A patient in the ICU doesn't want to be there, so he got loose from his restraints and hit my hus in the face.

Question

He thinks his nose is broken. The patient hit two other nurses today. He is mentally OK, but medically unstable. Do you think the doc is wrong to keep him in the hospital in restraints receiving treatment, if the patient says he wants to go home?

The hospital and doc will NOT release him because he is medically unstable.

He will not heal at home. He would die before he left the building.

My hus is a Critical Care RN. He is his man's primary nurse. The man has NO history of psych issues and he is oriented to time, place and person.

There ARE case managers in this hosptial and they are aware of his condition, yet they still hold him. I think it is wrong.

This patient is not having any kind of reaction. He is as lucid as you or I. BUT, without the meds he is receiving and if he gets up and moves around, he will quickly die. He just doesn't want to be there. They have explained to him he needs to lie down and take his meds or he will die. He told them where specifically they could stick their meds. He's not old. He's middle-aged.

Answer 1

Yes the MD is wrong to hold a patient against his/her will (that is if the pt. is mentally stable, and that the pt. is not on a 10-13 or 10-20 hold). The pt. can sign out AMA and then the MD nor the hospital is accountable for anything that might happen to the pt. if they leave against medical advise. Putting the pt. in restraints is to protect the pt. and/or the staff (in this case sounds more like the staff). Pt's. have rights & responsibilities and are allowed to refuse any treatment at any time. Medical staff is suppose to explaine to the pt. the benefits and risks of not receiving the treatment and then respect the pt's wishes without judgement. The nursing staff is suppose to be the pt's advocate. I would recommend getting the social services dept. at the hospital involved. I'm sorry your husband got hit in the face, and I hope he feels better soon as well as the other nurses that have been injured.

Answer 2

Yes! Many years ago I was in Hospital due to my Arthritis. They started a new drug and within 24 hours I was being rushed to ICU due to high body temprature, blood pressure, a big headache, was blind and had a real bad pain in my chest. I guess I passed out? However when I came around, I was still blind and all I could hear were these peeping noises. I have never been so scared in my life, so the flight or fight instinct kicked in and I legged it! Little did I know I was attached to various instruments? It took three male Nurses and something called DF 118, which they injected to get me out for the count and back into bed! I will remember DF 118 for as long as I live. When I came back again I had some vision, light, so was not so panicky. According to the female Nurse, 'You looked like a drunk staggering across the bar room floor taking tables and chairs with you!'
Now in hindsight, the problem as I now see it, I was blind! Whatever was going on, whatever reaction I was having, no one bothered to explain anything to me, the Patient. I was just litrally wheeled out in the bed from the ward to ICU, without anyone saying anything to me. The Docs and Nurses were screaming at each other, as if I was deaf as well as blind. I think Patients tend to get 'lost' somewhere in the treatment, when all they need is someone to explain things to them. I spent one week twice a year in Hospital and the lack of open honest communication between Doc and Patient leaves me speechless. Perhaps if this Patient was told 'You are having a reaction to the drugs and we need to keep you here' he might just accept the truth. Gee, if I was unstable on medication, reckon I would be willing to lock myself in a padded room, in case I hurt anyone.

Answer 3

The nurses are not able to disclose the reason why this person is in the hospital. Even though a person may seem ok mentally he/she may not be. There are processes that may affect their ability to reason. There are many medical reasons why people are restrained in the ICU, which could a person may also be restrained for mental illness. The patient is obviously a danger to self and others and this alone is reason enough to restrain. Many metabolic processes can cause people to lose their ability to reason and until the people are brought back to baseline in regard to their health they lack the ability to consent, therefore decisions are made for them in regard to their health.
My guess is this person has a metabolic problem along with a psych history and unfortunately your husband was a little too close.

As an addendum to you comments, your critical care nurse friend should sit down with you and explain how people have a sense of impending doom when their oxygen saturations drop or they have a drop in blood pressure the first thing they want to do is get up which will put them in immediate peril and drop their blood pressure even more.

It is terrible to watch anyone held against their will. My advise to all the people who say it is illegal to hold this person (which none of us can truely make that determination), make sure you have an advanced directive completed so you don't find yourself in the same circumstance.

Answer 4

Legally he must be released. If the patient is mentally sound and doesn't wish to be there, then he can't be held. Get the doctor to make the patient sign a waiver saying the doctor isn't liable as he was released against the doctor's judgement, and give him instructions on how to heal at home, but beyond that, he cannot be held against his will.