Mental health nurse suspended from practice after telling staff to use pain compliance on dementia patient

Carlton Court in Lowestoft. Picture: Courtesy of Norfolk and Suffolk NHS Foundation Trust

Carlton Court in Lowestoft. Picture: Courtesy of Norfolk and Suffolk NHS Foundation Trust - Credit: Archant

A mental health nurse who recommended fellow staff use force to subdue an aggressive patient with dementia has been suspended.

Christina Patricia Sinclair-MacDonald worked at Carlton Court Hospital, in Carlton Colville, run by Norfolk and Suffolk Foundation Trust (NSFT) on August 19, 2017, when she told staff to use a method known as pain compliance to control a patient.

Mrs Sinclair-MacDonald was the nurse in charge of Foxglove Ward, which treats patients with advanced dementia and the challenging behaviours that come with it.

Following the incident and an internal disciplinary procedure, a Nursing and Midwifery Council hearing ruled last month Mrs Sinclair-MacDonald should be suspended from the register for six months.

The panel heard how the patient in question, who had Lewy Body Dementia, could not control all of his movements and had incoherent speech.

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On the day the panel heard how the patient was particularly "challenging to manage" and that he was "irritable" after a friend had been discharged.

The patient had punched doors, knocked over furniture, punched a visitor, and assaulted members of staff.

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But an agency nurse working on the ward at the time told the panel: "I think Christina told us to go down the pain route. I did not know what this meant as I had never been trained in using pain. I did not ask Christina what it meant as I was not going to be involved."

The nurse said she had not seen the method actually used, but that other staff members seemed to not want to go along with the suggestion.

She added it would have been unreasonable to use the procedure on a patient who lacked capacity, as they would not be able to understand why someone was hurting them.

A healthcare assistant also said Mrs Sinclair-MacDonald had told them to use pain compliance, after the patient had already been restrained, but said "we didn't use it because we didn't feel the need to use it".

The trust's prevention and management of aggression lead practitioner told the panel pain compliance should only be used in self-defence, and there was no situation where pre-planned pain compliance techniques should be used.

He said that applying pain to the thumb, which had been described by witnesses, was only to be used in an emergency and he added Mrs Sinclair-MacDonald's instruction raised "very serious concerns" about her understanding of the training she received.

The panel also heard how Mrs Sinclair-MacDonald had not recorded her instructions in the patient's care plan, however, she had said a medical review had been carried out when it had not, as there was no doctor on duty.

Ruth Alabaster, the case presenter, said Mrs Sinclair-MacDonald placed an elderly and vulnerable patient who lacked capacity, at risk of harm.

And the panel decided the instruction - which they found "radical and extreme" went against the patient's best interests, regardless of whether it was carried out or not.

Mrs Sinclair-Macdonald did not attend the hearing.

An NSFT spokesman said: "NSFT takes issues regarding the professional conduct of its staff very seriously.

"On August 19, 2017, a member of staff reported to our freedom to speak up guardian that Christina Sinclair-MacDonald had mistreated a patient. Mrs Sinclair-MacDonald was removed from clinical duties.

"Our head of patient safety and safeguarding made a referral to the Nursing and Midwifery Council due to a potential breach of the NMC's code of conduct and also to Suffolk County Council in respect of a safeguarding allegation.

"A trust disciplinary hearing took place on April 19, 2018 when Mrs Sinclair-MacDonald was dismissed for gross misconduct."

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