OUTBURST

I did make an attempt to train my older sister, soccer mom, at Mystic Bay Azlheimers Unit. The training started out well; she came on time and was looking forward to learning all about my patients, their special needs and all their medications. The training was going as planned until we get this frightful call from a nursing assistant on the North wing. “help! Come quick! Mr. Brown has a long handled dust pan and is swinging at everyone.”

It always amazes me that nursing assistants look up to me like I’m a person that can handle any situation that may come my way. Fires, toilets over flowing, death, and altercations of all kinds. I am small built: five feet & four inches and 106 pounds, but they think I’am some kind of a wonder nurse.

Soccer Mom and I went to the wing to intervene. On the way to the wing, my sister and I were talking about how we would handle aggressive patients who were locked up at the state hospital. We would get on the red phone and call for a “”show of force” this call would go to all wings on the adult units. In a matter of seconds there would be about 15 to 20 people on your ward to help you with the aggressive, phycotic patient. The person was taken to the ground and then restraint to a bed or chair. Five point restraint: arms, legs and waist.

I reminded my sister that Mystic Bay Alzheirms Unit is a “restraint free facility” Patients are not even allowed to have bed rails. We would need to use our coping and strategy skills to deescalate Mr Brown. We get to the unit and had the nursing assistants take the other patients away from the day area where Mr Brown was swinging the dust pan. I had a male nursing assistant step back from Mr Brown. Mr Brown was calling him a fat pig. I could see that most of his agression was directed to this nursing assistant. I also noted that Mr Brown was highly delusional and paronoid. Note to self: he obviously needs a med adjustmenet. My sister and I tried to calm him down by using deversion techniques. Like “Mr Brown did you know that your family is coming by for a visit today”. This didn’t work, he was to paronoid. My next plan was to take him to a quiet place to reduce his stimuli. My sister and I tried to walk him to his room. Mr Brown was adament about staying put and he continued to swing the dust pan. I tried to get the dust pan out of his hand but his grip was a death grip. Mr Brown then grabbed my key chain that was around my neck and started to choke me. Big sister –to the rescue! She took the key chain off my neck. By this time, the male nursing assistant was assisting us with Mr Brown. We managed to take him to his room for quiet time and shut the door. Yikes!

I immediately called his family and highly suggested that they come to the facility as soon as possible, I also called my nursing manager at home and gave her all the details of my exciting morning. she suggested that I try and get a psych evaluation done.

My sister and I we are quite the team. I told her over and over again that this was a very rare occasion. Mr Brown is usally a sweetheart. “Please don’t quit!” She is a tough cookie. She didn’t get very much training. After the incident we had an hour of paperwork to do, plus we were about an hour behind on our medication pass.

Mr Brown’s family came within the hour. Of course, by this time, Mr Brown was a sweetheart again. I still directed his family to take him to the ER and have him medically and psychologically evaluated. Many, many hours later. He came back to to the facility with no new orders. No UTI, Digoxin level was good, no impaction, no difficulties with his congestive heart failure. He was in stable conditon. I did call his doctor and asked for an increase in his Risperdal. The doctor was generous and double his dose of the antipsychotic med.