Running head: REFLECTION 1

Patients Verbal Violence

Abeer Manea 10138483

University of Calgary in Qatar

NURS 406

Nicole Boulais-McBain

October, 8, 2017
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Patients Verbal Violence

As nursing students, we have learned throughout the past four years of nursing, how to

identify areas that need improvements. Reflections have been the key role in addressing my

concerns as a student and find solutions that facilitate my job to provide holistic care. Therefore,

I used Gibbs model to write my reflection to organize my thoughts and concerns.

Description

Last week, I was taking care of an 87 years old male patient with heart failure. In the

morning, I performed my morning care with the assigned nurse for all of her three patients. All

of the patients were cooperative and interactive with me as a nursing student. However, one of

the patients was really mad at me and at the nurse as well. I could not understand why he was

mad. Whenever I try to touch him he starts screaming and says out loud Go away. He is Qatari

so it was a lot easier to communicate with him unlike the nurse who does not understand what he

was saying. After I performed my head-to-toe assessments for other patients, he was the only one

remaining. I decided to go in and talk to him and try to convince him that what I am doing is in

his favor. I opened the door and smiled but he was staring at me. I said How are you doing

today? he replied, Good. Then I started talking about doing head-to-toe assessment.

Suddenly he was extremely mad and he was yelling at me. I tried to calm him down, but he was

not responding so I apologized and left the room. One hour later, I decided to talk again with

him. I went again and fortunately I found his son with him. I started talking about the importance

of measuring his vital signs, blood glucose, and performing head-to-toe assessment before the

doctors rounds. His son was cooperative and welling to help me start my work, but his father

was not cooperating at all. Then I asked him why he is refusing the assessment. Then he said

because you are a female. His son was laughing and said Dad she is doing her job and she is a
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Qatari nurse with the best qualifications. I said No I am not Qatari I am Yamani. The patient

looked at his son and pushed him away. He offended his son so badly and he told him why you

are lying to me? The son said She looked Qatari so I assumed that she is then he looked to me

and said Did I ask you before about your nationality I said No, you did not. Then the father

was relieved. He told me if you would like to do anything to me, wear gloves. I took his vital

signs, electrocardiogram (ECG), and blood glucose while I am wearing gloves. At some points

the patient was annoyed, but I tried to perform my assessments as fast as I could.

Feelings

I felt very scared in the beginning when the patient was screaming. I thought I did

something wrong. Additionally, I felt disappointed when I left the patients room the first time

without doing anything. Therefore, I decided to go back and try. I was mad at myself because I

did not question why the patient was annoyed when I touch him. I was not thinking a lot about

the reason but I was focusing on doing my assessments. I believe because I have not been in a

cardiac unit before; I was scared to deal with patients with cardiac conditions. Later on, when the

patient verbalized why he was rejecting my help, I found the situation upsetting to witness

because as a nurse I have to look the whole picture.

Evaluation

My role as a nursing student was to perform my initial assessment and save all

information to the system. I was able to do that for two patients but for the last one it was

challenging. In a study done in Taiwanese nursing students to explore the barriers to

communicate with patients and families, the results revealed that one of the reasons was patients

or families rejection for the student nurse (Lin et al., 2017). In my case, I was rejected by the

patient; therefore, I walked away because I was hesitant and self-conscious to start therapeutic
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communication with the patient. As stated in Lin et al., (2017), students tend to leave patients

rooms when they struggle to overcome barriers and develop strategies to enhance

communication. That exactly what I did, I reach a point where I cannot move forward with the

patient; therefore, I walked away. Another barrier to develop an effective communication was

the patient culture. According to Arungwa (2014), culture and language were the main barriers to

develop nurse-patient relationship. The patient and I came from the same culture and we share

the same values and beliefs. When I read his name it did not think that he is going to be strict to

as healthcare provider. Later, when he disclosed the reason why he does not want me or the

nurse, I understood his point of view.

Analysis

What I did in the beginning might be the right thing to do, because at that point I was

unable to communicate with the patient when he was angry. A study showed that young female

nurses are more vulnerable to verbal violence more than male nurses (Ramacciati, Ceccagnoli, &

Addey, 2015). The patient was calling me with really bad words, I could not even respond

because I would be the one who will be blamed if he complained. I could not imagine how I

controlled myself by leaving the room. I am a very aggressive person and become angry easily,

but I believed being a nursing student for the past four years changed a lot of things inside of me.

What I felt after leaving the patients room was shock, confusion, and I did not tell anybody

about it. The literature showed that after any serious incidence nurses tend to deny the situation

because of the embarrassment (Ramacciati, Ceccagnoli, & Addey, 2015). I admit that I was little

bit embarrassed to share what happen because I have never been in a situation like that before.

In those kinds of situations, I have to work on my coping skills to overcome patients

aggressions. The study showed that ineffective coping skills will impede the engagement of
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patients in care (Ramacciati, Ceccagnoli, & Addey, 2015). One of things that I felt when I was

taking care of the patient was unsupported. I was there alone, the nurse was on her break and

there was no family member available. According to Ramacciati, Ceccagnoli, and Addey, (2015)

studies have shown that nurses who have been attack verbally by patients were felt unsupported

and feeling vulnerable. I totally felt like that because there was no one beside me, no one

defended me, so going back to him again required a great courage of me.

Conclusion

It was a difficult experience for me as a nursing student. But from another perceptive, I

learned a lot about those kinds of patients who tend to resolve things by yelling and screaming. I

would prepare myself from now on to expect different patients with different attitudes. I believe

if expected that reaction from the patient I would be able to take responsibility from the first time

I met him instead going and coming back several times. In addition, I learned the importance of

acting within a time limit in order to avoid further problems. When the son told his father that I

am Qatari and I said No the patient thought that we were laying to him, but we acted

immediately, and we clarified that his son have not asked me before.

Action plan

If this situation would happen to me again I would act differently. First, I would rather

have someone else with me to go and assess the patient. Secondly, I would tell the patient that I

am not going to touch him without his permission so he can feel safe and secure. Thirdly, I

would rather have a conversation with the patients son to understand the patients concerns and

fears of having a female nurse. Based on the information that I would be told I might seek help

from others. Fourthly, we learned that patients have the right to choose what they believe will

make them better. In this case, the patient told me that he would be happy if he has a male nurse.
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Unfortunately, I could not talk with the head nurse to consider the patient preference, but if it

would happen again I would advocate for that.

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References

Arungwa, O. T. (2014). Effect of communication on nurse-patient relationship in national

orthopedic hospital, IGBOBI, LAGOS. West African Journal of Nursing, 25(2), 37-49.

Lin, M., Hsu, W., Huang, M., Su, Y., Crawford, P., & Tang, C. (2017). 'I couldn't even talk to

the patient': Barriers to communicating with cancer patients as perceived by nursing

students. European Journal of Cancer Care, 26(4), n/a. doi:10.1111/ecc.12648

Ramacciati, N., Ceccagnoli, A., & Addey, B. (2015). Violence against nurses in the triage area:

An Italian qualitative study. International Emergency Nursing, 23(4), 274-280.