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| |  What would you do if you were making the decisions?
I'd like to post a few vignettes of patients and ask what would you do if you were in charge of the program/unit involved (i.e., how would you handle the situation)? Please provide a rationale for your decision.
1) John, is participating in an outpatient substance abuse research program. As part of the program, she receives a voucher to be turned in to the business office for money as compensation for her participation in the study. One day, Mary decides to place an additional 0 at the end of the dollar amount. The business office notices this addition and calls the clinic to verify.
2) Billy, Jeff, Carl, and Darryl are adolescent patients in a residential substance abuse treatment program. They decide to bring assorted products back from the cafeteria (e.g., fruit, sugar, bread) and make their own alcohol. Staff, during a search find the fermenting concoction.
3) Jill, Mary, and Joe are patients in an inpatient psychiatric facility for depression. They decide to cheek their meds and at night crush them and snort them. Staff walk in on the trio while inhaling their crushed meds.
4) Matt and Nicole are adolescents in a residential substance abuse treatment program. One afternoon they are found in the laundry room having sexual intercourse.
5) Vince has been hospitalized in your inpatient psychiatric unit 3 times in the past 2 months. His story each time he presents to the ER is that he is depressed, suicidal with a plan to walk into traffic, and hearing voices that tell him to harm himself. He also reports using crack cocaine on a regular basis. At each discharge there is a plan established, but he does not follow through on his end, only saying that he can't. When he gets onto the unit, he becomes demanding for food and medications (pain meds and psychotropics that will knock him out), refuses to take a majority of his non-sleep inducing psychiatric medications, and is disruptive to the millieu.
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| | Advertisement Sponsored Links | | | | No. 1 | 
Sep 13, 2009, 07:07 AM
Re: What would you do if you were making the decisions?
i think you need to check the wording on the first one
| | No. 2 |
Sep 13, 2009, 11:38 AM
Re: What would you do if you were making the decisions?
oops, lol; unfortunately I cannot edit, so from hereforth, John is a female
so aside from the lack of editing on my part, do you have any responses to any of the scenarios?
| | No. 3 |
Sep 13, 2009, 12:20 PM
Re: What would you do if you were making the decisions?
There really isn't much to do other than document what needs to be documented, pass along the information to the proper people, follow your facilities protocol for such infractions and continue to care for them in a therapeutic manner.
| | No. 4 |
Sep 13, 2009, 12:30 PM
Re: What would you do if you were making the decisions? Originally Posted by PsychRN03  I'd like to post a few vignettes of patients and ask what would you do if you were in charge of the program/unit involved (i.e., how would you handle the situation)? Please provide a rationale for your decision.
1) John, is participating in an outpatient substance abuse research program. As part of the program, she receives a voucher to be turned in to the business office for money as compensation for her participation in the study. One day, Mary decides to place an additional 0 at the end of the dollar amount. The business office notices this addition and calls the clinic to verify.
2) Billy, Jeff, Carl, and Darryl are adolescent patients in a residential substance abuse treatment program. They decide to bring assorted products back from the cafeteria (e.g., fruit, sugar, bread) and make their own alcohol. Staff, during a search find the fermenting concoction.
3) Jill, Mary, and Joe are patients in an inpatient psychiatric facility for depression. They decide to cheek their meds and at night crush them and snort them. Staff walk in on the trio while inhaling their crushed meds.
4) Matt and Nicole are adolescents in a residential substance abuse treatment program. One afternoon they are found in the laundry room having sexual intercourse.
5) Vince has been hospitalized in your inpatient psychiatric unit 3 times in the past 2 months. His story each time he presents to the ER is that he is depressed, suicidal with a plan to walk into traffic, and hearing voices that tell him to harm himself. He also reports using crack cocaine on a regular basis. At each discharge there is a plan established, but he does not follow through on his end, only saying that he can't. When he gets onto the unit, he becomes demanding for food and medications (pain meds and psychotropics that will knock him out), refuses to take a majority of his non-sleep inducing psychiatric medications, and is disruptive to the millieu.
well, i am not a psych nurse, but a few comments
1) mary just commited a crime...minimum she is out of the research project
2) potentially crime here, minors in possession....dont think that would be pushed, but i would think loss of privleges....
3) better supervision
4) unless these are emancipate minors (or adolescents over 18) this again raises legal issues, and the parents may need to be notified
5) he should no longer be welcome, if he is not doing......perhaps a "Rogers" order is in order?
| | No. 5 |
Sep 13, 2009, 12:46 PM
Re: What would you do if you were making the decisions?
thank you for your responses; overall I agree with you except I'd probably boot the frisky adolescent couple out of the program; word gets around in the mental health community and if the word is that you can hook up and the consequences aren't too severe, it invites trouble from future patients, and potentially brings a bad name/reputation to the program
on the other hand, since I stated this was an adolescent program, chances are that they don't want to be there, so perhaps this was, among other things, motivated by the desire to get out early; hmmmmm....I might have just changed my mind a little bit
what is a "'Rogers'"?
| | No. 6 |
Sep 13, 2009, 12:49 PM
Re: What would you do if you were making the decisions? Originally Posted by Jules A There really isn't much to do other than document what needs to be documented, pass along the information to the proper people, follow your facilities protocol for such infractions and continue to care for them in a therapeutic manner.
you are the "proper people"; congrats on the promotion; so what do you do with these folks?
| | No. 7 |
Sep 13, 2009, 12:57 PM
Re: What would you do if you were making the decisions? Originally Posted by PsychRN03 thank you for your responses; overall I agree with you except I'd probably boot the frisky adolescent couple out of the program; word gets around in the mental health community and if the word is that you can hook up and the consequences aren't too severe, it invites trouble from future patients, and potentially brings a bad name/reputation to the program
on the other hand, since I stated this was an adolescent program, chances are that they don't want to be there, so perhaps this was, among other things, motivated by the desire to get out early; hmmmmm....I might have just changed my mind a little bit
what is a "'Rogers'"?
i figured if it was adolescents, probably not voluntary,lol
a rogers is a legal order mandating medication....can be im i believe.....this guy is actually not ill, and using the system to house and feed himself, or is ill enough he needs longer term rx; in my humble, nonpsych nurse opinion!
| | No. 8 |
Sep 13, 2009, 03:07 PM
Re: What would you do if you were making the decisions? Originally Posted by PsychRN03 you are the "proper people"; congrats on the promotion; so what do you do with these folks?
I'm not sure where you are practicing but in my area our DON, facility administrator or even the Physician does not have the legal right to just kick people out based on their actions even when they are criminal. Psychiatric treatment takes a long time, many tries and often is not successful. In the meantime I carry on as indicated in my original answer. These people all have problems there will be malingerers, con artists and criminals that will have to be cared for and in my experience getting the word out in the psychiatric community isn't very effective especially not with career malingerers or the truly psychotic. But thanks for the promotion.
| | No. 9 |
Sep 13, 2009, 03:22 PM
Re: What would you do if you were making the decisions? Originally Posted by Jules A I'm not sure where you are practicing but in my area our DON, facility administrator or even the Physician does not have the legal right to just kick people out based on their actions even when they are criminal. Psychiatric treatment takes a long time, many tries and often is not successful. In the meantime I carry on as indicated in my original answer. These people all have problems there will be malingerers, con artists and criminals that will have to be cared for and in my experience getting the word out in the psychiatric community isn't very effective especially not with career malingerers or the truly psychotic. But thanks for the promotion.
someone in every facility has the "power" to determine how to manage a given situation, whether it's as part of a committee, or if you are the owner/founder of a private facility; there are rules in place and consequences for violating those rules, whether it would be a change in the treatment plan, expulsion from the program, or loss of privileges; so the scenario is that you are to pretend you are the person who must decide how to proceed; so how would you proceed/what would you recommend?
or if this still doesn't sit well with you, pretend you are making up the rules/consequences for a new program; what would you have in place for the given scenarios, should they occur in your program?
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