Reflective Statement
During the course of my studies in Behavioural Health Science unit we had the opportunity to propose, for a case study, a solution/s for some issues at a mental health hospital that were occuring in one of its wards. There were varied issues of concern within the ward including those relating to nurse injuries and resident aggression, ward facilities and those relating to widespread use of PRN and seclusion and restraint. Our group's main focus was on patients and the use of PRN and seclusion and restraint.
In the course of doing the assignment and having had exposure working in an aged care facility, I found seclusion and restraint as one issue that featured prominently in my mind. Residents, often have dementia and pose a great deal of problems with aggression especially physical and verbal aggression. One issue is how to deal with these?
At the aged care facility, often times they are strapped in lap belts or in the extreme they are given medication so they can "rest". I found this compared very similarly to what was in the case study. Further, only the other day while on my shift a certain patient, who I had only just met, was screaming and shouting. He had indicated he needed the toilet and according to the care plan he had to be hoisted in order to do this. The resident would have none of it!! He insisted he can stand up by holding on bars in the toilet on his own. My buddy and I, had an issue in our hands on how we could handle this?
I have learnt a lot during the course of the unit and one thing I have learnt is that, for behavioural issues of concern, that giving medical intervention alone is not the best solution. There could be a myriad reasons a patient may be behaving inappropriately including that they be asking for help due to physical, emotional and physiological needs. It is our role as nurses to have strategies that seek to assist not only us in our daily tasks, but those that can assist the patient to better manage their inappropriate behavioural tendencies (as far as possible). One way is a communication strategy in which we have to approach the patient in a non-threatening way (which we did with resident at the aged care facility and did not work!) but also teach the patient communication strategies that are contrary to the aggression the patient is normally used to. We walked away and left the patient for a while (de-escalated) until he had calmed down. With the help of the clinical nurse at the aged care facility, we ended up toileting the resident without use of the hoist as he had wanted and for which he did very well!! Although this conflicted with what his care plan had indicated, listening to the resident and giving him the benefit of doubt, proved to us that he could indeed do the toileting as he had described. Obviously, his care plan needed to be amended and the clinical nurse became aware of this.
So upon reflection, the cause of the resident aggression was not so much his need to go to the toilet but the use of the hoist. In dealing with the resident issues and by trying the behavioural approach, finding the cause of the aggression and eliminating that cause made the resident aggression irrelevant in that situation. Certainly, I now know how to better help this and other residents should they be showing inappropriate behaviour. In other situations and as learnt during the course of the unit, looking at the consequences following the behaviour also sheds light on the course of action i.e. do the consequences reinforce the bad behaviour. If they do, then there might be need to modify the consequences to make the inappropriate behaviour irrelevant and vice versa.
Other presentations by my classmates also enlightened me on how to deal with behavioural issues in health facilities and in the community. Ways can be as sophisticated as creating a Snoezelen room of bright lights to calm the resident or as simple as doing a ‘token’ approach to reinforce the resident whenever they show behaviour that is acceptable.
For the future and should I encounter residents with behavioural issues , this exercise has surely equipped me with the requisite knowledge and skills on how to deal with residents that show behavioural issues ( examples of solutions as alluded to above depending on time, money and the particular resident) . I am confident this will make me a better nurse in my future career in the nursing field.