Downey VA Hospital Restrains Assaultive Parients

Yes, I have a personal  history with patient assaults. Here is a link with the gory details if you would like to peruse the sad tale  http://oldfoolrn.blogspot.com/2015/08/knock-out-punch.html

Part of the problem with patient vs. staff  assaults  at Downey was the lackadaisical attitude of the administrators who were supposedly running the show. Assaults were so common that the hospital director's office had a form letter that was sent to all victims. The themes of this letter were that we were dealing with very psychotic patients and such unfortunate incidents were inevitable and oh, by the way, thanks for trying to help these poor unfortunates. Next time learn how to duck. OK I made that last one up, but that seemed to be the underlying message. There was no such thing as patient accountability or accountability of anyone for that matter.

The head nurse,  Matty,  of Building 66 where I worked  was a stout pit bull of a woman who rarely ventured past the safe  confines of the nursing office. She was an office-sitter of the highest order. Of course she had strong feelings about how to manage patients on the ward, but had no experience in the clinical realm.

Miss Matty loved to pontificate about patient assaults on employees. It was one of her favorite topics and her main point was that the employee's insecurity and lack of confidence communicates a sense of vulnerability to patients who then slug them. Her favorite refrain was, "Carry yourself with a sense of authority."  This made no sense to any of the staff. Ward attendants and nurses used to discuss this while on the ward within earshot of patients.

I quickly deduced that some patient on staff  assaults were entirely unpredictable and were deeply rooted in the psychopathy of the patient's illness. See, I can use that psychobabble speak just like all those highly educated big shots! Other assault episodes seemed to follow a pattern of escalation and were somewhat predictable. Some assaultive patients even expressed regret for the incident.

After an assault the patient was always placed in full leather restraints with a robust leather cuff around each extremity which was anchored to a steel bed frame with a heavy leather belt. The cuffs had a sliding lock mechanism that required a key to release. The bed itself was bolted to the floor to prevent the patient from kangarooing the bed around the restraint room. Some of the more experienced patients knew how to bounce an unbolted bed up and down when in restraints to move about the room. "Kangarooing" was a very good, descriptive  term for this phenomenon.

Putting an uncooperative, assaultive patient in restraints was not a pretty picture. One technique involved at least 4 nursing staff members to do the dirty work. A secret code word was agreed upon and since I was always hungry, "Big Mac" did the trick for me. After hollering the code word each staff member grabbed one extremity and physically carried or in the case of a really big patient, dragged him to the restraint room and tethered him to the bed with the leathers.

The alternative  technique involved a couple of staff members grabbing a twin mattress and while holding the mattress vertically, force the patient into a corner. Once cornered, the patient usually surrendered after an interval of punching and kicking at the back of the  mattress. It required a seasoned nurse's best judgment to ascertain when the pugilistic activity subsided enough for restraint application. The attendants were fairly good evaluators of the degree of "fight" left in a cornered patient and I usually left the decision up to them as to when restraints could be used. If a patient had too much "fight" in them when the mattress was retracted, it could always be pushed back into position pining the patient back in the corner. I always thought that the sudden eruption  of the punching  fists on the surface of the mattress looked just like that carnival whack-a-mole game. When the surface of the mattress settled down, the game was over.

I really detested the drama that accompanied the restraining process. There were about 4 patients out of 40 that required restraints. The youngest, Danny, was a Viet Nam veteran and had a predictable pattern to his violent outbursts. He would scream like a Howler monkey before striking out and once secured in the restraint room, he voiced remorse for his behavior. Danny told me that he felt like striking out when he felt threatened and out of control. I assured him that he was safe and maybe the next time he felt the urge to strike out to come and talk with me and we could figure something out to avoid that unpleasantness of being wrestled into the restraint room.

Whenever Danny approached me with that rage in his eyes, I always asked him what would work to make him feel better. Sometimes he just needed to lie down for a spell and other times he requested restraints. I complied and after the restraints were on, I always said, "Just let me know when you feel like coming out and I will release you."  This worked well for Danny and we established mutual trust because I promptly let him out at his request. For Danny this worked really well, but when he made his request to other nurses, I got called out by the head nurse who thought my interventions were unwise to say the least. Oh well, at least I tried.

Danny's schizophrenia suddenly went into remission and he was discharged to live happily ever after. APRIL FOOLS on that last sentence.