Contraband

[Nancynurse1983, BSN]

Nurses,

I understand we work in psych, we have patients that will measure and assess all means In which to harm themselves.  But unless you are in acute crisis what is the harm in allowIng a patient to floss under supervision , or to have a 1" elastic to gather there hair.  They don't come to us to be imprisoned. They come to us for help battling the crippling anxiety and depression that have caused them to reach out for help.  They are already on routine 15 minutes safety checks.  We confiscate all policy banned items.  What's stopping us from using our critical thinking skills to allow them to apply chapstick at the nurses station, or let them have a small cup of their own body wash to shower with? Why can't they apply hair products under supervision?  I have a lot of patients coming to me that have been so depressed they haven't showered for weeks, and when they finally feel up to it they are denied the small comforts like their own hair gel, or deodorant to make them feel more like themselves. It's demoralizing to them, but staff seems to take some kind of authoritative stance that allows for no comforts at all.  And relishes in it.  Psych is not a task oriented profession.  We are not so busy monitoring telemetry, hanging IV's or performing wound care. We are there to assess and help meet the mental needs of our patients. Why do so many deny them the small comforts that are easily obtained? And don't come to me with "well I had a patient that ate his deodorant and died" or "I had a patient that swallowed all his shower gel to OD on".  This is few and far between and can be accomplished with hospital provided products.  They can harm themselves on the beds they sleep upon by smothering themselves with blankets (yes, I've seen this happen). Where is the compassion in psych?  Is it the litigiousness of society?  Or the gleeful satisfaction some people get from taking an authoritarian stance?  

[Julie Love]

Sounds like your facility has horrible policies.  Are you in any position to work on getting them changed?  A lot of these arise from places having a very "black and white" approach, backed by the idea that finding a safe middle ground might be "too much work."  (Like the body wash -- if a whole bottle is deemed dangerous, fine; give them a cup.  But that runs into "but that's an added staff task")  (We actually had a girl chug some laundry detergent one day.  Basically fine, puked all day.  Freshest smelling emesis basin ever.  Almost got the nickname Bubbles though.)

The way to elicit change, though, is to find out who in the hospital is setting the policies, find someone at least willing to listen, and then go collect info from other hospitals.  Look them up, and then ask them to please share their sharps policy.  The McLean Southeast ART unit (adolescent, part of McLean Hospital in Middleboro MA) had great policies.

And I really appreciate you caring about this.  I get so frustrated with people saying "but we have to... for safety."  Around here, the ERs piss me off.  Friend on a psych assessment, kept in a johnny for 24 hrs (and WAY too tall for that to be a comfortable experience).  When I complained, they tried to explain (as if I was a lay person, and an idiot) that they have to do it...  And then I lectured them about how you do a proper johnny search to go through all their clothes, keep anything actually dangerous, and then GIVE THEM BACK.  And that if they really cared about safety, maybe not have three patients all on a "1:1" with the SAME staff person who was sitting engulphed in the privacy curtain, no line of sight with any of them, and reading a magazine....

[Nancynurse1983, BSN]

Thank you so much for your reply. I completely understand and agree with the safety measures we have in place, but our policy is ambiguous. It leaves it up to the charge nurse, and unfortunately we have some that do see things in black and white, and don't apply critical thinking skills. For example, I allow a patient with no history of self harm to have a small hair band, I know what it's like to have out of control hair and the need to keep it pulled back. I'm also culturally conscious and understand that skin and hair needs vary and will allow home products as needed with an appropriate assessment and supervision as needed.  It's the black and white approach as you mentioned that frustrates me.  The biggest concern is, if we make their hospital stay feel like prison, they will be much less likely to reach out to us again for help. 

[njmonsterboi80, BSN]

I'm a little late to the conversation here..  I run the contraband committee at my unit at a major academic medical center.  We have similar issues, to a lesser extent.  Due to the increase of RNs from more restrictive facilities, our patients have suffered by not being able to access their basic home items to attend to their ADLs. The issue is also creating friction between shifts.   The general feeling I'm getting is that a select group of RNs are looking for permission to give these basic items.  While we have a contraband list, I'm also developing an allowed list (hair products, home toothbrushes, home deodorant), etc.  I'm bringing up a list for approval with my nurse manager, unit chief, and select techs on the committee this week.  

Feel free to contact me if you would like to coordinate.

[maggie0, BSN, RN]

A lot of this is what some colleagues call "safety theater.” It does keep staff on our toes, but I think it also sets up challenges for the patients: You think I'm going kill myself with a hair tie? Watch me do it with my underwear! My unit allows hair ties, shampoo, bras, etc, though we keep them locked up when they're not being used. It's a pretty good compromise ??‍♀️