Psych Pts Are Found Throughout the Hospital: 5 Quick Tips

Patients with psychiatric disorders are found throughout the hospital. Here are 5 quick tips to non-psych nurses to help avoid injury to staff, patients and visitors. Nurses Announcements Archive Article

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verene, MSN

1,790 Posts

Specializes in mental health / psychiatic nursing.

I do know 1:1 has to be done for hospital risk management but what's the sitter to watch if it was toxic chemical Ingestion? It's unlikely I have a gallon of cleaning fluids in my hospital room. If a patient didn't attempt with a sharp object, what makes them think they're gonna hurt themselves with sharp objects if the attempt was poison ingestion? Honestly, what is their for the sitter to watch for?

As a CNA I am semi-frequently a sitter for SI patients. Most of them are not still a risk to themselves (though a few still have been) once in the hospital. However, hitting rock bottom is very difficult and sometimes things can change rapidly. While I know I am in the room from a liability perspective to prevent "what ifs" I am also there to support and advocate for my patients. My role is to provide support and compassion to someone who is likely feeling emotions ranging from fear to shame and anxiety to anger and help them feel heard and understood. I also can assist them in bringing concerns to other members of the care team and generally do my best to make the hospital experience more humane and less anxiety inducing.

Not all psych patients are just "psych' patients. Many normal people just hit rock bottom..

Perhaps that patient went through a divorce, lost a loved one, etc

Suicide is not a mental illness. Depression is and a depressed patient is not just a psych patient, they are a depressed patient! A patient who is sad is in no way violent.

Schitzophrenics can go violent if u press the wrong buttons.

Individuals with mental illness are just people - and many people who may outwardly appear fine are very ill, and many times meeting those who outwardly appear "crazy" are very functional within their own capacities. It helps to meet people where they are at - where ever that may be.

ANYONE can become violent if the wrong buttons are pressed - depression, schizophrenia, or no mental illness at all. Part of why it is important to build rapport and trust with ALL patients no matter who they are. Also to never take for granted that a patient is going to be safe - I've had any number of non-psych patients who seem just fine, (or in once case even comatose) suddenly change and present me with potentially unsafe scenarios.

That definately answers my question on the concerns I had. If a patient is on suicide precautions, does the nurse have to have the patient opened his or her mouth to see if the pills were swallowed so the patient doesn't hoard the pills?I know in the psych unit, they do for sure.

verene, MSN

1,790 Posts

Specializes in mental health / psychiatic nursing.
That definately answers my question on the concerns I had. If a patient is on suicide precautions, does the nurse have to have the patient opened his or her mouth to see if the pills were swallowed so the patient doesn't hoard the pills?I know in the psych unit, they do for sure.

I've only rarely seen it done at the hospital I work at; it seems to be at nurse discretion. We don't have a dedicated pysch unit at this hospital and my personal opinion is that our overall management of patients with mental illness-- crisis or no crisis-- is very inconsistent, in large part do to lack of any real training or guidance, but that is another issue altogether.

However even if the nurse isn't checking the mouth immediately after administration, it isn't easy to hide something while constantly observed and patients have to remove the cheeked pill from the mouth at some point in time in order to horde. So this is usually an issue caught by a sitter, who reports to the nurse immediately that the patient is cheeking pills. Pretty hard to build up enough of a stash to cause harm.

When I worked a mental health group home staff did check for cheeking in residents where it was a known problem, or if we suspected hoarding meds was an issue. There it typically wasn't an SI issue at all, but an issue of residents cheeking pills to then later sell on the street.

SheriffLauren

92 Posts

Specializes in Adult Psych.

I've been at the infamous state facility for nearly 3 years now and I totally agree. It's almost always 99% of the time the people with personality disorders or addictions that assault staff and peers. I've only been truly afraid of a patient once-and she was part of the 99%. The 'classically' mentally ill patients rarely do so and usually only when provoked/feeling threatened.

SheriffLauren

92 Posts

Specializes in Adult Psych.

usually a psych facility will provide the defence training they want you to use during orientation. Its like non-aggressive passive defence stuff. I don't think people really use them in real life honestly.

MSNce1

29 Posts

Specializes in med-surg, mother-baby, teaching, peds.

I agree with you totally and have been severely depressed and suicidal in the past. Many facilities focus on getting the client to help themselves providing the mental tools needed but do not always have a kind and compassionate bedside manor. It is especially important in psych to remember you are dealing with a human being and not just their pathology. Providing them a purpose outside themselves is crucial to healing.