Contribution of an institutional accompanying person to the reporting of 3 episodes of violence by a hospitalized patient at the Moussa Diop clinic of the Fann psychiatry department, in Dakar
Racky WADE-KANE1, Boubacar BAGUE2, Ibra DIAGNE3, Aida SYLLA1
¹Department of Psychiatry and Medical Psychology, Fann hospital, Cheikh Anta Diop University,Dakar,Senegal.
²Department of Psychiatry, Joseph KI-ZERBO University, Ouagadougou, Burkina Faso.
³Health emergency operations center (Cous), Dakar, Senegal.
*Corresponding author
*Dr Racky WADE- KANE, Department of Psychiatry and Medical Psychology, National University Hospital Center of Fann, Dakar, Senegal, PB 5885 Dakar-Fann, 10700, Senegal.
DOI: 10.55920/JCRMHS.2023.06.001273
Abstract
Introduction: At the Fann Psychiatry department, institutional accompanying person is often very close to patients. Sometimes, they are the only ones to witness pathological attitudes or behaviors coming from patients. Thus, we will study the contribution of an institutional accompanying person to the detection of 3 episodes of violence in a hospitalized patient and then formulate recommendations.
Methodology: Our study is qualitative and was carried out at the Moussa Diop clinic of the Fann psychiatry department. We relied on the case of a patient who benefited from two presentations, one of which was taken from a summary of the medical file written by the medical team and the other described orally by her institutional accompanying person named FN during a semi-structured interview.
Results: Presentation of the medical file: This is a 54-year-old patient treated for dysthymic schizophrenia with a medical history of 3 hospitalizations. During his last hospitalization, no episode of aggression or violence was mentioned in his medical file. She is known to be very calm by caregivers.
Presentation of the patient by the institutional accompanying person FN: “Madame was very violent. With each hospitalization, she can end the life of her accompanying if the latter does not flee.” She specifies: “During her last hospitalization, I narrowly sketched the chair with which she wanted to smash my head. The first 3 days of each hospitalization are permanent insecurity for me, it’s our job, what should we do? However, in the days that follow she becomes cooperative.”
Conclusion: Due to the undefined working conditions of the institutional accompanying person, episodes of repeated violence by a patient were not transmitted to the caregivers. Which makes these recommendations for this clinical case a priority to help them in the exercise of their functions.
Keywords: Patient violence, Institutional accompanying person, Prevention
Methodology
Our study is qualitative and was carried out at the Moussa Diop clinic of the Fann psychiatry department. We relied on the case of a patient who benefited from two presentations, one of which was taken from a summary of the medical record written by the medical team and the other described orally by her institutional accompanying person named FN during a semi-structured interview.
Results
Presentation of the medical record:
This is a 54-year-old patient followed for dysthymic schizophrenia with a medical history of 3 hospitalizations in the same division for similar reasons. During her last hospitalization, she followed her treatment calmly with a good progression of psychotic symptoms until her discharge after 15 days. No episodes of aggression or violence are mentioned. She is known to be very calm by caregivers.
Presentation of the patient by the institutional accompanying person FN at the request of the medical team:
She begins with: “Madame was very violent during her first 3 days of hospitalization. With each hospitalization, she can end the life of her institutional accompanying if the latter does not flee.” She specifies: “During her last hospitalization, I narrowly sketched the chair with which she wanted to smash my head even though I didn’t see it coming. It was the same with the 2 other hospitalizations that preceded it. The first three days of each hospitalization are permanent insecurity for me, it’s our job, what should we do? However, in the days that followed, she became cooperative and adapted well to the rest of her hospital stay. In any case, her family will have to find another accompanying person for her if she returns to hospital because I am getting older.”
Comments
Presentation of the medical record:
We note that the episodes of violence during this hospitalization were not noted in the medical file. It is the same for the first two hospitalizations which preceded it. Indeed, we can understand the absence of detection of episodes of violence by caregivers, by the fact that after prescription of medication by the doctor and their administration by the nurse, the latter return to see other patients in hospitalization. There is no surveillance camera in the institution either. Added to this is FN's psychological and physical "capacity to cope", which was reflected in the absence of counter-violence coming from her. Counter-violence is defined as an inappropriate or disproportionate reaction, dangerous for the aggressor.
Presentation of the patient by the institutional accompanying FN
Most often, it is FN who stays with the patient and during this period there may be a reappearance of the symptoms which motivated the hospitalization.
When it comes to an episode of violence, it is often unpredictable, and events unfold very quickly before the caregiver is informed. With this risky situation, FN is trying to find immediate ways to protect itself. She specifies that she narrowly sketched the chair thrown by the patient. For past hospitalizations, she had fled when leaving the cabin. This demonstrates in her, the absence of technical training in simple self-defense to be able to protect herself.
Through her presentation, FN claims that it is her work that requires her to confront this violence and that she should not complain about it to either the caregivers or the patient's relatives. Which reflects the lack of understanding of its role in the institution. Also, she fears being described as incompetent by the patient's relatives and that the support will be withdrawn from her and entrusted to someone else, hence her silence.
The presentation described by FN reflects her psychological experience faced with the violence of the patients she witnesses in the course of her work. She feels permanently insecure with apprehensions that resurface each time a violent patient is hospitalized.
To deal with this violence, she has put strategies in place such as resilience. She says, “the risk is during the first 3 days of hospitalization after which the medications begin to take effect”. It thus raises the reflection that should be made by caregivers on the use of physical restraint which is not authorized in the Fann psychiatric service. Another strategy is now his avoidance of supporting violent patients.
Recommendations
- Official definition of the status and prerogatives of institutional accompanying person.
- Training in simple self-defense techniques.
- Systematic participation of institutional accompanying person in patient visits, not only for requests for hospital discharges.
- Setting up a listening space to allow institutional accompanying person to share their daily experiences.
- Reflection and introduction of supervised physical restraint on medical prescription within the institution.
Conclusion
Due to the undefined working conditions of the institutional accompanying person, episodes of repeated violence by a patient were not transmitted to the caregivers. Which makes these recommendations for this clinical case a priority to help them in the exercise of their functions.
References
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