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Physical assault on aggressive mental health patient (12HDC01008)
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Registered nurse ~ District health board ~ Forensic mental
health unit ~ Assault ~ Right 4(1)
A woman was admitted to a district health board's (DHB) medium
security mental health unit (the Unit) due to her increasingly
changeable mood, psychosis, and associated aggressive behaviours.
She was being nursed in the de-escalation area, being the highest
level of care available in the Unit. She had been placed in and
released from seclusion the day before due to her unsettled mental
state and behaviour.
A registered nurse (the nurse) was assigned to care for the
woman during this particular shift in the de-escalation area. She
was also the woman's associate key worker. The nurse had been
employed by the DHB as a registered nurse (RN) for 4 months and
this was her first job as an RN.
A mental health support worker and another RN were also present
in the de-escalation area, together with another client. The
Clinical Co-ordinator and senior RN in charge were on duty in
different but nearby areas of the Unit.
The woman began swearing and acting aggressively. The nurse told
the woman to go to her room for time out. The woman swore at the
nurse and went to her room. She then returned and demanded a hot
drink. The nurse told the woman that she would make her one if she
calmed down. The woman then approached the nurse and punched her on
the left side of her head. The nurse responded by punching the
woman at least twice on the upper part of her body. The nurse's ear
was bleeding after the incident.
The woman was restrained and with the agreement of the senior
RN, the nurse administered an intramuscular injection to calm her.
The woman was then escorted to her room and put in isolation. The
nurse declined offers to debrief or see a doctor. No formal
debriefing was held with any staff.
It was held that the nurse failed to provide services with
reasonable care and skill when she punched the woman and,
accordingly, breached Right 4(1) of the Code.
It was held that the DHB was not vicariously liable for the RN's
breach of the Code, or directly liable for the assault on the
woman. Adverse comment was made about the DHB, the Clinical
Co-ordinator and the senior RN in charge in relation to events
following the altercation.