Help? How do you give 'consequences' to adult patients?

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 6, 2006

When I worked in psych the adults would loose smoking priviliges for that kind of behavior. I felt bad for the adult patients. They are already in a crisis and depend on their smokes. Then they have their smoking priviliges taken away. It usually caused an increase in behaviors. They also would get a change in level, such as loss of in house activities, loss of visitor priviliges and be on unit restriction- meaning no cafeteria priviliges or going off the unit. Loss of smoking and loss of cafeteria priviliges were the biggies taken away.

JeanettePNP, MSN, RN, NP · Feb 7, 2006

Don't you ever get non-smokers?

leonogist · Feb 7, 2006

a nice big needle waved near the general area of their buttocks works for me CAUTION.... irony alert

StuPer · Feb 9, 2006

Hi Meerkat

It would depend on the nature of the arguement for me, if it was merely 'acting out' and not as a result of illness, then we would inform the antagonists of the impending call to the police should they start fighting.

If it is illness related then things get much trickier, however threats of violence in this case can result in enforced treatment.

Seperating the individuals and moving them to diferent parts of the ward for de-escalation should be attempted first, but in any case you should never get 'in between' patients.

If de-escalation works, great, if not then IMI meds maybe required, and in the worse case scenario restraint and seclusion.

Although it may not be practical other 'consequences' for repeat antagonists could be transfer to another facility, possibly far from family/friends, hopefully the knowledge of which would be sufficient for some control over themselves.

I have too often seen patients get away with destructive/aggressive behaviours on a ward, because we dont want to be unnecessarily prescriptive and infringe their right to express frustration. However I take the view the ward is a community and as such all members of the community deserve equal consideration, if one client is upsetting the rest of the ward and destabalising fragile patients I would tend to act for the larger good, rather than an individuals.

regards StuPer

MadRedneckRN · Feb 10, 2006

We send our Adult patients to their room to calm down. Sometimes they are there for just a few minutes, sometimes it's for the shift. If they won't redirect, the option is area restriction to their room, loss of level, and sometimes we have to go to seclusion or restraints. A nice PRN Ativan goes a long way with my patients:chuckle

Lori

Thunderwolf, MSN, RN · Feb 11, 2006

Instead of seeing it as "sending them to their room" as a punitive thing, see it for what it is and what it is for...to reduce environmental stimuli and/or a chance to recollect oneself (much more positive).

Just a thought.

GooeyRN, ADN, BSN, CNA, LPN, RN · Feb 11, 2006

Don't you ever get non-smokers?

Very rarely. And when we do a loss in level works well. (ie no cafeteria priviliges or visitation)

Meerkat · Feb 11, 2006

Thankj you everyone for the great replies!

CharlieRN · Feb 13, 2006

It depends on what the philosopy of treatment is for your unit. What is the dx of the patients? What are you trying to accomplish with the patients? Are the patients capable of better behavior or are they incompetent?

If its a drug detox program you can show them the door if they don't behave.

If they are psychotic your options may be drop in level and increase in observation.

In some instances it can be policy to inform them that acts of assault or battery will be turned over to local law enforcement.

Assuming that you can't kick one of the combatents out, consider transfer to a different unit or in extream cases a different facility. Our facility has an intensive care area that is a locked, separate, one patient mini unit. We use it for patients who display the most severe inappropriate behavior.