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Nurse who slapped patient guilty of professional misconduct.

A REGISTERED nurse (RN) who slapped an intellectually disabled mental health patient's face while attempting to restrain her, and who subsequently failed to tell the doctor carrying out a medical assessment of the patient about the slap, or fill in an incident form about it, has been found guilty of professional misconduct and censured.

Kees de Bruin was employed in Canterbury District Health Board's (DHB) psychiatric services for adults with an intellectual disability when the incident occurred in March 2011. The Health Practitioners Disciplinary Tribunal, at a hearing in April this year, heard evidence that during a "messy" restraint procedure, "Patient E" slapped de Bruin's arm and then spat in his face. He then slapped Patient E on the side of her face. She was then removed to a seclusion room. De Bruin was sacked as a result.

Following proceedings in the Employment Relations Authority and the Employment Court, he was reinstated to his job. At the tribunal hearing, the tribunal stated it was not bound by the findings of the Employment Court and had placed that decision to one side, reaching its conclusions "solely on the basis of the evidence placed before it".

After hearing evidence from de Bruin and two nurses who were also involved in restraining Patient E, the tribunal concluded the slap was a reflex action, with no element of premeditation. But to assault a vulnerable patient in any way was a very serious matter and should never have happened. "It is always wholly unacceptable for any health practitioner to assault a patient, even if there is provocation. The tribunal is well satisfied that physical abuse occurred," the tribunal stated.

After hearing evidence from one of the nurses involved and written evidence from Patient E regarding a charge that, during the restraint procedure, de Bruin knelt on Patient E's chest and/or upper abdomen, the tribunal found neither account sufficiently reliable. It found there was "no deliberate application of force by de Bruin's knee" during the restraint.

In discussing the penalty, the tribunal said there were aggravating and mitigating factors. Aggravating factors included the requirement that health professionals should never apply unwarranted force to any patient and that, when incidents occurred, they had to comply with appropriate protocols. De Bruin also failed to take into account the stress and emotional harm his actions inflicted on the patient. Mitigating factors included that de Bruin was suffering significant personal stressors, he realised immediately he had acted inappropriately and, since being reinstated, he had taken positive steps by attending appropriate courses and undertaking supervision. The tribunal also noted his 42 years' service to nursing.

The tribunal imposed conditions on de Bruin's practice. For three years from April 4, 2013, the Nursing Council must approve any employer of de Bruin as an RN. This does not apply to Canterbury DHB. Professional supervision must continue for three years from April 4, 2013, reducing from four sessions a year in the first year, to three in each of the last two years. He was ordered to pay $6000 in costs to both the Professional Conduct Committee, which laid the charges, and the tribunal.

The tribunal ordered a notice stating the effect of its decision be placed in Kai Tiaki Nursing New Zealand and the Nursing Council's newsletter News Update. The full decision is available on the tribunal's website, www.hpdt., reference 533/Nur12/226P.

Kees de Bruin, RN
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Title Annotation:disciplinary notice; Canterbury District Health Board
Author:de Bruin, Kees
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Oct 1, 2013
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