did i do the right thing???

Discussion in 'ARCHIVE FORUM: Support discussions' started by inkypink, May 23, 2008.

  1. inkypink

    inkypink Registered User

    Jan 2, 2008
    15
    hull,UK
    i really need the opinions of everyone who knows someone with dementia that is either in a care home or that you care for yourself at home.honesty is a must!!!!
    i work as a night senior carer in an emi home for older ppl with dementia & older ppl with mental health probs.the home is a specialist home(although,not recognised as 1)as we look after ppl who can present very challenging behaviour either through violence or by being very vocal or by showing bizarre behaviour,we accomodate ppl that no other carehome will.my home is run by a large non-profit making company who have all their own policies & procedures all inline with the national standards.
    anyway,we have recently had a new admission,he has dementia & came from another carehome but they couldn't meet his needs as he was showing signs of aggression.since being with us(6wks now)he has assaulted staff & residents alike.he is not always like this,he can be very lovely but with dementia,as you all prob know things can be pretty unpredicable at times.there is no trigger & we have all been made aware of what signs to look for & of how to try & deal with him when he starts to become anxious but nothing or no one can stop his behaviour we just have to let it 'run it's course'.
    a few weeks ago i was doing my night shift & this man had been awake all night,which isn't unusual,at about half 4 in the morn i could see he was becoming anxious so i kept my distance & avoided eye contact like we are supposed to.he was walking back & forth down the corridor when another resident in a wheelchair came out of his room,the man started to attack the other resident by punching him in the head & trying to pull him out of his chair.i went to intervene & got in between them both resulting in me getting punched & throttled by the man,as we as carers are not allowed in anyway to physically manhandle or restrain a resident i had no choice but to take the assault until a carer could distract the man.when this happened i quickly took the other resident into the lounge followed by the other carer & closed the doors,the lounge doors had 2 handles which can confuse residents as they don't know that they have to use both to open the doors,so the man couldn't get in the lounge & we were safe but he could see us & was picking up coffee tables & throwing them at the doors to try & get in.all this was very frightening for the other resident & also the other carer as she was new & it was her very 1st shift!!!
    we were in the lounge for half an hour waiting for the man to calm down but he didn't so i had to use the crash call to get assistance from the other staff upstairs as we needed to get out of the lounge to check on everyone else.
    with the help of the other staff the man was distracted long enough for us to get out of the lounge but as he was still being 'challenging'after staff tried all they could to calm him down i had no choice but to get him to go in the lounge himself & close the doors so he couldn't assault anyone else.i could only think of the safety of all the other residents at the time.
    i documented everything in detail as i was supposed to & when the morning staff arrived the man was still throwing furniture about & trying to smash windows.apparently,he calmed down about an hour later.
    i'm sorry this is so long but i'm getting to the point now!!!
    on my next shift i noticed that 1 of the lounge door handles had been taken off which i found odd & then on tues night the area manager was at work when i got there & called me into the office.
    someone(another member of staff)had reported me for using restraint against the man by keeping him in a room he couldn't get out of.
    i was dumbstruck but no matter what i said to defend myself the area manager still said i was in the wrong & that no type of restraint what so ever is to be used in the carehome at any time.
    she was adamant i could of handled the situation differently but i know i couldn't.all i see is that i had to protect other residents & myself also & keeping him confined to 1 room was the only option i had at the time.
    i haven't been disciplined or had a warning or anything but i've made a complaint to head office cos i think i've been treated unfairly.
    now,my question to everyone.......
    did i do the right thing???
     
  2. citybythesea

    citybythesea Registered User

    Mar 23, 2008
    632
    coast of texas
    Inkypink....I'm gonna go out on a limb, I'm going to give you an honest answer. Don't think I'm talking in circles to how you handled the situation. You stated that where you work has a set of standards that are equal to the gov. standards and you tried to stay in those bounds. You had a duty to all the patients and within your mind you have done that, if your supervisor has talked to you but not disciplined you he/she knows that you were put in a tough spot. It doesn't matter what we think on TP, it matters that YOU were comfortable with the way the situation was handled. I imagine that while what you had to go through was tough imagine how the family of the patient that you rescued feel and try to understand that not only do you have to handle situations...your supervisors will have to explain some things also..to other families and hope for the better.

    I hope you understand what I am saying and I hope you don't have to handle many situations like this again.

    P.S. If your wondering, talk to your supervisor on a one to one basis and ask him/her if they can give you better guidance. They are supposed to be trained in this also and sometimes a person can see things from a different view when explained to them. I have a friend whose mother also has AD...we bounce ideas off each other and I use the forum to better understand AD. I can't get in her head, but I can try to figure it out and make changes where it is needed.
     
  3. inkypink

    inkypink Registered User

    Jan 2, 2008
    15
    hull,UK
    thank you for your honest answer.i'm meeting with the area manager on weds to try & sort this out.you see the problem is that the home is not classified as a specialist carehome but it is just that.the company bought the home 3yrs ago & it's the 1st home they have owned that accomodates the type of residents we care for & they are still trying to run as if it's a 'normal' residential carehome like all their others.
    it's getting bad reports from inspections carried out by the care standards dept & the company are still too stubborn to make changes to the way in which the home is run.
    i love my job with a passion i get so much satisfaction out of it but trying to some white collar company director/manager to see that they are in the wrong is beyond impossible,all they see is money money money with a big bonus at the end of the year for filling all the empty rooms in their homes.
    it's very sad......
     
  4. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    #4 TinaT, May 23, 2008
    Last edited: May 23, 2008
    Many of the men on the long term care ward where my husband was for 9 months displayed exactly this behaviour. No EMI unit or Nursing home were able to manage their behaviour, so they will probably stay on this ward for the rest of their lives.

    The nurses on the ward confined the violent and aggressive outbursts by putting whichever man was 'kicking off' into their bedroom. The door was not locked but a nurse then had to sit by the door and hold it closed - restraint but not locked in I suppose.

    These violent men were each constantly trailed by a nurse 24 hours a day. They called it 'observations'. My husband suffered many a black eye and bruised face during his stay on this ward, caused by the violent behaviour of others.

    So I suppose that you holding the door is not restraint but you closing a door which he cannot then open is restraint. What a mess the law of restraint is in!!!

    I saw horrendous injuries caused by men who could not walk but got themselves out of a chair and then fell onto the floor. The staff were not even allowed to put a table in front of them in an attempt to prevent this as this would be unlawful restraint.

    As this man is so violent and a danger to others I would think that your manager will either have to get in extra staff to 'special' him or he will be sent to a specialist long stay hospital ward where they do have extra staff for this.

    I do know that you had a duty of care towards all of your patients and in the same circumstances, I would have done exactly as you did. However the manager has to be very careful about any form of restraint in this present day and age. It is his job to give you alternate strategies when dealing with this man in the future. Make sure that you know exactly what the manager wants you to do in such a situation as I'm sure this was not an isolated outburst and will be repeated at some other time.

    You and your fellow workers are wonderful! I truely admire you for doing a very difficult, hard job with little reward or thanks. God bless you.

    xxTinaT
     
  5. inkypink

    inkypink Registered User

    Jan 2, 2008
    15
    hull,UK
    many thanks for your kind words tina t.the problem that the management don't do any care anymore or they have never done care so they don't experience the realism of it all.even though this particular resident behaves this way at times i sympathise with him as it's the dementia that's causing him to be like that so he must be confused & scared himself.
    there's no simple solution because the issue of restraint is seen as depriving someone of their human rights but there are times when this needs looking at for the welfare of others,residents & staff alike as we constantly get told we don't go to work to get assaulted but we are not allowed to defend ourselves when we do so it's a no win situation.
    there is a reasonable restraint policy in force but we still don't know what the limits of that policy are.
    when we try & discuss issues with management,i'm sure they are thinking 'what do you know,you are just a carer'.
     
  6. Lynne

    Lynne Registered User

    Jun 3, 2005
    3,433
    Suffolk,England
    In my opinion,

    you did everything that you could possibly do DEAD RIGHT.

    Had it been my Mum in that wheelchair, I'd have recommended you for an award, not an undeserved reprimand.

    Do you belong to any sort of Union or Association to look after YOUR welfare?

    Best wishes
     
  7. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    I would insist that the manager gives you clear strategies for dealing with this situation, should it arise again (which it no doubt will). His job is to manage and he should be helping you by letting you know in clear language what you should do when this happens again.

    All the violent and aggressive men I've encountered on the ward were to be pittied. They did not chose to have dementia and were not responsible for their actions. Dementia had deprived them of so much. I also felt very sad for their wives and families. They were also upset and worried about their husband's behaviour. Dementia in all its forms is a 'no win situation'.

    Please God that this stem cell research, which the government have just voted on, will produce some hope for all of us involved in dementia care.

    xxTinaT
     
  8. jc141265

    jc141265 Registered User

    Sep 16, 2005
    836
    Australia
    If it had of been my Dad being violent, I would have understood completely what you did. You are only human and were dealing with a very stressful situation. Dad did pretty much the same thing but at home to my mother. She locked herself in the bedroom while he had his mad rage.
    Its terrible for the people who have to deal with the violent behaviour, it is terrible that the man's dementia is causing him to be like this. Thank god that there are homes that will look after people like this.
    It is a very difficult thing to deal with, and I don't think there is any right or wrong, in this situation so long as people are doing their best to do the right thing.
    Can you ask your supervisor what they would recommend you do if such a situation occurs again (ask it in a genuine way, because you never know maybe they have some amazing insight). Or ask that there be some standard operating procedure be put in place so that you will know what to do next time. This way it makes it clear that the blame was not yours but in fact lies with the system. If they want you to do something other than you did, they need to tell you what to do. It needs to address the safety of the other patients in care, and it probably needs to involve consultation with family members, so that they are clear on what will have to happen if this kind of incident occurs and can agree to it.
    There must be legislative answers that someone needs to research when it comes to keeping many safe, compared to one man safe. Demand that your employers find out what this compromise is.
     
  9. May

    May Registered User

    Oct 15, 2005
    627
    Yorkshire
    If I was a relative of a resident of the home you work in,I would say you did exactly the right thing in trying to keep all your residents safe, including the chap who was aggressive. In my Mum's care home (EMI unit)they have doors that cannot be opened by residents, does this mean that they are being deprived of their human rights, or being kept safe? More to the point, if the place you work is not classified as EMI, and run as such, given that dementia throws up the most challenging of behaviours, how are the company getting away with taking residents who have these types of behaviours? Do you have 'qualifieds' (ie nursing staff) on duty at all times? Do staff have specific ONGOING training for managing residents behaviour? This should be a must for people with dementia.But more than that the company has a duty of care to it's residents AND STAFF! You need to find out what the 'bottom line' is, I'm uncertain whether there is a legal stance on this but I did think that homes had to be licenced for dementia residents. What ever you do, best wishes and take care.
     
  10. inkypink

    inkypink Registered User

    Jan 2, 2008
    15
    hull,UK
    thank you all for your support.yes my home is registered for dementia care but not for emi even though its running as an emi.my home is known as the 'end of the line' home,we take in residents that no other care home can manage.yes we do have training & the training is very good but still,the company who owns my home will not tolerate any form of restraint,physical intervention of any kind they are even adamant that they won't budge on this even though the new mental capacity act has come into force.their policy is that all residents have a choice to do as they more or less please even if they aren't capable of making the right choices anymore so if 1 of our residents has had a bowel movement & is covered in faeces & we try to assist them,if they say no we have to leave them.isn't that abuse in itself!!!
    it's really frustrating cos you can guarantee that the ppl behind their policies & procedures have probably never done a days care in their life & started at the top.
    i've made an app to see the area manager again to demand an apology from her & to try & convince her that i was in the right but it prob won't go my way.
    i'll keep you all posted....
     
  11. heartbroken

    heartbroken Registered User

    Feb 17, 2008
    747
    derbyshire
    Hi
    I think you did the right thing and I would have done the same thing. you was only thinking of the others if it had been my step mum he was attacking I would have given you a great big hug and thanked you so much. it is a shame they can't see the good you do. you are one fantastic women doing this very hard job.

    it is disgusting they leave them to sit in their own mess.
    can't you talk to the family of the man that was attacking to see if they are happy with what you did.

    hugs and best wishes to one great lady thanks for caring
     
  12. TinaT

    TinaT Registered User

    Sep 27, 2006
    7,095
    Bolton
    Dear Heatbroken,

    I'm not criticising your advice in any way and with reasonable people this could have been a good solution but I'm sorry to say differing people react in very differing ways. I would not advise talking to the man's family in any way whatsoever about the event. In doing so this poor care worker could very well be opening up a new 'can of worms'. Who knows what the result could be? In fact I would only talk about it with the management themselves. When your job is on the line and you need the money to keep your family going, it is wise to be very careful. It would be the job of the management to talk to the relatives involved and perhaps the care worker could ask the management has he/she asked what would be their wishes.

    As I have previously mentioned, I've witnessed some very violent assaults but in deference to the relatives and their own feelings, I have never mentioned this to them, even if the assault has been done on my own husband. If the senior ward staff have done so, it has been in privacy where their own dignity has been maintained.

    xxTinaT
     
  13. Lynne

    Lynne Registered User

    Jun 3, 2005
    3,433
    Suffolk,England
    Dear Heartbroken

    You are, of course, free to give an opinion so please don't take my comment as a personal affront. However, I feel that this suggestion would help no-one.
    His family are only going to be distressed & embarrassed by their loved one's violent behaviour, which may be why they can't care for him themselves in the first place. Making them confront yet another example of it is only going to spread misery & guilt to them too.:(

    Regards
     
  14. inkypink

    inkypink Registered User

    Jan 2, 2008
    15
    hull,UK
    hi,
    just filling everyone in who replied to my post.
    i had the meeting with my area manager,the 1 who reprimanded me in the 1st place,& it seems she has had an about turn & decided to let me know that i was in the right after all!! i think she'd had a week to mull over what had done & prob realised i had done everything i poss could with in the homes guidelines.
    she also told me that the company is going to look at personal alarms for us night carers too which is going to help a bit.
    i'd just like to say though that 2 nights ago the same thing happened with the same resident but this time he kicked 1 resident,started punching another 2 & when i was trying to remove the assaulted residents away he started hitting me in the face,i had no choice but to take it as there was no where to go that he couldn't get to me.i was working on my own on the ground floor not in reach of any of the wall alarms so had to get in the lift with the other residents & go upstairs for help!!!
    i've documented the incident but have no idea how long it's going to take for anything to be done by it. imagine what it was like a few hours later when me & another carer had to give this man personal care as he was inco of very loose faeces!!!
    we had no choice we had to clean him up,it was horrendous,we were headbutted,kick,bit,punched,you name it!! it took all our strength to keep hold of him to do what we had to do,we are both quite small females so after we had finished we looked like we'd gone 10 rounds with mike tyson.
    i've had no sympathy from my manager,she hasn't ask if we are ok or anything.i'm now looking for another as i just can't take it anymore,it's not the job,not the fact that i get hit or anything like that,it's the fact that none of us have any support or help from the company that owns the home even though they are supposed to be so good that they won awards this year for being such a good care provider & staff trainer!!! joke hey.....
     
  15. christine_batch

    christine_batch Registered User

    Jul 31, 2007
    3,388
    Buckinghamshire
    Dear inkypink,
    My husband has AD and has been in a E.M.I. Unit for one year.
    Although my husband is placid, there are people in the unit who are very violent to staff as well as other residents.
    If it had been my husband in the violent stage and you had taken the same actions with Peter, I would have thanked you for what you had done in protecting the other residents and I would have made known to the Manager my feelings.
    You did do the right thing.
    Unfortunately,there are some who are in charge do not know what it is like to actually work with a person with AD/Dementia.
    I wish you all the best in a very difficult job.
    Best wishes
    Christine
     
  16. ishard

    ishard Registered User

    Jul 10, 2007
    98
    #16 ishard, May 30, 2008
    Last edited: May 30, 2008
    Inky your company has a duty of care for its employees too you know. There are restraints that can be used you just need the training to do it.

    DO NOT go near a violent patient, leave him/her to calm down even if they have sh** up to their ears but make sure other residents are moved out of the way. If you cant do this without putting yourself at risk then dont do it. That is the mantra of all nurses, DONT PUT YOURSELF AT RISK!

    I would write to your manager asking for the gp to evaluate the patient and perhaps sedate him and ask about training and personal safety. Ask who take the responsibility if you are hurt?

    I would also think about reporting this home as it obviously hasnt got a licence for EMI care
     
  17. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #17 Margarita, May 30, 2008
    Last edited: May 30, 2008
  18. Margarita

    Margarita Registered User

    Feb 17, 2006
    10,824
    london
    #18 Margarita, May 30, 2008
    Last edited: May 30, 2008
    Read this also


    So what polices in place does your Care home have ?
     
  19. rose_of_york

    rose_of_york Registered User

    Mar 22, 2008
    94
    York
    This poor woman is regularly being assaulted in her place of work and she has to just accept it. I can think of no job description where your duties include being beaten up.

    I will say to you what I would say to a victim of domestic violence - get out at once, there are other jobs, fry chips if necessary, but DO NOT PUT YOURSELF IN DANGER.

    Join a union if there is one and get some advice, your employers have a duty to take care of your health and safety. Whatever is wrong with him this man is being violent towards you and there is no excuse for allowing him to do it.
     
  20. ishard

    ishard Registered User

    Jul 10, 2007
    98
    I would even go so far as to say that particualr patient should not be on your care home Inky as his challenging behaviour makes it inapropriate for you to care for him.
    Has a risk assessment been done? I bet it hasnt.:(

    Care homes should not act as EMI units when they dont have the trained staff (nurses) to back it up.
     

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