Frustration

On a recent placement i was given a patient to treat who had a head injury. From the first session with him, he would thump his PCA, PT and me. It was frustrating because we couldnt punish him.

After talking to the clinical psych we implemented "gym rules" which said "keep hands and feet to ourselves, no hitting, punching etc...". This worked well. The patient did require constant reminders of the rules, but generally there was no thumping after it was implemented.

The treatment session i didnt start with a review of the gym rules, the patient started being physical. He continued to be this way even after being reminded of the rules. Then as i was sitting next to him, he scratched my eye with a bean bag. I reacted quicker than i could think and i took the bean bag from him and gave him an assertiveish/very annoyed/angry talking to. I mentioned that he was out of line, and that his actions were unacceptable. I was fuming!

For the rest of the session he did nothing...just sat there on the bed. We tried hard to get him to walk with our assistance but he declined. We ended up just t/fing him to his w/c and letting him go back to his room.

The following session i started off by mentioning to the patient that i didnt hate him and that i was looking forward to having a good session with him that day. We reviewed the gym rules together and actually had a good session with no thumping or innapropriate behaviour.

I learnt in this situation how difficult it can be to deal with children with head injuries. I learnt that there must be a consequence for their actions and being in a position to take something of value away from this child may have given me more leverage to control his behaviour. The problem was that there isnt much we can actually limit or stop him from doing.