I worked for a time on an in-patient hematology-oncology unit with an amazing group of nurses. They were smart, compassionate, tender, funny, and they could handle anything, and I do mean anything that came their way. They were wonderful with chemo administration, managing side effects, pain management, patient education and support, but they were also terrific when it came to working in creative ways with challenging patients.
The young man in purple underwear was just such a challenge. He was 24 years old and alone. He had no permanent residence but stayed with "friends" for days or weeks at a time until he was asked to move on. He worked as a cage dancer in a night club -- dancing alone in a cage suspended high above the floor, wearing next to nothing, creating "atmosphere" for the patrons. He was clever, fit, and often outrageously suggestive.
More than once, his doctor and I were sent to discuss his inappropriate behavior with him, and I believe that he tried, but he simply didn't have another way of relating, so the inappropriate behavior never completely disappeared. The team strategized ways to make it more manageable: Only the nurses who felt comfortable dealing with his sexual advances and innuendos cared for him; everyone gently, but firmly redirected him to his room when he wasn't properly dressed; we all turned him down when he asked us out -- and when he asked, as he inevitably did when discharge rolled around, if he could move in "for a while."
Despite our efforts to set limits however, he proudly emerged from his room one day sporting sparkly purple underwear, his IV pole, and nothing else. He stood in front of his door, casually leaning against the wall in a "come-hither" pose. The first nurse to spot him headed down the hallway to "redirect" him to his room for a hospital gown but when she arrived he promptly unsnapped the front of his sparkling underpants to reveal himself completely, saying, "Cool, right?! A drop panel…"
Back in the nurse's station, the discussion was complex. There was great empathy for the nurse, of course, but also for this young man, who was so clearly alone, lonely, and personality disordered. Still, this type of behavior couldn't continue. So, one of the senior nurses decided to put an end to it once and for all.
She headed down the hall to where he was standing, the panel snapped and ready for more drop action. She said hello and waited for his move. He dropped the front panel dramatically and she took a slow step back, looked him up and down and, shrugging her shoulders slightly, said, "Yeah, I've seen better…" before calmly walking away.
There were so many different ways that this could have been handled, but this nurse's great intuition in sensing that what would be most helpful in terms of putting an end to the behavior was not calling in some authority to scold or threaten, but to deal with him in his own language and style, to speak to him in a way that made him feel connected, was just brilliant.
He laughed as she walked away, then went inside and got his hospital gown. We never saw that purple underwear again. He desperately needed someone to understand that what he was doing was not meant to be upsetting or insulting, but funny and engaging, and this nurse, with her quick response, managed to let him know that she "got it" while simultaneously letting him know that the joke was over.
I'm wondering what kinds of challenging patient interactions you've had and how you've worked through them on your teams.