Nurse’s Care Of Elderly Resident In A High Dependency Unit

Deputy Health and Disability Commissioner Rose Wall today released a report finding a registered nurse in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for failures in the care provided to a man in a high dependency unit (HDU).

The man has lived at the HDU in a rest home since 2012. He has chronic schizoaffective disorder and vascular dementia, and is subject to an indefinite compulsory treatment order. His care plan noted that out of confusion and disorientation, he tended to get unsettled and agitated and exhibit verbal and physical aggression.

On the day of the events, the man broke a glass pane in a door by kicking it. CCTV footage of the incident shows that in response, the nurse went over to the man, grabbed him by the back of his collar, and pulled him away. The force of the nurse’s actions knocked a cup out of the man’s hands. The nurse then pulled/pushed the man out of the lounge. The man did not appear to be agitated or to be resisting the nurse.

The nurse submitted that he was reacting to an emergency situation at the time. However, he acknowledged that he should have given the man more time to de-escalate, and should have obtained assistance from another staff member.

Deputy Commissioner Rose Wall considered that the nurse’s response to the situation was inappropriate, and that his actions towards an elderly and vulnerable resident were unacceptable and a departure from fundamental ethical and legal standards. Ms Wall also considered that the nurse’s actions were disrespectful to the man.

"[The man] had no family or friends to advocate on his behalf and, as such, he was especially vulnerable to abuse," said Ms Wall. "The actions of the staff member who reported the incident to the rest home’s management are to be commended."

The Deputy Commissioner recommended that the nurse attend training on de-escalation, restraint minimisation, and person-centred care, and apologise to the man in writing. She also recommended that the Nursing Council of New Zealand consider whether a review of the nurse’s competence is warranted.

The full report for case 18HDC01346 is available on the HDC website.

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