Differing types of therapeutic self-defense philosophy and techniques

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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 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!
    Joe V and Davey Do like this.
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  3. 26 Comments so far...

  4. 0
    Nothing? I was expecting this to be a hot button topic... :flamesonb
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    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.
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    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?
  7. 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.
  8. 0
    This is interesting because my facility (i'm in NC) does teach the blocks for all different types of punches.
  9. 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.
  10. 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.
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    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.
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    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.


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