I was asked by staff in a nursing home to see a resident who has been transferred from the local hospital two weeks prior for long term care. He had diagnoses of vascular dementia. I asked to see the doctor and nursing notes and also obtain collateral from the staff. A patient called Joe Ross had been admitted post stroke, when he first arrived he was physically unwell but became agitated when approached by staff to care for his physical needs e. G. Washing and changing.
Unfortunately Joe became more violent and physically aggressive and injured a number of staff, which resulted in a member of staff having to go off sick. I went with a nurse to see Joe I was aware that tensions were high and the staff were keen to see him moved to a more secure environment. As I entered the day area the nurse immediately entered his personal space and tried to wake him, he hit out and swore but luckily we managed to avoid getting hit. When we moved away he settled back into his chair and closed his eyes. My feelings at the time was shock at how I allowed yeses walk into this situation unprepared.
I felt shaken as I didn’t expect the nurse to wake him so suddenly but I was annoyed with myself, as I should have taken charge of the situation and dealt with it more delicately. His symptoms indicated a delirium, which can be easily resolved once diagnosed. Irwin & Foreman (2006) states that nurse are key in improving delirium outcomes for patients. One of the key roles is communication with all team members Nurses, Doctors and all team members. The outcome was that I asked a doctor to Join me in the nursing home as I felt if this tuition were not resolved it would escalate further.
We again saw the patient in a quieter environment and he didn’t hit out but was abusive. People with dementia can communicate their views, wants and wishes Allentown M, Bryan K, (2007). He was diagnosed with a delirium and treated appropriately. I felt that the patient was frightened and in a strange place. He saw lots of uniforms and due to his stroke his cognition was affected and he was confused and disorientated. I explained to them that once he settled into the nursing home and that his delirium resolved he would e manageable.
Stokes (2010) states that challenging behavior is not simply a reaction to the actions of others but an expression of a person’s attempts to meet or communicate their personal, social and emotional needs. If I had to deal with this situation again I would have not allowed my actions be influenced by the staff. They were agitated by the situation, which had been escalated for over a week. I should have asked for the patient to be moved to a quieter area or moved the other patients away. I should have laid down ground rules e. G. NT enter his personal space, also it’s important that Joe knew we were there before touching him. It would have helped if I had taken the nurse aside after the incident to debrief and talk about her understanding of what happened. By doing this would have helped her empathic with the patient and would have learnt from it and felt more confident if an incident happened like this in the future. I feel the outcome would have been more positive if care maybe amenable to non-pharmacological strategies such as identifying some personal touches such as covering their private areas.
Kenton P, Anglia G, (2007) On reflection one positive aspect is that it was a learning experience for all involved and out of the incident good relations were developed between the two organizations. The nursing home requested training on challenging behaviors and behavioral and psychological symptoms of dementia. I discussed the case with my line manager and also the consultant psychiatrist on our team. I explained that I felt I could have managed the situation better but that I had learnt a lot from it.
My line manager said hat in situations like these there are no right and wrong answers. We don t know how he would have reacted even if we hadn’t entered his personal space. The consultant talked about previous experiences when patients hit out with no interference. He said that he always felt it was important to assess each patient individually. Patients react differently after any change in their physical or mental health. I discussed that I had offered training to the nursing home in view of this case. Both felt that this was a good idea and offered assistance if required.