emergency psych interventions?

Specialties Psychiatric

Published

hi all,

just wondering if any of you have personal experience utilizing interventions other than restraint (chemical or mechanical) to assist patients through a psychiatric emergency. Just sorting through a bit of personal cognitive dissonance, wanting to do the best for the people I'm caring for but not certain I"m making the right choices. Want to keep all safe, myself included but feel like maybe there's too much medication being tossed around. Lot's of grey area and often decisions that happen so quickly without much time to process afterwards. For those of you who are masters of verbal de-escalation can you point me to any good resources?

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

There's a lot you can do:

early assessment & intervention, therapeutic communication, 1:1, time out, distraction, alternative activities, early medication, seclusion.

http://www.crisisprevention.com

http://educate.crisisprevention.com/Ten-Tips-for-Crisis-Prevention.html?code=ITG002SCWE&src=Pay-Per-Click&gclid=CJ7_4f39-b4CFTMiMgod9xcALA

Also, remove chemical restraint from your vocabulary. To CMS & TJC, that's a four letter word. A chemical restraint is a medication given inappropriately, often for staff convenience, to control or sedate a patient. An emergency medication is a therapeutic intervention given to treat a patients condition, to maintain safety, decrease distress, and to allow the patient to regain their self control.

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Specializes in Psych ICU, addictions.

In addition to the above...food.

Seriously, think about Maslow's needs. Someone who hasn't eaten in several days isn't exactly going to be a happy camper and may not be the most cooperative and receptive, especially if they're there involuntarily in the first place. I always offer my 5150s something to eat and drink as soon as possible. They may not be all hearts and flowers after a sandwich, but with one of their most basic needs met, they are often calmer and more cooperative.

Of course, if they're highly delusional and think that the food is poisoned...it's not going to really work in that case :)

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Try to keep calm, keep your voice low. We have aides who are very loud and treble all the time. Some aides refuse food or drink other than at meal or snack times, get mad at staff who offer it otherwise.

Intervene sooner rather than later.

Literally keep out of harm's reach, no matter how great your relationships with the patients.

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How do your coworkers deal with things? Do you admire their ways? Do they get good results?

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Be honest. Establish good rapport. Never tell a half truth, these clients have trouble building trustful relationships. Try to keep a relaxed posture, with your voice low. Know your exit before you approach.

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Give them choices!! This has proved VERY effective for me.

"You can go to your room to calm down or you could journal about it. What would you like to do?"

Again it all depends on the patient. If they are too aggressive and agitated, placing a pen on their hands to journal is not advised! :) I have also noticed that a crowd of people makes psych patients nervous. However, do NOT put yourself in a situation where you will be all alone and possible put yourself in an unsafe situation. I make a point to introduce myself to every patient at the start of every shift if they do not already know me. I want them to feel safe and comfortable with me as their nurse. I believe this helps tremendously when a patient is in crisis. Never underestimate the power of SIMPLE back to basics interventions. ;)

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Thanks for your response.

I don't feel there's any reason to remove the words 'chemical restraint' from my vocabulary. Though I would never use this term in charting because I understand the politics, I have seen Emergency Medications used both as a 'therapeutic intervention' and as 'chemical restraint' and sometimes the boundary between 'sedating' a patient & 'decreasing distress' is a little (or completely) fuzzy. words are to be used to communicate ideas and there are times that medications Are being used to restrain someone.

there's data showing that allowing someone to exist in a state of psychosis causes grey matter damage so of course it is therapeutic to intervene in such a way that will calm the but also there's a lot of data which shows how many of the medications we (at the place I work) utilize as 'therapeutic' also cause grey matter damage hence my question regarding non-pharmaceutical interventions be them 'chemical restraints' or 'therapeutic interventions'.

with the exception of seclusion (which the facility where I work doesn't allow) we have tried all of your suggestions. well maybe not 'time out' which for some of our current patient would require a mechanical restraint. …

thanks for the links I'll check them out.

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yes offering food is often a go to...though the patients I'm thinking of have definitely eaten in the last few hours and yes! food being thought as 'poisoned' or lately 'laced with AIDs' is common...

thanks for your input

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with the patients I was writing about...everyone is at a loss...

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