Best practice to manage the low functioning, aggressive, psychotic patient

[fawnsternurse]

Hello,

Just seeking input and others thoughts on this topic.

I have been a psychiatric Nurse for a while now and have also worked in otehr realms of Nursing.

I have my thoughts on the above but I am posting because I would like others feedback on this topic.

Generally these patients need long term management but because they have closed so many State run psychiatric facilities they are now being admitted to short term units in Hospital settings.

It is difficult to utilize any therapeutic communication techniques.

These patients are very low functioning,. very violent, aggressive and psychotic.

Thoughts?

[vintagemother, BSN, CNA, LVN, RN]

I think I'd try to determine what the pts triggers are and avoid those triggers.

Also, establish a positive therapeutic relationship while maintaining your authority as a nurse.

I agree with what was said about not putting more demands on the pts.

I have not had experience with pts who are randomly aggressive toward staff. In my unit, the pts were mostly only aggressive toward peers and the only staff assaults I witnessed were when staff was intervening with a pt who was already trying to be aggressive. In those cases, certain protocols were typically not being followed because we are supposed to work as a team when de escalating.

I did have a pt attempt to hit me but I moved out of the way (leaned back like I was in the matrix movie😏). Even then, in hindsight, my communication was what triggered him. --he was sexually assaulting a tech and I intervened verbally which caused him to threaten me with bodily harm. I told him he will not touch me. My mistake, I realized in hindsight, as he took my comment as a dare to hit me.

Anyhow, staff responded to my help call and the pt was redirected to a secluded area.

[MrChicagoRN, RN]

I went to work in a new facility recently. The medication nurse talked down to the patients. A patient became irritable and said to her "don't talk to me like that, you work here too long." She went back at him verbally, berating him and shouting at him. He became agitated and began shouting at her. Crisis was called and the patient was medicated with Ativan and Thorazine IM. I felt really bad to be a witness in that scenario. The patient was right and was asserting himself the best way he knew. As a new employee; you are not supposed to voice your opinion. You are not supposed to complain. You are not supposed to advocate for patients. I no longer work there.

Patients who are treated with respect act out less often.

i don't hesitate to pull a staff member aside to inform them that their interaction was too harsh, or to remind them that they are not here to argue with the patients. Sometimes it's just verbal coaching, sometimes a write-up.