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
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.
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.
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!