case study:
Tim, a 32 year old man, was admitted via the emergency department following a fight at a
weekend football match he attended as a spectator. Examination has revealed a dislocated
shoulder, deep scalp lacerations and extensive bruising to his face and upper body. The
emergency department was very busy, with multiple ambulances arriving and many
patients being admitted. It took some time for Tim to be admitted for surgery, during this
time an alcohol and drug screen was undertaken and these tests were clear. Tim did not
like waiting; he stated he felt unwell and drowsy, he became increasingly noisy and
uncooperative - this was a change from when he arrived; at that time, he was lucid and
polite. Tim fasted, went to the operating theatre and returned to a room on the ward. On
waking, Tim’s observations were stable, although the nursing staff had difficulty doing his
postoperative observations as he was drowsy and noncompliant. Two hours after surgery
Tim stated, “I’m going back to the football match because my team need me to play”. The
Registered Nurse (RN) and doctor on duty tried to persuade Tim not to leave, he continued
arguing and shouted, “Leave me alone, don’t touch me, I want to get out of this bed”. The
doctor thought perhaps the behavior may be attributed to pain, and ordered intramuscular
morphine. Tim stated, “I’m not in pain, I don’t want morphine”. The RN went ahead as per
the orders and administered the injection to Tim, whilst another RN and a nursing assistant
held Tim to prevent him from struggling, causing the needle to break off, and necessitating
further surgery, which resulted in an additional four weeks in hospital.