A Mannequin in my Room!

[Davey Do]

I was charge nurse Saturday night and was walking down the hall in the wee hours of the morning to compliment an LPN on her charting when a patient, Dobbs, came out of his room and asked, "Why is there a mannequin in my room?!"

I replied, "There is no mannequin in your room". Dobbs then asked, "Well then, what's that?!" and pointed to the roommate, lying in bed. I said, "That's your roommate". Dobbs then said, "You'd better check on him. I think he's dead".

I did as requested, shining my little pocket flashlight on the roommate who said, "I'm okay".

I told Dobbs, "The patient is fine. You need to go back to bed". Dobbs became very animated, speaking rapidly and nonsensically, throwing circular punches in my direction. I said, "Dobbs, you need to stop this behavior because it's not safe". When Dobbs continued the behavior, I said, "Dobbs, stop his behavior or you'll need to deal with the ramifications of your actions". Dobbs continued to throw the circular punches and moved closer to me. I got Dobbs in a therapeutic hold and loudly said, "Call a Code Green!"

The LPN working the floor answered "Okay!" and was back in a matter of seconds to assist .

We escorted Dobbs into the Quiet Room and several staff arrived within a few minutes. I talked to Dobbs, giving the reason for the therapeutic hold, focusing on safety, and said that the intervention would be increased or decreased, in accordance to the responses received.

Dobbs had had 50mg of scheduled Seroquel at HS and could have 10mg of Zyprexa PRN. A choice was given to administer it IM or PO. Dobbs consented to take the Zyprexa PO.

Dobbs sat on the floor of the Quiet Room, took the Zyprexa, and I asked questions to ascertain a perception of reality. As Dobbs calmed and was behaving relatively appropriately, the other staff members slowly left the Quiet Room.

By the end of our discourse, Dobbs was able to relate the reason, with relative accuracy, for his admission, the events that led to this intervention, and the criteria to leave.

Dobbs had been brought into the ER after visiting a relative in a LTC facility, informing the staff that, as an inspector, he would close down the facility. The Police were summoned and Dobbs informed them of his Super Hero status and that he lived in a Yellow Submarine. He became agitated and the Police brought him in to our ER.

Dobbs was furnished a pillow and cover and choose to sleep in the Quiet Room that night on a mat. In the morning, as I was leaving, Dobbs stood at the Quiet Room door and asked to be allowed into the general population. Dodds assured me staff's directions would be followed, was allowed to leave the Quiet Room, and the oncoming charge nurse was informed.

Just sharing an experience.

[adventure_rn, MSN, NP]

Strong work de-escalating the situation. I have so much respect for psych nurses! It's pretty remarkable to see the delusions that people's brains can construct.

[nursel56]

I even felt calmer after I read through that, Davey. ? I imagine in psych nursing you can't always expect to have outcomes such as this one with you, your staff and Dobbs, it's heartening when it does.

[Davey Do]

1 hour ago, adventure_rn said:

Strong work de-escalating the situation. I have so much respect for psych nurses!

Thank you, adventure_RN, and back atcha for the respect. Seeing medical nurses in action in a intense situation has me feeling a tremendous amount of appreciation!

It all comes down to experience and technique- fathoming the variables and acting accordingly, right?

Plus, trying not to let our emotions get in the way.

[Davey Do]

52 minutes ago, nursel56 said:

I even felt calmer after I read through that, Davey. ?

It is good to hear from you nursel56, and if you're ever in need of de-escalation, I hope you'll think of me!

52 minutes ago, nursel56 said:

I imagine in psych nursing you can't always expect to have outcomes such as this one with you, your staff and Dobbs, it's heartening when it does.

Having good backup can make or break a situation. From the LPN who was there to call the code and assist me with Dobbs, to the security guards who stood silently and strongly by, to Jason Hiney who ran to the unit and called Dr. Dadda to get orders, the situation was almost picture perfect.

It's also heartening when these situations are consistently handled well. Friday night, I was pulled to the men's psych unit and worked under a quality charge nurse and staff there.

One patient was starting to go off, but consented to take his HS meds which included Haldol 10mg. He still went off and needed to be restrained both mechanically and chemically.

In that situation, the Techs and charge RN handled everything. All my job was to do was to inject 2mg of Ativan into his gluteal muscle!

A lot went on this weekend, and it feels good to process it with my allnurses friends!

[sirI, MSN, APRN, NP]

6 hours ago, Davey Do said:

I was charge nurse Saturday night and was walking down the hall in the wee hours of the morning to compliment an LPN on her charting when a patient, Dobbs, came out of his room and asked, "Why is there a mannequin in my room?!"

I replied, "There is no mannequin in your room". Dobbs then asked, "Well then, what's that?!" and pointed to the roommate, lying in bed. I said, "That's your roommate". Dobbs then said, "You'd better check on him. I think he's dead".

I did as requested, shining my little pocket flashlight on the roommate who said, "I'm okay".

I told Dobbs, "The patient is fine. You need to go back to bed". Dobbs became very animated, speaking rapidly and nonsensically, throwing circular punches in my direction. I said, "Dobbs, you need to stop this behavior because it's not safe". When Dobbs continued the behavior, I said, "Dobbs, stop his behavior or you'll need to deal with the ramifications of your actions". Dobbs continued to throw the circular punches and moved closer to me. I got Dobbs in a therapeutic hold and loudly said, "Call a Code Green!"

The LPN working the floor answered "Okay!" and was back in a matter of seconds to assist .

We escorted Dobbs into the Quiet Room and several staff arrived within a few minutes. I talked to Dobbs, giving the reason for the therapeutic hold, focusing on safety, and said that the intervention would be increased or decreased, in accordance to the responses received.

Dobbs had had 50mg of scheduled Seroquel at HS and could have 10mg of Zyprexa PRN. A choice was given to administer it IM or PO. Dobbs consented to take the Zyprexa PO.

Dobbs sat on the floor of the Quiet Room, took the Zyprexa, and I asked questions to ascertain a perception of reality. As Dobbs calmed and was behaving relatively appropriately, the other staff members slowly left the Quiet Room.

By the end of our discourse, Dobbs was able to relate the reason, with relative accuracy, for his admission, the events that led to this intervention, and the criteria to leave.

Dobbs had been brought into the ER after visiting a relative in a LTC facility, informing the staff that, as an inspector, he would close down the facility. The Police were summoned and Dobbs informed them of his Super Hero status and that he lived in a Yellow Submarine. He became agitated and the Police brought him in to our ER.

Dobbs was furnished a pillow and cover and choose to sleep in the Quiet Room that night on a mat. In the morning, as I was leaving, Dobbs stood at the Quiet Room door and asked to be allowed into the general population. Dodds assured me staff's directions would be followed, was allowed to leave the Quiet Room, and the oncoming charge nurse was informed.

Just sharing an experience.

Most EXCELLENT! ?

[Hoosier_RN, MSN]

@Davey Doyou are a gem among the stones! Your pts may not deal in reality, but your calm guidance keeps them, and staff, safe.

[tnbutterfly - Mary, BSN]

Davey...GREAT job! Thanks for sharing. I hope you'll share more of your experiences.

[Daisy4RN]

Having a good team always helps, I have worked with good ones and bad ones. Either way, you do seem to be able to keep a calm head and demeanor in those situations, not a small feat for anyone and especially with your past history (that you have shared here).

Sounds like another "extraordinary" job well done!!

[Davey Do]

17 hours ago, Davey Do said:

I was charge nurse Saturday night and was walking down the hall in the wee hours of the morning to compliment an LPN on her charting when a patient, Dobbs, came out of his room and asked, "Why is there a mannequin in my room?!"

Thank you, sirI, Hoosier, Mary, Daisy for the compliments and kind words.

Knowing we do a good job is one way pursuing peace and being happy with ourselves, but it sure is satisfying to be acknowledged by respected members!

Thanks again!

[Kooky Korky, BSN, RN]

It's great when everything goes as it should. I recall one incident in which everyone did his or her part. It was, as we used to say, just like downtown. It was so cool!!

[Davey Do]

On 2/11/2020 at 8:47 AM, tnbutterfly - Mary said:

I hope you'll share more of your experiences.

Thank you for that seque, Mary. I believe I shall:

I worked last night with Jason Hiney, RN with whom I think highly. We had an elderly female patient with dementia who believed, and proclaimed, "You're all out to kill me!"

Jason, who is intelligent, caring, cute and charming attempted to supportively reassure this patient in his gentle, kind way. Yet this patient continued to exemplify the fact that a delusion is a false, fixed belief in spite of evidence to the contrary.

Jason discussed his concern and tentative solution with me: "This patient believes everyone is out to kill her and she says she will kill anybody who tries to kill her. She is a threat of harm, so she meets criteria for a chemical restraint, and my charting will show that."

I agreed, yes, that in theory, she did meet criteria for a chemical restraint. However, no other patient was approaching her and she was not at all acting out or being physically aggressive. Sometimes these situations are transient and perhaps the mere attempt to administer a chemical restraint may drive her over the edge and cause the solution to become a problem.

I told Jason that I would support whatever decision he made, however, I told him that I would handle the situation differently. I had spoken to the patient before, informed her she had HS meds, and that her safety was our priority and no harm would come to her. She did not believe me and said that I was trying to poison her. I planned to repeat the same safety scenario everytime I came in contact with her and as long as she made no move toward physical aggression, I would do nothing more.

Later, as Jason and I sat in the nurses station charting, the patient came to the window near me and tapped on it. I went to her and she said, "I'll take my meds now".

The patient slept through the night, even though it was on the couch in the small, open day room across from the nurses station.

After the patient took her meds, Jason called me a name. But it was a good one.