Once upon a time, it was quite common for larger male staff to get a phone call early in the shift. As I remember, it was commoner on afternoons. Responsible, experienced shift leaders were already thinking about what kind of shift they’d be handing on to the night staff. It would go along these lines.
“Hi Old School. How many men have you got on today?”
“Hi Libby. Just me and the student.”
“Oh dear. That’s not enough. We’ve only got Bob.” (NB Bob is sixty-five and only just came back to work after a heart attack.)
“What’s the trouble?”
“Morning shift just left us without doing anything. Patient X came in three days ago and has been refusing his tablets. Doctor Y wrote him up for an imi this morning but they didn’t give it. He’s mad as a hatter, getting on the other patients’ nerves. One of them is going to twat him soon if we don’t jab him.”
There would then be a chat about which reliable and trustworthy male managers were still likely to be in their offices and which other wards had men on duty. Libby would agree to round up as many as possible and set a time for them all to come to her ward. Then you’d sit in the office/nursing station waiting for the last ones to turn up, drinking tea, flirting, telling tall tales. Libby would be in the clinic drawing up the jab.
The number and size of the men needed would depend on the size, history and acuity of the patient. Our aim was, in this order –
1. To give the injection, without putting hands on, if possible.
2. If we had to restrain, to do it calmly, professionally, so the patient knew we were in control and he wasn’t going to get hurt. Except for the jab, but even that can be done with minimal pain. Then you leave the patient in his room to privately, at his own pace, acclimatise to what just happened and what it meant.
3. If it was going to turn into a scrap, with the patient threatening to get the staff later, then it would probably need seclusion. The same acclimatisation process would have to happen while locked up, until he accepted the situation. So there had to be enough experienced men to transfer the patient, under restraint, to seclusion, put him on the deck and Libby would give the jab there. Then we’d exit the room safely, lock him inside, someone would start the paperwork and we’d all go back to our own wards. You’d probably get a few more phone calls later to go to seclusion and supervise – or restrain – while Libby took in food and drink, tablets, bedding, had a friendly chat and so on.
I’ve been in all of these and others where it didn’t go as smoothly as I described. Maybe I’ll write a few posts on those that went pear-shaped. Most of the time though, when the patient is presented with three, four or five male nurses around his bed, he sees sense. Even the maddest can do this. They accept defeat and allow the jab. You don’t have to touch them. It can be trickier if the patient isn’t in his room. In the same way as a moving hostage situation is much more dangerous than a confined one. (Obviously, the degree of danger isn’t the same.) If say, they are in the dayroom or on a corridor, you have to act now, it took ages to assemble the team. You tell the other patients to go to their rooms for a bit. You can’t allow the patient to run away to who knows where on the ward. Sometimes you just have to give the jab on a corridor or open area, even the garden. That’s a bit of a failure, you’ve made the patient have a public loss of face, public embarrassment. Far better to talk them into their side room, give it in private.
Other times, the patient shouting threats is all mouth and trousers, just masking their fear. Give them a face-saving way out and they’ll take it. They also learn the nurse are human, have a sense of humour and prefer peace to war. At the opposite end, there are patients who the first jab doesn’t touch. Usually they need knocking out with Acuphase. They sleep for a day or more and while they do, the medication starts working. When they come round, you might have a patient you can start to work with.
Next post on this thread will be – How it is now Pt 1. Restraint and seclusion reduction at all costs.
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