Forcibly removing piercings in psych patients

[KathyDay]

I have a very sensitive question. I have recently learned of a patient, who is bipolar and who was having a crisis, went to the ER. There, every patient has to go through a metal detector, and security checks bags. The smaller ER across town does not do any of that. This woman had piercings, nipple and belly button and she was told to remove them. I am not sure who made that demand, but when she refused, a security guard forcibly removed them lacerating both areas. Apparently a nurse was in the room. This exacerbated the woman's anxiety and she fought back...escalating the situation and she ended up netted and medicated.

As a retired RN who worked many years in an ER, I found this appalling. If a patient refused anything I would have brought that to the attending ER doc and gone from there. NEVER would I have allowed unprofessional, untrained, brutes to forcibly remove sensitive piercings like that.

I was also told that patients in mental crisis are stripped and searched at that hospital where I use to work. Is that routine? Is that done by security people or professionally by nurses? Are male security officers allowed to do such things to female patients? Is it right that male security people stay with female psych patients even in the bathroom?

I understand that in order to protect patients from themselves if they are deemed potentially harmful to themselves, that some of these measures may be needed, but from what I was told, it seemed that patient was assaulted and that escalated her anxiety and combativeness. The results were disastrous.

Exactly what is the general policy regarding people in mental crisis? How far should security people be allowed to go? Should male security people be allowed to even touch a female patient unless she is threatening to others? Would a professional nurse first look out for the patients rights to safety and privacy and seek the doctors opinion, before allowing such a horrible scene to take place. What about calliing in professional mental health crisis workers?

I am very serious about this discussion and would love to hear from ER nurses who work with this type of issue every day.

[jdub6]

What harm have you seen swallowed nipple or navel rings cause? I'm trying to understand this, because it's not a button battery or a magnet. It's a small foreign body that will most likely pass with no adverse sequelae. Am I missing something? I'm really more curious than anything...

If a stud there is a sharp-ish end, a hoop could be broken to create one, and either could be used to cut oneself or if swallowed has potential to cause damage much like a swallowed soda can tab. It's certainly possible, maybe even likely that they would pass without damage if swallowed and that any self-inflicted cuts with them would be superficial but that cannot be guarenteed.

To me though the biggest problem is the psychological implications of successfully doing something [potentially] harmful, using something they aren't supposed to have but the rules were bent. It could encourage competition (she snuck in x and did y with it, i want attention so I'll use xx to do yy) or copycats, it sends a message to families that the hospital can't keep patients safe. The patient feels she can manipulate staff to allow self-harm. She feels the staff is incompetent and can't keep her safe. she may feel accomplished and enjoy being the center of attention/gossip and now seek to do it again but bigger. She can now say "i even cut/tried to kill myself in the psych ward."

Policies exist for a reason. Psych patients can be very manipulative, and clear consistent boundaries are a must. If rules are bent for one person, the entire unit loses respect for them and other patients feel cheated.

I don't necessarily agree with the methods used in OP. I do believe that at times force may be justified to prevent actual or potential harm to self/others. While the jewelry is hardly the most dangerous item a patient could ask to keep, it sets a dangerous precedent to tell someone they must turn something in for safety and then back down because they throw a fit.

It's the same reason the police don't drop criminal charges because a patient tries-or pretends-to hang themself in jail. They go to a hospital or psych jail and get suicide watch but they don't get to say "if you bust me ill kill myself" and skip away. I know the two situations are very different in severity but psychologically the implications are the same.

[jdub6]

The risk of forcibly removing piercings is greater than the risk of leaving them in. That's why at my hospital we ask patients to take them out, and if they refuse, the piercings stay.

I am a psych nurse.

I have seen the most horrific things done to patients to force them to comply with rules. This is a very big problem in psych. Bigger than I can handle sometimes.

I agree that the danger of a physical conflict may be worse than some jewelry. But, then don't make the rule at all.

Patient A's earrings are very sentimental to her, but she understands and appreciates safety efforts and turns them in.

Patient B doesn't really care about his earring but is angry about being on a psych hold so argues about everything. Staff lets him keep the earring because he seems about to blow.

Patient C has borderline personality disorder and self-harms. She has used her bracelet to cut herself before and is thinking about doing so again. When asked to give it up she whines and cries and swears. She's allowed to keep them because staff doesn't want to escalate her.

A, B and C came at the same time and witnessed each others admits.

A feels cheated. She's the only one who did what was asked and didn't fight and she is the only one who lost her jewelry. She got no reward for compliance. She feels that B and C are in charge and not the staff. She is afraid B or C could blow up and the staff wouldn't protect her from them.

B feels triumphant and now threatens violence whenever he doesn't get his way. He already felt the psych program was a joke but now that feeling is stronger. His focus is now on what he can demand next to enjoy himself. He puts no effort into groups or therapy. A thinks B is in charge, not the staff.

C smugly heads to her bathroom and cuts herself. She comes out and displays the cuts to another patient. She is the center of attention and gossip and calls her mother saying she kept her jewelry against the rules and used it to try to kill herself. Her focus is now on what she can do next that's bigger and better, and is silently challenging staff to stop her. During future intakes and evals she will tell how she brought sharps to the psych ward and used them in a "suicide attempt."

Again I feel that consistent firm boundaries are so important in psych. If you don't want to enforce the rules by whatever means necessary then maybe the rule shouldn't exist.

[canoehead, BSN, RN]

My hospital also removes phones and tablets from patients. Someone barely coping lands in an unfamiliar environment, with less freedom, and all their normal coping skills aren't available, it seems mean to take away electronics. Who knows how many prn meds could be avoided if we just let the patient play candy crush? Where I work they also lock the TV room at night, so patients are left sitting in the dark in their room. I'd lose my temper too, frankly.

[EllaEmoris]

I know this post is kind of old but I was trying to find out if someone can refuse to remove piercings and stumbled upon this. That treatment sounds horrific and traumatizing and I can't understand why there are speculations about if it happened that way or not. As someone who has been to psych many times I can tell you 1. This is not an unusual thing to happen to patient (depending on the place obviously but I am somewhere in the US where mental health treatment sucks). And they do not care all much about you as much as the nurses here would like to believe. Also 2. The insinuation that may have not happened that way and that the patient "may have ripped them out herself" is exactly why patients don't report things in psych wards because who's going to believe us when there already preconceived assumptions? (Also there are not usually cameras in the rooms where you're inspected so the staff member could have easily lied and said the woman did it herself.)

Also I have piercings and am always asked to remove them but it honestly doesn't make sense to me as I've had it explained as "we don't want to risk another patient pulling them in a fight". Which to me is useless reasoning because hypothetically if there was an altercation, I feel like i would get hurt either way, and as someone else said in terms of self harm, there's only so much you can do. Also piercings aren't generally cheap. And I don't want to have to get everything re pierced over and over again. (I'm sorry this was so long...this is just something that makes me very upset and annoyed as someone who really hates themselves and piercings are the only thing I sort of enjoy and that ground me back to myself. And i feel like the hospitals make it worse than it needs to be, in addition to treating us like we are stupid and less than human.

[EllaEmoris]

Wow thank you for understanding. This is how I feel. I hate that I have the illness in the first place and I hate having to go inpatient and then on top of that there is zero freedom. Every thing is unfamiliar and you are more than likely getting a med change and then you're(at least I am) very sleepy and having side effects and on top of that all these rules. Last time I was inpatient I was locked out of my room by staff from 8 am til 5 pm everyday because I would go back to my room to lie down because the new med change made me tired all of the time and they thought I was "isolating" so they basically forced me to go and sit in group all day. And when I went as a child/teenager there was a patient who was also always tired (they wouldn't give us anything for insomnia until 3am) and in the mornings before group, staff would just stand in her room and yell until she woke up and basically drag her out of bed (again we were under 18 at the time). I understand having rules but...they don't have to be so aggressive. Like what is the worse thing if we miss group?? There's another group later. Or someone can just talk to us one on one. We are in a MENTAL Ward. You can't just force people to engage.