I'm an RN Case Manager and I follow a number of patients at an assisted living facility who all have dementia. One was a 72 year old man with temporal- frontal lobe dementia with combative behaviors. Unfortunately he had a psychotic break and became violent. I cleared the room and eventually he allowed me to take his hands. I spoke calmly and quietly to him and he relaxed his body and affect. I was slowly leading hin to a sofa to sit down. We were almost there when he tackled me to the ground and started to kick and punch me. He is not a frail man,actually quite strong.
We ended up having to call 911. It took 3 police officers and three EMTs to get him on the stretcher. He was sent to the ER for evaluation and geri-psych placement. Needless to say I'm a little shaken up. I may have to have surgery on my shoulder as the one I landed on has a hemi-arhtroplasty now with pain and 0 range of motion.
I keep going over it in my head. What did I do wrong? I though I had him de-escalated. We discharged him as he is moving out of area for treatment. He is going to come back to our area after a few weeks in geri-psych. We will probably re-evaluate him for re-admission. I requested that if we do re-admit him that I not be his case manager. I'm frankly afraid of him and I think that would interfere with the nursing care I could provide him. Was that an unreasonable request? I already have a good relationship with his wife(HCP)
Dec 18, '14
You did everything you could, an unpredictable resident like that could kill a staff member or peer.He belongs in an LTC dementia unit or a dementia care facility.He is not going to be appropriate for AL much longer and I doubt he is appropriate for it now but I bet he has the money,the admin will try to keep him until he is broke.
Your request is also appropriate,we have moved residents to other floors due to this type of conflict between the charge RN and an elderly male Alzheimer's resident.He grabbed her by the throat and almost picked her up off of the floor-staff were able to intervene before she lost consciousness. It was felt her fear could trigger him further so he was moved,his family was fine with it.
Dec 24, '14
Oh my gosh, I'm so sorry to hear that this happened to you. I get what you're saying about whether you will be able to care for him the way you'd want to, should he be re-admitted to your facility. The worst that happened to me was that I was punched in the face by a former bouncer - shook me up for the rest of the day mostly because I didn't expect it, but this doesn't compare at all to what your experience was.
Dementia is so difficult because as you said, he was physically strong. I don't know what's the proper and safe way to provide care for such patients. Certainly, even with a calm affect and no signs of agitation, it doesn't seem responsible to leave staff alone in such situations in case s/he needs backup. We had one patient some months back who was a big guy, physically strong, but with a lot of altered mental status issues. He was at risk of elopement related to poor insight - in these cases, we normally assign them 1-to-1. However, we felt that doing so would cause a safety risk for the nurse assigned to watch him, especially considering that he was perfectly ambulatory and could go off-unit to who knows where. In the end, he was transferred to a locked facility. This worked for him, but I don't think is the right choice for your guy....
I hope you'll update on the situation, both yours and how your facility ends up working this out?
Jan 12, '15
So sorry to hear of your incident!! Note to self...always have an exit, stay close to the door if possible. And, look for signs of increasing agitation in family or patient. You can ALWAYS excuse yourself from the room, don't turn your back, just back out. Call the office and talk to someone. You may have to buddy up for a visit next time. Safety first friend!
Jan 12, '15
It sounds like you did everything correct. As far as your request it sounds completely reasonable to me. We do the best we can to provide safe and comforting care to our patients and dealing with Dementia Can be difficult. Maybe talk to the wife and explain to her why you can not continue his care. Any reasonable person would understand.
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