Differing types of therapeutic self-defense philosophy and techniques - pg.2 | allnurses

Differing types of therapeutic self-defense philosophy and techniques - page 2

As a nurse who's recently gone back to psych (my true love), I was totally taken aback by the type of training my state psych facility provides. I'm a patient-first advocate, and always... Read More

  1. Visit  nrsdolphin profile page
    0
    I worked at a VA hospital for 12 yrs, 5 on psych unit. We were taught to defend ourselves and not injure the pt, we also had a code red response specifically taught pt takedowns and defense that specifically kept the pt safe. Also, staff have been injured by pt's and sued the pt's, with unions help.
  2. Visit  Psychcns profile page
    1
    I like what alpha-sierra said above--about 90% of interventions being verbal...there should be a culture of non-violence, a culture of negotiation with patients, a culture of supporting patients needs/ Violence should be an aberration and taken seriously by leadership that there has been a failure of communication. and...staff should not get hurt. and when there is violence it is dealt with safely....
    elkpark likes this.
  3. Visit  Gregmercer601 profile page
    1
    Quote from mingez
    As a nurse who's recently gone back to psych (my true love), I was totally taken aback by the type of training my state psych facility provides. I'm a patient-first advocate, and always concerned for what's right for patients. Patient's should never receive any form of abuse. However, I feel there's a balance between patient's rights and the rights of the staff to be safe and free from abuse. At my facility (which is a state-run facility) I feel as though they've completely sacrificed the rights of the nurse and techs in favor of the rights of the patient. I want to preface this with the understanding that we are assuming all verbal therapeutic communication, and early interventions are exhausted prior to crisis events.Case in point:Blocking a punch in any way if it's directed outward from the body (as happens in any karate tournament, 99% of the time without injury) is considered abuse as it MAY injure the patient's striking arm. There is a difference between assaulting a patient with a punch and a block, however the state does not recognize this difference. To me, this is extreme. 2nd issue: Our state does not provide security personell for interventions. In Colorado, we had a designated security team trained in detaining, restraining, physical and mechanical restraints. BOTH staff and security would intervene and answer distress signals. (Mech restraints were the responsibility of the nurse ONLY, but they were still trained in application) This was back in 2005.In my current state, there is no provision for security, and the staff is to intervene in any and all crisis situations. My unit is VERY acute, and we have physical altercations often. Again, I'm all for "balance". I understand that we are not the patient, and are not psychotic, however I disagree with the idea that the training they provide (which is 2, 6-hour sessions) is enough to be proficient. And even if it WAS enough training, my opinion is that it wouldn't be effective even if one WAS an expert with years of experience in many crisis situations. (qualifier: I'm a black-belt level Jiu Jitsu, Mixed Martial Artist with years of self-defense training) Essentially, I feel as though it guarantees the staff member an injury...eventually. Situation that makes me post this:We had a tech fired for blocking a patient's arm using an open hand out-ward block. We all saw it, we all described it accurately to the investigative team. The patient bloodied the nose of the tech, and the tech NEVER used an offensive-based maneuver, just the block. QUESTION for you all:Is this the way it is at your facility? Are you state-run or private? Is this overly-progressive in your opinion? Please share you thoughts and experiences!
    I've worked inpatient Psych for twelve years, generally on the most acute units in our all-Psych facility. Many confrontations with violent patients over the years, but never injured. I've learned a few things : always work on strong rapport, with everyone : you build a reputation with patients and they listen more often, enough to make it worth your while. Show no emotion, speak slow. And clear. We have private security but mostly rely on staff coming from other units - I call early and often, and it ends up we need less force, as I give options with consequences - go here, take this or this will happen, time limit, go. Many folks back down, many at the last minute, and I then defer restraints, give Medication PO - very clear it's IM unless I'm convinced it's taken. Whenever you can avoid force, you gain a better working relationship, no grudge. As soon as thru back down, no hard feelings,judy monitoring as needed, backing off ASAP - whole unit learns you're good to them if they play safe, and the alternative is no fun. Most staff I've seen get hurt (many) took too many chances, tried to be a hero. You need to learn movements that are allowed in your culture - I too took martial arts, mostly used it to position self well, dodge, soft block - defections really, open hand, stay to pts side, stay on top of unit & team so they know what I want fast & we see problems coming. I can't speak to your unit - not there - but I've seen acuity vary wildly shift to shift based on different staff approaches. As I've gotten better at it, same patients get violent less, and most emergencies that used to go violent don't - not all, but much better. When you assume violence is inevitable or avoidable, either way you greatly influence the odds in favor of your expectations. I've even learned to pretend I'm fearless when I'm surely not - it helps. You can't change others nearly as much as you can yourself, so that's where I focus -learning how to become accepted by patients & staff as a trusted respected leader - its more possible than most people think.
    elkpark likes this.
  4. Visit  voban profile page
    1
    I am a psychiatric nurse educator in a not for profit hospital. Our psych unit is stand alone and we have no specially trained security, just your regular outsourced security staff. Only one on at a time generally. They will come and back us up if needed but the nursing staff is pretty much on their own and must do the take downs. The acuity is high, we are much like a county facility and have an intensive care unit where we try VERY HARD not to seclude or restrain people; as a matter of fact, we try so hard, sometimes we let it go too long before we use s/r.

    New orientees are taught basic self defense techniques and blocking and what we must avoid (sitting on chest for instance) and what we must do (protect patient head, etc) and that" hands on" is the last resort. If the patient is psychotic and small enough to handle, we will do our own take downs but we have a problem with anti social types who come in and do nothing but threaten lives, etc and have the capacity to really hurt someone (and are focused on that). We don't have enough staff to handle that and NO ONE should be expected to put themselves in harms way.

    In those cases, we WILL all the police. We will not risk more injury than necessary and our staff have pressed charges on patients who were more behavioral than psychotic and have caused injury intentionally. When a patient has been nothing but overtly threatening (consistently) or has already damaged property or injured someone, they will sometimes be taken to jail. Sometimes they are simply put in restraints with assistance of the police.

    Our manager stands behind us although upper leadership isn't happy about it. It is a person's RIGHT to press charges when they feel the assault is intentional, mental illness or not. Several of our RNs and assistive staff have been permanently injured by patient assaults.

    In NO WAY are we expected to be punching bags. By the way, MOST of our patients aren't ANYTHING like that (violent).
    elkpark likes this.
  5. Visit  pamnock profile page
    0
    In my state, (Pennsylvania), it is a felony to assult a health care worker. Our doctors advocate for staff safety and encourage staff to press charges if assulted by a patient. We can certainly block a punch to protect ourselves from injury. A patient can just as easily injure their hand from punching staff in the mouth as they can from staff blocking the punch. Here is a list of state statues addressing patients assulting health care workers.
    http://www.ena.org/IENR/Documents/St...d%20Felony.pdf
    Pam
  6. Visit  greenykilt profile page
    0
    For those of you that hold martial art belts and extensive experience, do you wonder if your response to a patient altercation. While even docile, would be trumped into something more because of your known fighting ability?
  7. Visit  TerpGal02 profile page
    0
    My hospital is 46 beds and that includes adults and C&A. We have training on therapeutic interventions every 6 months. Obviously verbal de escalation is stressed, but we do learn hands on maneuvers. We don't have specific security, but we can call staff from any part of the building if needed. The Sheriff's office is the last resort. Our physical safety is a priority, and we are taught how to deflect punches, grabs, choking, hair pulling and biting. Usually we can verbally de escalate adults, or at the very least escort them to the quiet room without much fanfare and we do give IMs. Honestly, its the younger kids we have to go hands on with much more frequently, and you are way more likely to get hit, kicked, bitten, or spit on by one of the younger kids rather than an adult.
  8. Visit  juschillin profile page
    0
    I have many years of psych RN experience in all types of settings. Here is my take on the whole topic: I firmly believe in non-violent approaches for psych inpatient. Wow, how novel! The delivery of psychiatric care and treatment is changing; rather than being violent and dehumanizing, it will eventually be humanizing and healing.

    There will come a time when we look back at how, in 2013, we still strapped down patients in 4-point restraints, locked them up in solitary confinement for their "time out", and allowed ourselves as nurses to engage in assault and battery with our patients. (And ECT? It will be a thing of the past, and we'll compare it to insulin shock therapy, right up there with a good old Jack Nicholson lobotomy.)

    My opinion, for whatever that's worth. Meanwhile, stay safe!

    -jc
  9. Visit  TerpGal02 profile page
    0
    Quote from juschillin
    I have many years of psych RN experience in all types of settings. Here is my take on the whole topic: I firmly believe in non-violent approaches for psych inpatient. Wow, how novel! The delivery of psychiatric care and treatment is changing; rather than being violent and dehumanizing, it will eventually be humanizing and healing.

    There will come a time when we look back at how, in 2013, we still strapped down patients in 4-point restraints, locked them up in solitary confinement for their "time out", and allowed ourselves as nurses to engage in assault and battery with our patients. (And ECT? It will be a thing of the past, and we'll compare it to insulin shock therapy, right up there with a good old Jack Nicholson lobotomy.)

    My opinion, for whatever that's worth. Meanwhile, stay safe!

    -jc
    Sorry, gotta disagree with the ECT thing. ECT has its place and its therapeutic value has been proven many times. My facility does ECT and I have seen for myself how well it works when nothing else does, and its actually safer than some of the meds we hand out.
  10. Visit  elkpark profile page
    0
    Quote from juschillin
    There will come a time when we look back at how, in 2013, we still strapped down patients in 4-point restraints, locked them up in solitary confinement for their "time out", and allowed ourselves as nurses to engage in assault and battery with our patients. (And ECT? It will be a thing of the past, and we'll compare it to insulin shock therapy, right up there with a good old Jack Nicholson lobotomy.)
    ECT is a safe, effective, and valuable treatment modality. I've seen it help many people over the years who were not helped by medication. If, God forbid, I ever found myself having to make a choice about treatments, I would happily take ECT before I'd take a lot of the psych meds we give people routinely.

    And seclusion and restraint are (correctly, IMO) considered less restrictive and intrusive interventions than emergency medications. Again, I would prefer to be restrained or secluded rather than injected with an antipsychotic. Once in a while, people do need to be kept from harming themselves or others, and, once you let someone out of restraints or seclusion, it's over. The antipsychotic medications stay in your system for hours to days.
  11. Visit  toughspot profile page
    1
    I see a bit of ECT. I have seen it at its worst (almost used punitively in cases where the research for its efficacy seems tenuous at best) and I have also seen it at its best, especially with geriatric depressions and major depressive disorder with psychotic features. I used to think of it as barbarous before I saw it done and held a patient's hand before they went under anesthesia. Seeing their progress over the course of their treatment made me a believer, so long as the evidence supports its use. I have also seen it seriously mess people up in terms of exacerbating or creating memory issues or throwing people into cardiac or respiratory issues.

    I HATE putting people in locked seclusion. I HATE IM "chemical restraints". I HATE having to restrain people in four-point restraints. And I do it all the time, because as much as I hate those things I also care about their safety, the safety of my coworkers and the safety of other patients has to come first. There are certainly situations wherein a patient cannot be controlled, placated or cowed by therapeutic rapport, verbal de-escalation techniques, or simple avoidance. Anybody who believes otherwise has never worked with an acute psychiatric population. I would strongly encourage those people (I believe everybody should be a server and work on an acute or gero psych unit once in their life for humility's sake) to give it a shot for a few months.

    I've seen lobotomies too, they don't do them for psych anymore but for seizure disorders...trust me, for some people what you may consider the most invasive and off-putting measures may be all they can do in hopes of something resembling an acceptable quality of life for themselves.

    I would agree with the previous poster...I would much prefer an ECT trial over medications with the types of long term side-effects psych meds give. Sedatives...not so much. I have seen many, many patients act out in HOPES and straight-up demand or request benzos...that's a problem in of itself. EPS, Tardive, weight gain...no thank you. Still...all of those things may trump command hallucinations or a crushing and debilitating depression. I have no frame of reference and god-willing never will.
    elkpark likes this.
  12. Visit  SNB1014 profile page
    0
    Quote from brillohead
    I'm a nursing student and will be starting my psych rotation in May. I'm curious to see what the protocol is like in my area....
    well when i was doing my psych clinic at the county facility we had an inservice at the staff & security told us this:

    students are not protected the same as staffing (idk what the difference was, but he made it clear that we were not insured by the facility and the facility would not be paying for "incurred" expenses.

    that in no way shape or form were students to be alone in a room with a patient. reasons included psych issues for the patient stemming from sexual abuse, torture etc and they could act out; some patients had abusive "habits" that as students we might not be aware of etc

    that when speaking with a patient you should never ever have your back against a wall and you must always be aware of the TWO ways you can dart to safety.

    when sitting with a patient we were to be in arms length distance and across a table. if in chairs, we should be one chair away or something
    ladies, no pony tails because if we ran, that is what they could grab on to. no necklaces for the same reason and ESPECIALLY do not wear anything with religous symbols or bright colors, as this may aggravate them.

    THIS SAID, when patients are (often involuntarily) in a *locked* county or state psych facility, they are at their worst. they are unmedicated (or i should say a therapeutic dose/ effect has not been reached), unpredictable and psychotic. and people with bad enough depression can become psychotic as well, in very extreme situations.

    i did a few days in a locked down child psych unit and it was bananas. it took 1 rn, 2 big male security gaurds, 1 tech and a pleading parent to physically, mechanically and chemically subdue a tiny austic 9 yo boy. i wouldnt have believed it if i hadnt seen it myself. but there was a clear cut system in place. it was very matter of fact and calm (in the weirdest way).

    take a couple mins to review the policy that you clinical site has regarding abusive pt and staff safety.
    if you dont follow policy , the higher ups will never ever back you up or cover your expenses.
  13. Visit  mikenmim profile page
    0
    We have an obligation to provide treatment. There can be no effective treatment if staff are in fear.


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