Care of an elderly patient with mental health issues

The Health and Disability Commissioner investigated a complaint about the care provided by a District Health Board’s (DHB’s) Inpatient Mental Health Service to a 76-year-old woman. 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 and smeared faeces over her body and clothes. A registered nurse used unreasonable force when removing the woman’s clothing to bath her, 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. Afterwards, the registered nurse escorted the woman to a seclusion room and, while doing so, pushed her with his knee or thigh sufficiently forcibly to jolt her forward. This was witnessed by two staff members.

The Commissioner, Anthony Hill, found that the registered nurse breached the Code of Health and Disability Services Consumers’ Rights in several respects. The registered nurse treated the woman roughly and unkindly, did not respect her dignity and independence and used excessive and unreasonable force. The nurse failed to comply with the DHB’s policies for restraint and managing challenging situations, and the Nursing Council’s Code of Conduct. The registered nurse was referred to the Director of Proceedings.

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 did not breach the Code. However, the Commissioner made adverse comment about aspects of the medication administration recording and management plan in place at the DHB for the woman.

The Director of Proceedings has decided to take a proceeding in this matter.

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