Differing types of therapeutic self-defense philosophy and techniques

  1. 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 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!
  2. Visit  mingez profile page

    About mingez

    mingez has '2.5 Years' year(s) of experience and specializes in 'Psych, Ortho, Stroke, and TBI'. From 'Washington, DC'; 41 Years Old; Joined Jan '05; Posts: 244; Likes: 54.

    26 Comments so far...

  3. Visit  mingez profile page
    0
    Nothing? I was expecting this to be a hot button topic... :flamesonb
  4. Visit  VivaLasViejas profile page
    4
    I can't think of anything much to say, except I hope that tech sues the pants off the facility and gets his job back with retro pay. NEVER should anyone lose their job for defending themselves physically against attack---what was the poor guy supposed to do, just stand there and let the patient beat him to a pulp? I don't care what the setting is, patients do not have the "right" to hurt or kill healthcare workers.
    chevyv, FranEMTnurse, Davey Do, and 1 other like this.
  5. Visit  mingez profile page
    0
    Quote from VivaLasViejas
    I can't think of anything much to say, except I hope that tech sues the pants off the facility and gets his job back with retro pay. NEVER should anyone lose their job for defending themselves physically against attack---what was the poor guy supposed to do, just stand there and let the patient beat him to a pulp? I don't care what the setting is, patients do not have the "right" to hurt or kill healthcare workers.
    Agreed, but how does your facility handle such situations?
  6. Visit  VivaLasViejas profile page
    1
    I don't work in Psych, but have dealt with enough psych patients in acute care to have been in some pretty brutal takedowns. At no time were we ever forbidden to ward off a blow, or told we had to stand there and take whatever somebody high on PCP or meth was dishing out. At the first sign of trouble, we'd yank the call light out of the wall, which was our universal distress signal, and within seconds we'd have half the floor staff, plus security, rushing into the room with restraints in hand. Once it took EIGHT of us, including a 450-pound guard named Tiny (what else?), to hold down a little scrawny fellow who had thrown a bedside table at me to start the festivities and proceeded to trash the room.

    By the time we got him into four-points and gave him a snootful of Haldol, he was bruised all over because of the sheer force needed to restrain him. With eight witnesses who were also bruised and battered PLUS nursing management on the scene, however, he'd have had a hard time sueing us or pressing charges. Thank God our hospital had policies in place that allowed us some leeway in protecting ourselves. I wouldn't work in a facility that didn't.
    Yosemite, RN likes this.
  7. Visit  Callisonanne profile page
    0
    This is interesting because my facility (i'm in NC) does teach the blocks for all different types of punches.
  8. Visit  Whispera profile page
    1
    I would not work in a place that didn't allow me to block attacks. I've worked in several psych facilities. All had training to help us de-escalate patients as well as block attacks.

    Think twice about staying at a place that expects you to accept being hurt.
    Davey Do likes this.
  9. Visit  Midwest4me profile page
    3
    Our state-run facility teaches a 12-hr class(1.5 days) on therapeutic communication and maneuvers (or "blocks" as you call them). This training has to be taken by ALL staff once a year, regardless of how long an employee has worked there. Chemical restraints are, of course, administered by nurses only. Seclusion and physical restraints are taught and practiced by every staff member.

    The rights of the patient ALWAYS take precedence over the rights of the staff. Our staff frequently go to the local hospital due to broken bones, lacerations, concussions suffered at the hands of patients. In this economy however, there are very few jobs....so people tolerate the abuse. I would venture to say that the majority of the staff are very stressed out; I know my blood pressure readings have definitely risen over the 6 yrs I've worked there. I also know many staff who must take antianxiety and/or antidepressant meds to deal with the stress and abuse.
    chevyv, Yosemite, RN, and Davey Do like this.
  10. Visit  Psychcns profile page
    1
    Places I've worked:

    1) there was a panic button and the sherriff's office in the building responded and I think took over

    2) another place, there was a policy for involving security.. they stayed in background unless the charge nurse told them to take over--and then it became a police emergency

    3) staff who were assaulted could press charges--the facility would assist- this was a union hospital.

    4) one place I worked, during a takedown, the officer told the patient he was arresting her for assault....(I dont think it stuck)

    At the very least there should be policies for emergencies and obtaining back-up...I have heard of 911 being called.

    Also there should be a commitment by the facility to reduce violence...ie have a more structured environment, involve patient families in their treatment, review of violence by the treatment team, etc
    mingez likes this.
  11. Visit  brillohead profile page
    1
    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....
    mingez likes this.
  12. Visit  gewmac profile page
    0
    Hey All

    As a follow up to this thread topic: Is there one style of martial arts that teaches the defensive moves without the offensive counter-moves? In my area Krav Maga is the next new thing, but this is way too offensive in nature.

    Although I try to keep a peaceful "Zen"attitude, I do not feel comfortable going to a local self defense school asking for all of the defensive and none of the offensive training. I tend to react stimulus/response and do not want any conditioning of aggressive responses.

    As a side note, I am a nursing student who works as a counselor in a MH group home. Our defensive training can be summed up by "run away as fast as you can".

    G
    Last edit by gewmac on Mar 7, '12 : Reason: formatting
  13. Visit  Psychcns profile page
    0
    I think any martial arts training can be helpful in becoming accustomed to violence...how it makes you feel..I think the challenge is to keep a clear head and choose how you intervene...as a clinician your interventions will be therapeutic--keeping everyone safe and helping the patient get control...
  14. Visit  alfa-sierra profile page
    2
    Thanks for your posting. I want to offer some comments because I see nowadays in our specialty a lot of chaff mixed with the wheat and a lot of wolf wearing lambskin.
    First red flag: "we have physical altercations often". There is a nationwide standardized JACHO recognized intervention tool called CPI for prevention of assaultive behavior. I'm sure everyone knows this. 90% is dedicated to verbal, psychological de-escalation interventions, 10% is for physical interventions. You said in your bolded caveat that there is an assumption that all verbal, early interventions are exhausted prior to crises events. Fair enough but I see something incongruent here. A milieu cannot have frequent physical altercations when skillful therapeutic techniques are used extensively, to exhaustion, unless a large percentage of your patients are high on PCP or amphetamines. If I were troubleshooting I'd look for opportunities to hone verbal interventions. Timing, tone, context are all crucial to verbal communication. In many years of diversified experience I've found that what we, staff in general, think of therapeutic verbal de-escalation has often little if any therapeutic value. It is impossible to be therapeutic while our mindset is such that we believe all along that we are the ones being wronged, abused or inconvenienced. It is impossible to be effective if we carry in our minds dehumanizing images of patients as dangerous, abusive,irrational, unworthy, filthy, "not-like-us" individuals. Whatever the case might be. I, personally, always look first and foremost at what kind of pain both psychic and physical the patient might have. I am always mindful that pain for psych patients is often under the threshold of awareness because of other competing internal stimuli. Given those circumstances can we reasonably expect patients to interpret correctly the other set of stimulus, the external stimuli that we are sending? How many times have we seen staff attempting to provide therapeutic verbal input and rapport in competition with the noise from the TV and other sources of distraction in the milieu? Too many. When we manage to replace fear, contempt and insincerity with genuine positive regard and a humanistic, service-oriented attitude we promote more stable and safer environments for both staff and patients without ever having to think of suing anybody.

    Second red flag:CPI physical component perceived ineffectiveness. You are absolutely right. No expert training in any sort of Martial Arts would be beneficial in a crisis if the goal is to resolve it without trauma/injuries to the patient or staff. I say this as a 20 years long student of judo and aikido. The most useful CPI techniques are the verbal interventions when made therapeutically and timely (this means with anticipation, preemption and purpose) and the evasive footwork until a sufficiently impressive response team is present. I believe that almost every physical intervention results from a failure in communication. The challenge for me is to identify its causes (poor skills, understaffing, demotivation, biases?) and make a honest effort to fix them.

    For those of us who entertain the misattributed notion of victimhood I recommend we research the history of mental health and medidate on the complicit role that doctors and nurses have traditionally taken in the institutionalized torture and abuse of persons with mental illness. Maybe you are very young and think it's all in the past. Think again.
    Kind Regards.

    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!
    elkpark and Whispera like this.


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