Night-time Urgency in a Hemiplegic Patient With a Recent Fall

First two minutes

• Stay with Mr. R and ask him to wait before standing. Do not pull him up by his weak right arm; that arm is fragile and pulling can cause pain, subluxation or a fall.
• Lower the bed, apply the brakes, put non-slip footwear on him and place the call bell within reach. Keep the IV line from catching on the bed rail.
• Call the staff nurse or another GDA for help. The nurse is with a chest-pain patient, so also try the ward phone or ask a colleague; do not simply leave Mr. R alone.
• Ask him whether the stool is already coming and whether he feels dizzy, sweaty or faint. Urgency plus recent fall and confusion means he is high risk.

Decision

• If he cannot wait, use a bedside commode or bedpan with privacy and stay within reach. This avoids a walk when he is urgent, confused and recently fallen.
• If he can wait and a second trained person is available, transfer him with a gait belt over his pyjamas, stand on his weak side, and walk the shortest safe route. A commode three metres away is still a transfer, not a simple walk.
• Do not let him walk alone even if he insists. A single GDA should not attempt a high-risk transfer without help unless there is an immediate life threat.

Why: the priority is preventing another fall while meeting a basic need with dignity. The choice depends on urgency, his stability, and whether help is available, not on his insistence alone.

• Acknowledge his wish: say clearly that you understand he wants to use the toilet and that you will help him do it safely.
• Explain the specific risk in simple language: he had a stroke, his right leg is weak, he fell two days ago, and he is confused about time. Walking alone at night with an IV line makes another fall likely.
• Offer real choices rather than a single command: bedside commode now, bedpan, or a assisted walk with a gait belt as soon as a second staff member arrives. Give him a short wait time if it is safe.
• Do not threaten, shame him, or physically restrain him. If he tries to stand, position yourself on his weak side, hold the gait belt if he allows it, and guide him back to the bed or commode. Use the least restrictive action needed to prevent immediate harm.
• If he remains confused or agitated, treat it as a change in condition and escalate to the nurse. Delirium at night is common and is itself a fall risk.
• Record his refusal, the alternatives offered, and the fact that the nurse was informed. Respecting autonomy does not mean abandoning observation.

Record and report:

• Time of the call, what he asked for, and how urgent he was.
• What he actually passed, and whether urine or stool leaked before assistance.
• Transfer method used: bedside commode, bedpan, gait belt, number of staff, distance walked, and whether he bore weight.
• Any refusal, the choices offered, and who was informed.
• Observations: dizziness, sweating, pallor, confusion, pain, breathing, IV site, skin condition, and whether the bed brakes and call bell were checked.
• Fall-risk actions taken and any near-miss.

Why each item matters: the record supports continuity of care, shows that you assessed and acted on risk, provides legal evidence if a fall is alleged, and helps the next shift plan night-time toileting. A near-miss is as important as a fall because it identifies a preventable hazard. Report verbally to the nurse at once and again at handover; do not wait until the end of the shift.