Bob had to have some blood taken recently and a pathology agency person arrived at the nursing home to make this happen. Myself and another carer were asked to hold Bob’s wrists as he sat in a chair. The lady told Bob what she was going to do and then placed the needle in his arm and Bob did not like it at all. He became tense and resisted, then as we all clamped down on him he became combative. No-one was hit or hurt but the potential was definitely there.
So why did this task turn pear shaped? I keep coming back to looking at events from the person with dementia’s point of view. So how did Bob see this event?…
Firstly, he had a stranger ask him to leave the lounge room (where he was laughing and enjoying his coffee and cake) and go to his room. He was then placed in a chair, was told the lady’s name and she explained she was going to “take some blood”. 10 seconds later both his wrists were grabbed and he had 3 people appearing to restrain him and hold him down.Bob would have been thinking “Is this a code black?..Am I going to be held down against my will again?….I need to fight back!”. Bob tensed up,his muscles tightened, the needle went in, a small amount of blood was taken, then the struggle began, the lady stepped back and things flared up for a split second. The lady was not happy and said “he is very strong, I don’t like what I just saw and he should be sedated more in future”.
I then decided to walk Bob out of the room to change the environment, I calmly spoke with him to de-escalate him, and he now had blood all over his shirt. Bob said to me “look what you have done to me!”. I felt I had to change his shirt asap to avoid the reminders of the incident. He allowed me to do this and was happy again within 5 minutes. (a very quick de-escalation indeed).
So how could we have done this differently?
– Firstly the lady taking the blood had no rapport with Bob and probably could have chatted some more, and got to know him. An extra 5 minutes of chit chat and a look through his photo album may have helped this situation. (it was too clinical)
– By holding his wrists down BEFORE the needle went in, made Bob react negatively making the whole process more difficult.
– Our focus was on protecting the person taking the blood (which is understandable) , but she was actually more at risk by having us “set the wrong scene” prior and restraining him. Of course Bob’s history would have warranted the action taken, but I know a better result would have occurred if we had a more ‘relaxed vibe’.
– Distraction has worked well in the past when taking bloods. I normally rub his knee quite vigorously and talk about old football injuries with him as the blood is being taken from his arm. This diversion takes the focus off the needle.
– Two people maximum should be involved to avoid “over crowding” and preferably have someone who knows Bob take the bloods.
*There are many ways to look at an incident like this, and there are no 100% black and white answers here. It does highlight once again that when dealing with a person with dementia, having their point of view ‘front of mind’ usually produces a better outcome.
*My Golden Rule – create relationship first, assess the risks, then do task (or defer it).