Forcing patients to attend groups?

[femaleRN]

Does your inpatient psych unit force pt's to attend groups. My manager and some of my coworkers are talking about implementing this. Currently I highly encourage patients to attend, but don't force the issue. I feel like patients have a right to refuse, just as much as they can a medication. I'm scared of the extra busy work this will cause; patients falling, complaining of pain to get out of group and blow ups.

What does your unit do and how has it turned out, pro's and cons?

[oceanblue52]

I worked in one place that started locking all the doors all day to force people to attend groups and citing it as a "safety issue." I don't think it really helped, it just made people angry and more prone to escalate. I too disagree with forcing attendance, the whole point of inpatient is to stabilize someone. If sitting quietly and journaling, coloring, or reading will help that process than I am all for it.

[femaleRN]

Their argument is they think this will detour malingerers.

[Davey Do]

Their argument is they think this will detour malingerers.

Good point.

At our facility, room doors are locked at 0730, in time to be up and about for breakfast. The patients have to be up and in the dayroom where groups are going on, but they don't have to participate. Administration believes these actions will aid in cutting down on the number of patients desiring to use the hospital as a flophouse.

Still, some patients will kick back in a recliner and snooze.

[femaleRN]

Have you seen a decline in patients using the unit as a flop house then? Do patients get agitated by doing it this way?

[Davey Do]

At first there was grumbling, but like everything else, when established, locking the rooms so the patients couldn't just lay around and sleep all day, the practice became acceptable, femaleRN.

[angeloublue22, BSN, RN]

Our facility took away privileges like smoke breaks or outside time (yes, ours had smoke breaks) for the reasons stated above and it seemed to work beautifully. Our rooms didn't lock so we couldn't do anything about that.

[Jules A, MSN]

Have you seen a decline in patients using the unit as a flop house then? Do patients get agitated by doing it this way?

Unless we are talking about psychotic, severely intellectually disabled or TBI patients I don't adjust my plan of care based on whether they will likely get agitated or not. In fact I believe in many cases encouraging patients to step out of their comfort zone can be therapeutic.

Word does get out. Where I saw the biggest difference in patients who were not on the unit to participate in mental health treatment was when they made it known in the ER that we were no longer prescribing subutex. Within a few days our patients seeking "detox" declined to almost none.

[SunnyPupRN]

I totally agree with you. And I think it is counter-intuitive to the truth that people must be ready for treatment and willing to go. On our part, that means being supportive and encouraging, but "forcing" patients breaks down relationships and trust. I suspect that insurance companies want to speed up the process and not wait around for patients to have that realization.

[Darkstar1485, BSN, CNA, LPN, RN]

We encourage patients to to to group but we don't force them. We don't have to force them simply because during group time bedroom doors are locked and the TV is turned off. I would go to group as well if I didn't have anything else to do.

[Jules A, MSN]

I totally agree with you. And I think it is counter-intuitive to the truth that people must be ready for treatment and willing to go. On our part, that means being supportive and encouraging, but "forcing" patients breaks down relationships and trust. I suspect that insurance companies want to speed up the process and not wait around for patients to have that realization.

But seriously on an inpatient acute unit there is not the time or ability to build up the trust and relationships that will really do much for the long term. Groups are more about basic behavioral modification which is very important, introducing a peer support system and hopefully adding a few basic coping skills. Acute units are for stabilization and discharge back into the community which is the culture since deinstitutionalization and don't even get me started on that disgusting folly.

[hppygr8ful, ASN, RN, EMT-I]

We toyed with the idea of locking patients out of their rooms during group time even ran it by the Patients Right's Advocate. The general consensus was that it could be a violation of a patient's right to refuse treatment. I usually am able to get most of my patients into group with the exception of the newly detoxing, meth crashers and those so severely out of contact with reality that it would disrupt the therapeutic milieu of the unit. We always encourage all patients to attend group but since our average length of stay is 5 to 7 days it's rare that a patient has a real "AHA!" moment. We do not have a TV on during group, nor to we allow phone use during group time. I find cigarette smoking to be a great incentive. When a patient tells me they missed a "Smoke Break" I remind them that smoke breaks occur after every group so if they go to every group they never miss a smoke break! It works most of the time.

Hppy