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

by mingez

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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... Read More


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    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
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    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...
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    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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    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.
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    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.
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    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.
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    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.
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    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
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    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?
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    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.


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