Psych Pts are Found throughout the hospital. 5 quick tips...

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    Patients with psychiatric disorders are found throughout the hospital. Here are 5 quick tips to non-psych nurses to help avoid injury to staff, patients and visitors.

    Psych Pts are Found throughout the hospital. 5 quick tips...

    Do psych patients scare you? You scare them more.

    That’s been my experience both in and out of inpatient psychiatry. Reality is patients with psychiatric disorders appear on any unit. Nursing care staffers often unintentionally let their uncertainties affect their practice in caring for this population.

    Stories abound of nurses who sustain serious injuries when a psychiatric patient decompensates on a non-psych unit. Scary, to be sure, for the patient involved as well as others, their families and staff. How many 1:1 sitters receive specific training for redirecting, de-escalating or removing themselves from a disoriented or psychotic patient?

    After a move from psychiatry to general medicine I discovered some habits and practices second nature to a psych nurse could help other staff stay safe and our patients to have more positive outcomes.

    Here are my top 5...

    #5. Suicidal thoughts, attempts or violent acts require unique environmental awareness.

    Meal trays should be ordered with plastics not silver and the utensils counted and removed from the room after the patient eats, not put in the trash inside the room. A historically violent patient's plate and tray can be replaced with a to-go box. A broken anything becomes a potential weapon, usable to inflict harm on self or others. Basic maintenance requests might require a request from the boss to expedite repairs in these patients' rooms. The same is true for extraneous medical equipment, bedside tables and even trash cans. Added safety can come from removing these items particularly prior to removing restraints after an episode of aggression.

    #4. Communicate. Communicate. Communicate.

    Explaining and educating must be elevated to a higher level than the usual priority. Don’t touch or attempt to medicate a paranoid,disoriented or hallucinating patient without calmly announcing your intentions.Nobody likes surprises. I’ve seen more than one scared nurse bolt from doorway to IV with a syringe without so much as knocking to announce their presence. One of them caught a knee to her jaw leaning over to push the medication, though the patient appeared sedated.

    #3. Reorient and redirect simply, calmly and often.

    Know that many psych patients have short term memory impairment and don’t recall or can’t process what you told them when you were in the room an hour ago, or even five minutes ago. Unintentional confrontation comes when a provider or caregiver is insistent about convincing a patient that their perception of reality is inaccurate. Patiently accept that until their symptoms are better managed, their reality is the only reality. We’re not going to fix that no matter how therapeutic we think we’re trying to be. Reorientation can wait if attempting it is agitating the patient or provokes a confrontational response from them.

    #2. Special empathy required.

    Aggression is often symptomatic of fear Simply put, imagine being a tachycardic patient paranoid that people are chasing you and trying to kill you. Now imagine how that patient might feel after somebody ties them down in four-point restraints. Consider the possible source of the fear. Your reassuring voice verbally confirming the patient's safety in a hospital and the identities of people actually in the room could be the most therapeutic thing you do for that patient that day.

    #1. Stay geographically safe.

    Whenever possible don’t position yourself with the historically aggressive patient between you and the door. We all move from side to side of the bed for care-related tasks without thinking. It’s second nature for a sitter to sit bedside away from the door with the good intention of staying out of the way of doctors and nurses. This one thing can be the habit that saves staff from injury. Don’t inadvertently make yourself a convenient target. Leave yourself an escape route and don’t be ashamed to use it.
    Last edit by Joe V on Nov 4, '16
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  3. Visit TXMedPsych profile page

    About TXMedPsych, BSN, RN

    TxMedPsych started her career in inpatient psychiatry caring for pediatric and adult patients. A certified PMHN nurse she now works in medicine motivated to see psych patients cared for safely and effectively & help co-workers avoid injury.

    TXMedPsych has '4' year(s) of experience and specializes in 'Psychiatry, General Medicine'. From 'San Antonio, TX'; Joined Jan '11; Posts: 12; Likes: 45.

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    53 Comments

  4. by   vintagemother
    Naw, they don't scare me! I try to see them where they are. Often, they're not lashing out at the nurse/aide, but at their own internal preoccupations.

    I heart trying to help psych pts. It's my passion!

    Well, maybe I was scared once or twice! But I shook it off!
  5. by   Farawyn
    I got beat up, once pretty badly, by 2 different male psych patients in a group home.
    One was schizophrenic and he was reacting to ... Not me, but he bit me hard and broke the skin. I still have the scars.
    The other beat the stuffing out of me, and if it wasn't for the staff I worked with I would have probably been choked out.

    That being said, I stayed another 2 years, until I became an RN.

    I was never scared. Wary, but not scared.
    When I write about it, it is scary, but in the moment I handled it.
  6. by   ThePrincessBride
    I just want to also mentioned that not all psych patients are equal in severity. I have been hospitalized for such issues but was never physically violent towards others, just depressed and suicidal.

    I hope I didn't scare anyone, lol.
  7. by   Farawyn
    Quote from ThePrincessBride
    I just want to also mentioned that not all psych patients are equal in severity. I have been hospitalized for such issues but was never physically violent towards others, just depressed and suicidal.

    I hope I didn't scare anyone, lol.
    *hugs* TPB
  8. by   ThePrincessBride
    Not liking because you got hurt, but liking to say thag I am so sorry that happened. I would have quit that day!

    Quote from Farawyn
    I got beat up, once pretty badly, by 2 different male psych patients in a group home.
    One was schizophrenic and he was reacting to ... Not me, but he bit me hard and broke the skin. I still have the scars.
    The other beat the stuffing out of me, and if it wasn't for the staff I worked with I would have probably been choked out.

    That being said, I stayed another 2 years, until I became an RN.

    I was never scared. Wary, but not scared.
    When I write about it, it is scary, but in the moment I handled it.
  9. by   Farawyn
    Quote from ThePrincessBride
    Not liking because you got hurt, but liking to say thag I am so sorry that happened. I would have quit that day!
    I had known the guys (residents, patients) 3 years at that point. It wasn't about me.
    Honestly, if I followed what OP is writing about, I may not have been attacked by the "beat the stuffing out of me" dude.
    Last edit by Farawyn on Apr 1, '16
  10. by   TXMedPsych
    Too true that lots of psychiatric disorders in many patient populations -- and certainly I didn't presume that assumes violence. At the same time, when at work it's a prevailing attitude with co-workers. They can't appreciate clinical anxiety either. We spend a lot of time with things that are reflected in test results without holistically seeing the psych disorder as a co-morbidity that impacts all the other.
  11. by   vintagemother
    Dang Far! I'm sorry that happened to you. Way to go persevering through that. ((Hugs))
  12. by   VivaLasViejas
    I used to be afraid of psych patients...and then I became one. Suddenly I could understand where they were coming from, as I could feel the uncertainty and the fear and the confusion that happens during psychosis, and see "the look" on the faces of other healthcare professionals while going over my med list. It's been an eye-opener, that's for sure, and it's given me a hell of a lot of empathy for other mentally ill folks.
  13. by   canoehead
    I have never gotten the point of substituting plastic utensils for metal. Our metal knives are duller than dirt, but by breaking off a plastic utensil, you're almost sure to get a sharp edge. If I wanted to hurt someone...I'd use the plastic.
  14. by   VivaLasViejas
    Quote from canoehead
    I have never gotten the point of substituting plastic utensils for metal. Our metal knives are duller than dirt, but by breaking off a plastic utensil, you're almost sure to get a sharp edge. If I wanted to hurt someone...I'd use the plastic.
    They let us have regular flatware on the psych unit where I was inpatient. We had to turn the utensils in for counting at the end of each meal. I'd been in for a few days when we had a guy in a mixed bipolar episode come in. He promptly snapped his hospital-issued toothbrush in half and used it to cut his wrists. So yes, plastic can be dangerous too.
  15. by   WinterLilac
    I work in mental health (psychiatric) recovery where people come to relearn skills and confidence after they have been in the acute inpatient unit. The people, when they come to us, are usually pretty well, having received intensive treatment in hospital. As such, we are prone to becoming lax in regards to our personal safety. We recently had a staff meeting where the HR officer asked us if we always have an 'exit route' when we enter the clients homes. A lot of us admitted we didn't always think of it so we have all been reminded that these people, although currently well, may have times they are not so well so always be prepared. I really enjoyed reading this article as it has reminded me of major key points when dealing with a person with a mental illness.

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