Posted: June 14th, 2023

Angelo is 42 year old male and has been experiencing psychotic

Assignment 1: Case Study
Angelo is 42 year old male and has been experiencing psychotic symptoms since the age of 18. He has been frequently hospitalized for his delusional thoughts and aggression; the last admission was in 2018. After this most recent episode, the attending psychiatrist, considering the complexity of the situation, discharged him to a group home.
At first Angelo seemed to adapt well to life within the group home, attending his normal activities and becoming a reference point for other guests thanks to his skills in computers and technology. He was still reserved and uncommunicative, but he continued to dedicate himself to his main interest, Ninja philosophy, and continued to study it on the internet.
At the group home, everything went fairly well although he struggled at times to respect the rules of living together. After 18 months, he stopped taking his medication and his case manager and Psychiatrist decided he would benefit from a short stay in an in-patient unit to stabilize him back onto his previous medication regimen.
While admitted to Psychiatry as an “Involuntary Patient”, he became aggressive both verbally and physically towards another patient. A strong delusional idea related to his identity emerged. He believed he was a Ninja with special powers and verbalizing paranoid, delusional thoughts of others taking his special powers.
This morning you go to meet Angelo and he is in the corner of his room practicing his ninja moves. He will not engage verbally and is seen to be talking to himself about how he will “get” everyone today. He appears agitated, with an angry affect stating he will “protect himself and must escape”.
In a Word document, respond to each of the following questions. Using critical analysis and supportive literature, reflect and explain your responses with evidence (be sure to include a reference page).
1. Describe how you would attempt to engage with Angelo by providing 3 techniques to de-escalate his behavior (think about your BCVP training). Consider your resources on Code White Protocols. Is this a necessary intervention at this time? Why or why not? Support with evidence.
2. Review the resources on Seclusion, Restraint, and Least Restraint Policy. Considering these, what would be the first steps to take in this situation (hint: consider the resource on IM Medications). Describe the process from least restrictive to most restrictive interventions and provide rationale and policy considerations for each.
3. What nursing considerations and monitoring parameters must be taken when giving a short-acting IM antipsychotic?
4. According to the BCCNM and the Mental Health Legislation, what are the Practice Standards regarding caring for a patient in seclusion? What are the nurse’s responsibilities and the patient’s rights?

______________________
To de-escalate Angelo’s behavior, there are several techniques that can be used. Firstly, it is important to maintain a calm and non-threatening demeanor. Secondly, it is important to use active listening skills, which involves listening to Angelo and acknowledging his feelings and concerns. Thirdly, it is important to offer reassurance and validation of his experiences. These techniques have been shown to be effective in managing aggressive behavior in psychiatric patients (Hallett et al., 2014).
As for the Code White Protocols, it is necessary to determine if Angelo’s behavior poses a risk of harm to himself or others. If it is deemed that he is a risk to himself or others, then a Code White intervention may be necessary. According to the Code White Protocol of the British Columbia Ministry of Health (2021), a Code White is a coordinated response to manage aggressive behavior in healthcare settings. This protocol involves a team approach, which includes trained personnel who can safely intervene and de-escalate aggressive behavior.

The first steps to take in this situation should involve the least restrictive interventions, in line with the Seclusion, Restraint, and Least Restraint Policy. The first intervention should involve verbal de-escalation techniques to calm Angelo down. If this fails, then the next step should involve medication administration, such as an oral or intramuscular (IM) antipsychotic. If medication administration is deemed necessary, the medication should be administered in the least restrictive manner possible, considering the Least Restraint Policy. IM medications are an option, but only after oral medications have failed or are not feasible (BC Mental Health and Substance Use Services, 2013).

When giving a short-acting IM antipsychotic, nursing considerations and monitoring parameters must be taken. These include monitoring vital signs, such as blood pressure and heart rate, and assessing for any adverse reactions or side effects of the medication. Additionally, it is important to ensure that the medication is administered safely and correctly, following the appropriate dosage and injection technique.

According to the BCCNM and the Mental Health Legislation, there are specific Practice Standards regarding caring for a patient in seclusion. These standards emphasize the importance of using the least restrictive measures possible and ensuring that the patient’s rights and dignity are respected. The nurse’s responsibilities in caring for a patient in seclusion include ensuring that the patient’s basic needs are met, monitoring the patient’s physical and mental well-being, and documenting all care provided. The patient’s rights include the right to receive appropriate care, the right to be informed of their condition and treatment, and the right to have their dignity and privacy respected (BCCNM, 2021; Mental Health Act, RSBC 1996).

References:

British Columbia Ministry of Health. (2021). Code White Protocol. Retrieved from https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/communicable-disease-control-manual/code-white-protocol.pdf

British Columbia Mental Health and Substance Use Services. (2013). Seclusion and Restraint Reduction Initiative. Retrieved from https://www2.gov.bc.ca/assets/gov/health/practitioner-pro/bc-guidelines/seclusion_and_restraint_guidelines.pdf

Hallett, N., Huber, J. W., Dickens, G. L., & Völlm, B. (2014). Strategies for the prevention of aggression and violence in psychiatric settings. The Lancet Psychiatry, 1(1), 20-28.

British Columbia College of Nurses and Midwives (BCCNM). (2021). Practice Standards: Seclusion and Restraint. Retrieved from https://www