Use all of your senses to assess ED patients
The way you assess a patient for violence can prevent assaults from occurring, according to Dianne Rallis-Peterson, RN, CEN, charge nurse for the ED at Community Medical Center in Missoula, MT. "Nurses need to use all of their senses when assessing a patient," she stresses. She recommends using your senses to answer the following questions:
• Smell. Is there a scent of alcohol, ketones, or marijuana? "Any of these scents can be a harbinger of violence," says Rallis-Peterson.
• Sight. Does the patient appear rigid or agitated? Does he or she seem depressed? What is the color of the skin (cyanotic, pale, etc.)? Is there evidence of recent needle tracks? Is there evidence of previous head injury such as scars or deformity of the head? Is his or her hygiene indicative of neglect?
• Sound. What is the tone of voice like? Is the person verbally abusive? Is there hostility in his or her voice, or does his or her voice sound menacing? Are they speaking in monotones? A monotone voice, coupled with lack of eye contact and "flat" facial expression, might indicate depression or drug abuse, says Rallis-Peterson.
"You may get a feeling that something isn’t right with this person, just as if you were glared at by the patient," she says. "That makes you a little more alert for possible psychological problems."
• Touch. Is his or her skin cold and clammy, as in an insulin reaction? Or is it hot and dry, indicating a high fever?
• Intuition. How does this person make me feel? "I am aware of the hairs on the back of neck standing up when something isn’t right about a person," says Rallis-Peterson. "You may begin to feel antsy around the patient or become hyperalert."
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