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Care of an elderly patient with mental health issues (11HDC00128)
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(11HDC00128, 30 January
Registered nurse ~ Inpatient mental health service ~
District health board ~ Restraint ~ Unreasonable force ~ Respect
and dignity ~ Rights 1, 3, 4(1), 4(2)
This case is about the care provided by an Inpatient Mental
Health Service to a 76-year-old woman with a history of paranoid
delusions, periods of agitation, distress and depression. The woman
was subject to a compulsory inpatient treatment order and had been
an inpatient for many years.
One evening, the woman became very agitated. There was a plan in
place to manage these episodes, which included giving her
anti-anxiety medication, placing her in her room for "time out",
and taking her to the Intensive Psychiatric Care Unit (IPCU) if she
did not settle.
The woman was asked to go to her room. She later emerged with
faeces smeared over her body and clothes. A registered nurse and
another staff member took her to the IPCU bathroom.
The registered nurse used unreasonable force to remove the
woman's clothing, by pushing her head onto her chest and pulling
her arm to the extent that her arm and hand hit the wall at least
twice. When the woman became agitated in the bath, the registered
nurse unplugged the bath leaving her wet, naked and cold in the
bath. The registered nurse made derogatory comments about the
woman, observed her from the doorway, and prevented another staff
member from going to her aid.
The registered nurse decided that the woman's degree of
agitation required her to be placed in seclusion and, aided by
another staff member, escorted her to the seclusion room. While
doing so, the registered nurse pushed the woman with his knee or
thigh sufficiently forcibly to jolt her forward. This was witnessed
by two staff members.
By treating the woman excessively roughly, the registered nurse
breached Right 4(1) of the Code. By leaving the woman naked, cold
and wet in the bath, making derogatory comments and preventing
another staff member from going to the woman's aid, the registered
nurse breached Rights 1 and 3 of the Code. By using excessive force
to remove the woman's clothing and to escort her to the seclusion
room, the registered nurse failed to comply with the DHB's policies
and the Nursing Council's Code of Conduct for nurses and breached
Right 4(2) of the Code. The registered nurse was referred to the
Director of Proceedings. The Director decided to issue proceedings,
which are pending.
The DHB had policies and procedures in place that made clear its
expectations of the standard of behaviour expected of staff. There
is evidence that the registered nurse had appropriate training in
the relevant policies, but failed to comply with DHB policy.
Therefore, the DHB was not vicariously liable for the registered
nurse's breaches of the Code.
Adverse comment was made about aspects of the medication
administration recording and management plan in place at the DHB
for the woman.