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?
