Nurse: Superhero, Villain...or Vampire?

Yesterday evening, after putting in a full day at my research job, I had to go to CAPE class for my second (psych) job.

Like many caregiver classes offered through the hospital, it was mandatory so we all get paid to take it, which is a good thing since it ate up six hours of my limited free time.

CAPE, or "Creating a Positive Environment", is more or less a method for deflating aggression, and if that doesn't work, using some skills to A) escape from a violent patient or B) help someone else escape from a violent patient. Unfortunately, it doesn't involve anything cool like kung fu moves or 007 style equipment.

First we got to practice using all the restraints in our arsenal, from the 5 point leathers (wrists, ankles, and waist) to the fabric restraints which are really more to help very old, ill, or confused patients from falling out of bed or a chair, to the restraints which are considered to be "medical immobilization" (such as restraining an arm for a minute or so while you put in an IV). The big difference between "restraints" and "medical immobilization" is that the nurse has to have an MD's order for a restraint, it has to be charted on frequently (depending on the type), and the patient has to be checked continuously for some and frequently for the others...while for a "medical immobilization", none of that has to occur.

We had to practice tying each other up in this stuff and then undoing it. Since you have to assume your patient doesn't want to have restraints, you have to realize you'll be trying to put these unwieldy things onto someone who's flailing and angry, so practice is good. It was a little spooky when my partner put leathers on me and I realized that even though the wrist restraint was on the smallest hole, I could STILL pull my hand out...which means a patient could, too. And we got to hear all the horror stories about patients who were put into the fabric restraints the wrong way and managed to suffocate themselves, which was NOT a cheery experience.

Then we got to practice our moves...what to do if someone grabs your arm, your clothes, your hair, bites you, grabs you in a bearhug, tries to choke you, puts you in a full nelson, tries to hit you with something, how to block a punch or a kick, how to hold a patient so they can't hurt you, how to trade off with another caregiver when you get tired, and how to hold someone really large with multiple staff members...and how to do all those things with the least harm to yourself or the patient.

We have to learn all this, but in the 15 years I've worked in mental health, I've never had to use it; and really, I've only had two patients who had difficult moments when I thought there might be trouble, but there wasn't. So I suppose I'm either lucky or doing something right.

Anyway when I got home, I was pretty tired. Gavin asked me how CAPE training went...and then asked "What level did you make, Mom?"

"Level?" I asked.

"Yeah, you know, like Superhero!" And he expansively waved his arms to indicate a graceful billowing cape as he leaped across the room while singing "Here I come to save the day!"...

...only to turn, his nose in the crook of his elbow, imaginary cape swirling around his feet, and his eyes narrowed, staring piercingly..."Or Vampire!" and immediately switching to a heavy Transylvanian accent, "I don't drink....vine..."

...then, in a half crouch, still with his nose in the crook of his arm, imaginary cape hiding half his face, twirling an imaginary handlebar mustache, with shifty gaze and deep commanding voice, "Or Villain! I'll tie you to the railroad tracks if you don't pay your rent, BWAA HAA HAA!!"

I'd MUCH rather have done that kind of "CAPE" training...and who knows, some of the patients might prefer that, too.