Patient Kicked off

It was my first day doing response in the ward yesterday.

Firstly I think I'd explain what is "response"? Basically every single staff and visitor would carry an alarm whenever they are in the ward. And when emergency cases happen (e.g. patients trying to attack you, patients fighting, patients doing self harm etc), we would press the alarm. In every ward, there would be one staff who is doing response in every shift. They carry a radio, a bunch of keys and a pager. So when someone presses the alarm, it would first come on the pager, saying, for example XX ward, staff base (or games area, or dining room, or west corridor etc, wherever the emergency case takes place. and yes, the alarm would locate where the person who presses the alarm is).

My first ever experience doing response yesterday was in another ward down stairs, which is an acute ward. I was the first two arriving there, and saw a patient was kicking off, but was restraint by 2 female staff (which apparently was from that ward itself), so the male response team took over the restraint (we learnt this during the TAMVA course, see my previous post).

The patient was very very unstabled, apparently he was responding to external stimuli, asking "why are you doing this to me? come fight me! you coward! come fight me. you spoilt my life. i lost everyone in my life now. now! come fight me" etc etc. For 10 minutes, he was talking with another person who doesnt exist. Staff trying to calm him down, but he couldn't listen to any of us and just carried on shouting. He tried to hit his head, tried to kick (his hands were restraint, and at the end so were his legs) and refused any medications.

About 15 minutes later, he stopped. And I could see his hands really trembling, he asked, "what happened?" The staff said they would discuss it later, they want him to rest for a while first, and calm down first. He said "I'm really scared. What happened? What just happened? Did I hurt anyone? I'm really scared" Despite staff stating that he did not hurt anyone, apparently he was so worried and scared about what just happened, he had entirely no memory on what just happened, and his hands were really shaking. At this point, he took his medications, but still asking what just happened. We left his room after he took the medications.

I went back to my ward after that, about 3 hours later when I was on another response in the same ward, I saw him, and he looked really fine, calm and steady, pacing in the ward. (This second response was another patient refusing depot and got a bit aggressive).

I'm happy he wasn't sent into seclusion room. I guess one main reason was because their ward seclusion was occupied at the moment, if they wanted to send this patient to seclusion, it would have to be the seclusion in my ward.. and that would really keep my ward busy and more unsettled. But I'm happy not because of this reason, I think sending patients like this into seclusion room wouldn't help them, when you're in an total empty room, four walls, one mattress and nothing else, for 24 hours every day, that would just make their conditions worse. They would simply become more unsettled.

It's the first time I really noticed one patient actually kicked off, it was really a shock in me, especially when I saw how he trembled and scared not knowing what himself just did. and am glad how settled my ward patients are. Though it's good, that I start doing response and see what is happening in other wards.

When I went back to my ward, passed by my manager's office, he asked how it was and I told him what happened. He said "good stuff", I thought that was just his habit of saying it. But when I went back to office, they all asked me how it was. Haha, the charged nurse told me, Phil worried that I couldn't handle it, but she said I look like I could survive everything, and I'd proven her right. =)