* Encourage her to talk about her feelings. Ask about people she feels most comfortable talking with, such as a relative or spiritual confidant. Ask if she'd like to speak with the hospital chaplain.


* Without violating patient confidentiality, visit with her family or friends, if possible, to understand how she usually handles her emotions.



Don't be tempted to avoid this patient. She's entitled to the same high-quality nursing care as any patient. By consistently reassuring her that you care about her well-being, you not only demonstrate your professionalism, but you also help ease her anxiety and encourage her to modify her behavior.