Tuesday, October 16, 2012

When I worked "The wards" ....

The other weekend while in Sydney for Rhonda’s conference we had supper with a group of fellow nurses attending the conference – that is, they talked shop and I sat back and listened.

The topic got around to nursing those with dementia in a closed ward environment, which led to the risks that the nurses felt exposed to, which progressed to “assaults” upon their persons. This eventually ended up on the topic of ‘self defence’ and the need to teach nurses some basic self defence techniques.

Several participants mentioned courses and in-services they had attended which they thought were “good” – good meaning they came away feeling a little more reassured. The topic then focused on self defence and moved to the area of martial arts training.

After a while I eventually opened my mouth and made the comment “The best form of self defence is not having to use it in the first place!”

I could feel the silence. I was the only male in this group, I was a retired nurse, I was a 'guest' among that group and I had dared to intrude into their currency of ‘professionalism’.

I quickly added that in all my many years of working psychiatric wards, including in the prison system and wards for the criminally insane, I had only been hurt twice and on both occasions it was my own fault. I had gotten careless and I had dropped my guard resulting in an attack penetrating my ‘self defence shield’. The latter comment provoked some interest and I was asked what training I had received.

My training in self defence in dealing with emotionally disturbed persons was imparted to me by some very good and experienced senior staff nurses who bade me follow their example and stay behind them.

The simple rules were:

  1. Never isolate yourself away from a colleague or ‘buddy’ when in the presence of psychiatric clientele.
  2. Never allow yourself and your buddy to become caught in a geographical ‘blind spot’ where other assistance could not see or hear you.
  3. Always let your planned movements be known to others and when you expected to report back to the front desk.
  4. Always walk slowly and deliberately.
  5. Keep your voice level and well modulated – don’t yell or raise your voice, don’t let it quaver and always speak authoritatively and firmly.
  6. Keep your hands down and don’t make any sudden moves with you hands unless its to block a blow.
  7. When entering a room, keep the door at your back.
  8. When moving around that room always keep to the perimeter of the room as much as possible.
  9. Make sure you have a planned escape route.

Coming on shift we would take report. This always related to people who were causing some concern to warrant being in the report. The first thing you did after report was to check the medication charts of the people under report and ensure that their medications were current and had been given regularly. If they were on 'oral tablets only' you ‘yellow flagged’ them in your memory banks. Such ‘pill takers’ were often known to dodge swallowing them or regurgitate them soon after. It took up to thirty days for some tranquilliser to reach optimum blood level but this could be quickly dissipated by one or two days of 'missed medication'. You then checked what ‘prn medication’, that is that sedative or tranquillising medication ordered as “To be given when required or indicated”. You then ensured that this was ready to be given ASAP – either in a syrup form or as an injection if you were to require it. It was a waste of time running to a medication room, opening it, finding the medication, drawing it up and running back to the scene of any altercation. Far better to have it prepared and in a central spot like the nurses station.

It was always a sign that you were climbing the clinically proficient ladder when you were nominated as the lead nurse in a pair and a lesser experienced nurse was assigned to work with you. My first words to my junior colleagues was always to bid them:

Follow my example, stay behind me and learn from what I do!


Cindy@NorthofWiarton said...

Fantastic Post, John. I will be passing along to my friend, Bob, who has been a RNA for over 30 years. He presently has been on the Physc Ward for the past number of Years.

Susan Heather said...

Great post, John. I have a friend whose husband is also in care. Unfortunately, the facility is always short of staff and they have been "importing" Asian staff who are not fully trained.

My friend's husband has lashed out due to frustration when not being cared for properly.

He is in D6 care but had calmed down and she was hoping to have him reassessed as D3 but when these untrained carers came on he became agressive once again.

The other side of the story.

JohnD said...

Cindy, pass it on by all means - I'd love some feedback.

Sue, untrained staff are always a hazard and an aspect that must be factored into the professional nurse's risk assessment. I rarely worked with untrained carers but when I did they received a 'rapid learning curve' from me!

The Elephant's Child said...

Sadly we have noticed that particularly on the weekends/holidays that many of the staff are very new to the job.