Forcibly removing piercings in psych patients - page 2

I have a very sensitive question. I have recently learned of a patient, who is bipolar and who was having a crisis, went to the ER. There, every patient has to go through a metal detector, and... Read More

  1. by   KathyDay
    What does this question mean, or imply?
  2. by   Julius Seizure
    Quote from meanmaryjean
    Color me skeptical of the original story.
    I certainly hope so. It sounds awful.

    Quote from KathyDay
    If things happened the way they were described, this was assault and the patient's nurse did not protect her patients safety or rights.
    The nurse may have been horrified as well and didn't know what to do. Or maybe she thought it was fine. We don't know. But the nurse didn't do it. The security guard did. The security guard didn't protect the patient's rights. The security guard escalated the situation unnecessarily. The security guard is the one that caused physical injury to the patient. Lets make sure the focus is on the right person here.

    If the story happened as described, I would be contacting the hospital as well, and maybe via my lawyer.

    By the way, I've never seen an ER with metal detectors for the patients. Out of curiosity, do they send all patients through it? Just psych patients? I can't imagine wheeling a trauma patient through. Just wondering how it works.
    Last edit by Julius Seizure on Oct 23, '17
  3. by   That Guy
    Quote from /username
    Hey guys... so there's no potential she ripped them out herself?
    This is why I hate this job, its so hard to trust anyone. I always assume the worst in people when I read this stories of second hand accounts.
  4. by   JKL33
    Quote from Anna Flaxis
    What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...
    I specifically didn't elaborate because I tend to agree with you and didn't want to make more of it than it is - - although digging, scratching, lacerations and other problems are certainly not impossible with body piercing jewelry. The issue isn't limited to what long-term "harm" it causes, though, but also what others can say about how well the patient's safety was being assured if they were able to do something like swallow a metal object. KWIM? What else might they have done ("since apparently no one was paying attention") - and yes, I have observed accusations like this. I won't even say it is likely to go anywhere legally. It is another layer of shenanigans that doesn't need to happen, and is not a therapeutic situation.

    Actually the more I think about it, the fact that any particular piercing may not cause much damage if swallowed may very well be purely secondary. The manipulations that tend to evolve from this general situation are a bigger deal, though. Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.

    Would I allow someone to be assulted? No. Not if I could help it. Which is also what I already wrote. I've had my rounds with security and even the police going to bat about things like this. But earlier in my career I've also had situations where I didn't consider all the possible ways things could go wrong, so I'm pretty reluctant to just say sure no problem, we don't need to follow our procedures for you. Rather, my belief is that there are usually ways to follow procedure while educating and giving appropriate information and interacting respectfully.
    Last edit by JKL33 on Oct 23, '17
  5. by   JKL33
    Quote from JKL33
    Say she removes the jewelry and then tells everyone she swallowed it and that she is having sharp lower chest or epigastric pains. Doesn't matter if it's "likely" to cause any harm or not at that point - we're now off track and won't be able to get a psych bed for this patient anywhere that isn't med-psych - which in plenty of areas simply means you won't be getting a bed. These, and more, are the kind of things that happen. There are actually reasons for the SOP.
    Should say "or" that she is having pain (after having actually swallowed). The point is the freedom to manipulate OR to actually cause harm to self or others is not okay.
  6. by   FNPTOB2018
    That was a very interesting read. Thanks for sharing!
  7. by   /username
    Quote from That Guy
    This is why I hate this job, its so hard to trust anyone. I always assume the worst in people when I read this stories of second hand accounts.
    Yep because patients can never ever harm themselves or be manipulative..
  8. by   Zyprexa
    Quote from /username
    Hey guys... so there's no potential she ripped them out herself?
    That's what I was thinking....
  9. by   hppygr8ful
    Quote from Anna Flaxis
    What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...
    We have had cutters do quite a number on themselves with the sharp end of piercings.

    Hppy
  10. by   FolksBtrippin
    The risk of forcibly removing piercings is greater than the risk of leaving them in. That's why at my hospital we ask patients to take them out, and if they refuse, the piercings stay.

    I am a psych nurse.

    I have seen the most horrific things done to patients to force them to comply with rules. This is a very big problem in psych. Bigger than I can handle sometimes.
  11. by   pluckyduck
    We have a six bed secured area for mental health patients. Anyone who is actively suicidal, homicidal or having hallucinations or acute psychosis is assigned a bed there by the triage nurse, as long as they don't require any immediate medical attention (any suspected intentional overdose would go to our highest acuity area to be medically cleared first). Our policy is the triage nurse must bring those patients back to the area and give report in person to the MHT nurse. The patient is asked to get undressed in a room and place all their belongings in bags (underwear, jewellery, everything.) I usually allow them a couple minutes to do so with the curtain mostly closed so I can keep an eye on them for any suspicious behaviour. Then the tech inventories and locks up their things in a designated locker and we provide them with a gown, socks, paper pants, blanket and make the stretcher up. They are not allowed to keep phones. We allow them to write down numbers so they may make calls if they want with a designated patient phone. we then place a tether on their ankle that alarms throughout the department if they try to leave.

    If someone is non cooperative I then ask security to send an officer to "supervise" and encourage patients to cooperate. If a patient escalates we notify staff MD and they order meds, and we restrain only if necessary. Security cannot apply restraints but they may hold arms and legs down for nursing staff to apply restraints. we are required to have face to face documentation and order within 15 min and q15min checks.

    What happened in your scenario is bizarre and I don't feel like the whole story is there.
  12. by   jdub6
    Quote from Anna Flaxis
    What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...
    If a stud there is a sharp-ish end, a hoop could be broken to create one, and either could be used to cut oneself or if swallowed has potential to cause damage much like a swallowed soda can tab. It's certainly possible, maybe even likely that they would pass without damage if swallowed and that any self-inflicted cuts with them would be superficial but that cannot be guarenteed.

    To me though the biggest problem is the psychological implications of successfully doing something [potentially] harmful, using something they aren't supposed to have but the rules were bent. It could encourage competition (she snuck in x and did y with it, i want attention so I'll use xx to do yy) or copycats, it sends a message to families that the hospital can't keep patients safe. The patient feels she can manipulate staff to allow self-harm. She feels the staff is incompetent and can't keep her safe. she may feel accomplished and enjoy being the center of attention/gossip and now seek to do it again but bigger. She can now say "i even cut/tried to kill myself in the psych ward."

    Policies exist for a reason. Psych patients can be very manipulative, and clear consistent boundaries are a must. If rules are bent for one person, the entire unit loses respect for them and other patients feel cheated.
    I don't necessarily agree with the methods used in OP. I do believe that at times force may be justified to prevent actual or potential harm to self/others. While the jewelry is hardly the most dangerous item a patient could ask to keep, it sets a dangerous precedent to tell someone they must turn something in for safety and then back down because they throw a fit.

    It's the same reason the police don't drop criminal charges because a patient tries-or pretends-to hang themself in jail. They go to a hospital or psych jail and get suicide watch but they don't get to say "if you bust me ill kill myself" and skip away. I know the two situations are very different in severity but psychologically the implications are the same.
  13. by   jdub6
    Quote from FolksBtrippin
    The risk of forcibly removing piercings is greater than the risk of leaving them in. That's why at my hospital we ask patients to take them out, and if they refuse, the piercings stay.

    I am a psych nurse.

    I have seen the most horrific things done to patients to force them to comply with rules. This is a very big problem in psych. Bigger than I can handle sometimes.
    I agree that the danger of a physical conflict may be worse than some jewelry. But, then don't make the rule at all.

    Patient A's earrings are very sentimental to her, but she understands and appreciates safety efforts and turns them in.

    Patient B doesn't really care about his earring but is angry about being on a psych hold so argues about everything. Staff lets him keep the earring because he seems about to blow.

    Patient C has borderline personality disorder and self-harms. She has used her bracelet to cut herself before and is thinking about doing so again. When asked to give it up she whines and cries and swears. She's allowed to keep them because staff doesn't want to escalate her.

    A, B and C came at the same time and witnessed each others admits.

    A feels cheated. She's the only one who did what was asked and didn't fight and she is the only one who lost her jewelry. She got no reward for compliance. She feels that B and C are in charge and not the staff. She is afraid B or C could blow up and the staff wouldn't protect her from them.

    B feels triumphant and now threatens violence whenever he doesn't get his way. He already felt the psych program was a joke but now that feeling is stronger. His focus is now on what he can demand next to enjoy himself. He puts no effort into groups or therapy. A thinks B is in charge, not the staff.

    C smugly heads to her bathroom and cuts herself. She comes out and displays the cuts to another patient. She is the center of attention and gossip and calls her mother saying she kept her jewelry against the rules and used it to try to kill herself. Her focus is now on what she can do next that's bigger and better, and is silently challenging staff to stop her. During future intakes and evals she will tell how she brought sharps to the psych ward and used them in a "suicide attempt."

    Again I feel that consistent firm boundaries are so important in psych. If you don't want to enforce the rules by whatever means necessary then maybe the rule shouldn't exist.

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