I’m currently on my musculo inpatients prac and have come across a potentially violent patient. Both myself and another physio student saw this patient together, the patient initially required some convincing to come to physio but did agree. She appeared to me to be a bit short and sharp in her communication but she was not unpleasant. We took her for a walk and whilst walking she began to be quite distressed about something which was unrelated and wanted to go home. The supervising physiotherapist tried to explain to the patient that she was not ready to go home just yet and that she needed to do more work in physio before she could go home. This was when the patient became threatening and the situation was quite tense, the physio stood back from the patient and it was decided that she could go back to her room which she was happy to do.
This was the first time I’ve been involved in a situation like this and it could have potentially been a lot worse. I didn’t feel unsafe however as the patients anger was not directed towards me or the other physiotherapy student, but it does make me think about how I would deal with a situation where a patient was potentially violent. I think that first and foremost we need to protect ourselves and make sure that we don’t place ourselves in a situation where we get backed into a corner or are left alone with the patient. Sometimes patients anger can be due to misunderstandings in which case it may be appropriate to try to reason with the patient and explain the situation, but in other cases the patient may be irrationally angry whether it be due to a mental illness or post-op confusion. Talking to the family can be quite helpful in finding out whether this is normal behaviour for the patient and what the best way to deal with it might be.
In this particular scenario, it was quite easy for the physiotherapist to back away slightly as both myself and the other student were still there to make sure that the patient did not fall and her anger was not directed towards us so I don’t feel that we were in danger, I would have acted in the same way. If the situation was different and you were treating the patient on your own, as I said above you need to consider your safety first and step back to a safe distance or place yourself in a position where you’re not in the patient’s firing line, chances are that if they’re going to lash out there’s not going to be much you can do to stop them from falling anyway. Ultimately, you have to deal with each situation as it comes to hand as every patient’s different and whether you choose to reason with the patient, call for help or step away from the situation, it’s a decision you have to make at the time.
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That must have been a really intimidating situation! Since it's not something that happens a lot we haven't been told how to deal with it but we should because as students/new grads we need to know what we can do to protect both ourselves and the patient, especially if we are on our own! I think it would be really helpful if they gave us an indication of when it is acceptable to step back from a patient. This could be something they include in the Y2 stuff with Penny, ways to cope with anger/threats and how to recognise when you need to call for help. I think you and your supervisor handled the situation the best you could, and raised an important issue.
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