The other day at my ortho inpatients placement there was an incident that made me think about a couple of things. The first was personal safety and the second was whether we're doing the right thing by not allowing people to leave hospital if we don't think they are safe.
The incident involved a patient on theward who desparately wanted to go home. The patient had sustained a head injury but was independent and could walk around without any walking aids. I don't know the exact reason why this patient wasn't allowed to leave as he wasn't my patient, but i assume that the staff involved did not believe that he would be safe to go home or thathe didn't have a safe home to go to. Anyway after one of many loud attempts at convincing the nurses at the nursing station to allow him to leave the patient began to throw files off the desk. When his watcher (this patient had to have some one watching him in his room to prevent him from wandering) tried to stop him the patient swung out at the watcher. He then picked up a large metal drip stand and tried to hit the watcher with it. After chasing his watcher away he substituted the drip stand for a portable O2 tank stand and began hitting the walls with it and chasing anyone who came close to him. His aggression was not directed at anyone in particular but he seemed to pick people at random to chase after. A code black was called as soon as the man had thrown the first file but it took about 20 minutes for security to arrive. Once security arrived the man seemed to calm down and the security guardxs were able to subdue him quickly and without much more fuss.
The first thing that occurred to me following the incident was how strange it was to feel like my safety was threatened while i was at work. I will admit that in my younger years i was involved in quite a few brawls and never really gave it much thought, but the difference is that previously i have never expected anything like this incident to happen while i was at clinic. I've seen all the posters that discourage violence towards staff but always thought it was to protect the smaller nurses and didn't really think that a patient in an inpatients ward could pose much threat. It had never occurred to me that a patient might try to use a weapon capable of inflicting serious injury.
After i got over the initial excitement of the incident i began to feel extremely sorry for the patient involved. I personally don't enjoy being in hospitals and would hate to have to live in one.
Other factors that would have compounded the issue were the fact that the patient was a smoker and was being denied access to ouutside areas to smoke, and the fact that i never once heard anyone explain to the patient why he was being kept there despite the patient constantly asking the nurses why they wouldn't let him go home. From the perspective of the patient it must have literally felt like he was being kept prisoner for no reason. I assume that the patients head injury must have lead the staff to believe that he was not mentally fit to make his own decisions, as surely the final decision to stay or go would otherwise lie in the patients hands.
I found this incident quite disturbing, as to me the patient didn't seem to be mentally impaired and yet the medical staff clearly weren't allowing him to make his own decisions. Even if this man had been to confused to make his own decisions i can think of other incidents where medical staff have bullied patients into staying at the hospital when they are desperate to leave.
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2 comments:
I felt the same way when I was on my neuro placement on a rehab ward. It was a locked ward where people could enter the ward as they wished but to leave, you had to enter a code on the door to unlock it, and only staff and selected family members could know the code. At the start of my prac, I thought this was a crazy idea because as you mention, it was like the patients were being kept prisoners. But by the end of my prac I realised it was for a very good reason, because quite a few patients attempted to leave without permission and it was often the patients who were physically normal but their cognition was way gone despite appearing normal. During my time on that ward, there were at least 3 incidents where patients jumped the fence (the ward has its own outdoor garden area) and escaped, before security caught them.
So I suppose it's important to remember that when dealing with head injured patients, looks can be very deceiving!
i had a similiar incident with a patient when i was on neuro inpatients where the patient would frequently abuse other staff not physically but verbally. He would hang around the nurses station and abuse staff members that were writing notes. Although he had a guard there wasnt anything we could do to stop him. Code blacks would be called don a daily basis and those who were inpatients on the ward became accustomed to the yelling.
The staff and other patients put up with the patients behaviour because they could understand his frustration. he was allowed to continue to behave in that manner
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