Monday, October 15, 2012

An Assault With No Visible Triggers

I've been working in Psych Units since 1981 and as psychiatric workers (nurses and mental health workers) we are trained how to manage assaultive behaviors (MAB). We are taught to watch for signs of an impending assault so it can be nipped in the bud, so to speak, before an assault happens, and the cycle that follows. When we see a patient starting to get agitated, we could intervene verbally and/or with medications to calm him/her down so that a full blown assault doesn't happen. Basically these are the steps to an assault: Baseline behavior where a patient is acting normally, a trigger which gets a patient agitated, the assault itself if the patient perceives that his/her needs are not met and attacks somebody, the recovery phase when the agitation declines, then back to baseline when the patient is acting normally again.
So what can you do when the usual signs of an assault cycle do not exist like it happened to me? There did not appear to be any triggers when the patient jumped off the bed twice nor when he tried to punch the respiratory therapist. Certainly none when he punched me at least three times on the head and face, since I was only helping him go to the bathroom. Whatever triggers all appeared to be hidden in the patient's mind. How does one defend from that especially when the patient exhibits baseline behavior right before and immediately after the assault? It was like turning a light on and off.
The doctor could have ordered a tranquilizer after the patient already tried to strike the respiratory therapist, but was concerned that it may impair his breathing if he fell asleep. But that was why I was assigned to watch him 1 to 1, so in case he had breathing problems, I could intervene by at least repositioning him or calling the nurse for assistance.
With the patient's history of assault, I believe he should have at least received a sedative. That may have prevented the attack on me and at the same time, I could have observed him all night to make sure he didn't go on respiratory arrest. Instead, I had to go to the emergency room at 4:15 a.m. to be checked out while leaving the patient alone with his breathing problems. I ended up not leaving the emergency room until close to 8 a.m.
So what happened to the patient after I left him? I don't know and I really don't care. What I care about is my own health because without it, I can't take care of the same kinds of patients who may or may not try to hurt me.

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