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A resident’s psychotic episode

April 30, 2012
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Angie (pseudonym) had been here a couple of weeks. Some staff noted that she had been here before. She propelled her wheelchair in the hallways and seemed to be making friends. 

Last Wednesday Angie was having a bad day. She did not want to go to the dining room to get her breakfast or be content with a health shake. She wanted breakfast in her room and she and her nurse had words about it. 

Afterward, her nurse revoked her "after breakfast" smoking privileges. Still angry, Angie refused lunch and a health shake. Coming up the hall after lunch, I noticed her call light was on. Looking in her room I was concerned because I could not see her head at the top of the bed. 

While the aides were putting residents to bed, I sat outside Angie's room where she could not see me listening.  I heard noises of things being thrown. When I heard glass break, I got an aide to check on her.

She found Angie with cords wrapped around her neck. She was also trying to get glass from the broken light fixture. An aide shouted and the two nurses and two available aides came to Angie's room. Angie was yelling and they were trying to calm her.

Angie kept yelling and aides began to move dangerous items out of her room. Angie became unglued. The assistant director of nursing and social services director arrived. With the situation escalating, they decided to send Angie out. Within a few minutes she was gone.

When things quieted down, the aides looked exhausted. When I asked them to assist me to the bathroom, they thanked me for helping with Angie and for waiting until the crisis was over before requesting assistance. 

Kathleen Mears



Kathleen Mears is a long-time blogger who has been a nursing home resident for 21 years. She is...



Since the resident posed a potential threat to others and herself,it was appropriate to have her sent out. Sometimes some medication adjustments done in a psychiatric setting can do wonders for the resident, other times not. But at least she deserves a chance. Funny, I believe our state is saying that psychotropics are bad for people and don't use them. The people who live in these glass towers probably haven't had to deal with people like "Angie." I wouldn't have taken her cigs though,because this would only further aggitate her, and some psychiatrists I have spoken to say ciggarettes have chemicals which stimulate the production of other chemicals that the schizophrenic brain is deficient in,and helps to calm them. and maybe they are right. Most schizophrenics I know smoke. Anyhow I think the staff acted appropriately given the care setting, and hopefully she may be able to return soon.

I would agree with not giving her a cig...she could have burnt herself or others, obviously if she is out of control a cig wont make a difference with behaviors,but only give her another tool to harm herself or others.

Taking away her smoking brake likely only added to the resident's frustration. It was a pretty bad judgment call. I'm sure the Ombudsman would agree with me. It sounds like the self-harming behavior happend after she wasn't allowed to smoke so it is very unlikely she would have harmed herself purposly with a cigarette. And why not let the resident eat in her room? Somedays I don't feel like eating in a restaurant and rather have a meal at home by myself. I hope 'Angie' will be well soon.

Evidently, something was bothering this resident. Something always causes the psychotic episode, whether it is something the nurse said that was insensitive or taking away the cigarettes. Nurses do not have the education or patience for the mentally ill, as they are so sensitive. Sometimes educating the nursing staff on your residents might help to make the nurse more sensitive to their needs, that even a hateful look at a mentally ill person can cause them to flip. Especially a mentally ill person that is so confined in a nursing home, could have a melt down quicker.

One thing I noticed in nursing staff, that social workers and counselors are just not used correctly. The nursing staff and social workers are often so overworked that all they can do is meet code.

It is time more attention is paid to the psychological needs and more money spent on education.

Thanks to all of you for your comments. Even though a situation is clearer in hindsight, I do agree that taking away a cigarette break was the last straw.

I think being required to eat in the dining room for every meal just gets old. Residents routinely skip meals.

The "resident rights" comment is quite appropriate. Not everyone does want to eat in a restaurant type environment for every meal.

Maybe planners ought to think about that one.

Many people self medicate via cigarette, and there is nothing wrong with that, it is legal, and smoking helps people to feel calm. (I have never smoked, but my mother did and she loved it) Just because a person lives in a skilled nursing setting does not mean meals must be eaten in a public dining area, some people prefer to eat in a quiet, private setting, (reminiscent of home) and would be much happier without rigid rule enforcement. Culture change is needed, residents are human beings who have committed no crime, elders and ill people must be treated with honor and respect. One day many of us will find ourselves in this same situation, and we need to change the culture to one of kindness and love toward others before it is too late.