How Violent is Your Unit?

[Meraki]

I was thinking about his awhile ago and I think I saw someone mentioned it not too long ago in a thread but I am very surprised by the amount of violence and injuries that posters report.

I have worked on an acute psych unit for 12 years and have never been injured. Neither have any of my coworkers in all the years I've been there. There has been the occasional bruise and some pulled back muscles but no serious injuries at all.

We are the only child/adolescent facility that takes complex, severe and acute cases in our area. Next closest unit is about a 2 hr drive away. There are no residential beds anywhere as that isn't the service model in my area either. We serve a population of about 1.5 million or thereabouts and have about 400 admissions a year (18 bed unit). So we get ALL the crisis cases, and all involuntary, and well pretty much all cases that require admission.

When I read on here about all the broken bones and attacks and kids being violent often, and swinging and units in chaos - it sounds so different than my unit. Not that we don't have hectic shifts but not to the point of violence. Yet all unit are going to have kids with similar presentations and all will those really challenging cases.

What do you think it is that makes the difference?

Is it staffing ratios? Program models and philosophy? Staff training? Daily programming? Team dynamics? Physical layout of unit? Unit policies? Rules? Staff attitudes? Admitting policies and exclusionary criteria? Parental involvement? Restraint policies? ...?

If you have worked on a unit that has a lot of violence, what do you think contributes that that?

If you have worked on a unit that has very little violence, what do you think has contributed to that?

(This doesn't have to be child/adolescent only - feel free to answer about other units as well)

[Jules A, MSN]

The difference at my hospital is that the acute unit is far less violent than the residential units and most of the injuries that happen are not on the acute corridor. We also run very short staffed so things that might be descalated prior to becoming physical are often missed.

[Meriwhen, ASN, BSN, MSN, RN]

Our detox unit isn't violent. Most of our patients aren't psychotic...and when they're going through the first few days of detox, they're usually too miserable physically to cause any trouble. There maybe a few people raising their voices when they can't get the medications they want, and once we had one patient whose behavior was escalating but we talked him back down, but that's about it. We explain the rules are we're firm about them, and they accept it...we have had some people go AMA because of those rules, but no violence.

The running joke on our unit is that should we ever have to call a non-medical code, no one is going to come because no one will ever believe they heard it right

[aloevera]

no codes generally called on de-tox unit.........but the adult mental health unit is a whole different ball game........the adolescent unit occasionally will call a code.......a child will act out, and on occassion, run away...........

Staffing has everything to do with it........if there are enough people to monitor these pts, we can see escalations and usually curb them.....not always, tho.sometimes it happens rather quickly and nothing could have been done to prevent it...........it is a combination of staff ratio and population.......

[Bella'sMyBaby]

I don't work Psych but I'm here to tell you I am seeing more violent types in our nursing home! No longer is it filled with "little old ladies." We are seeing more & more mentally ill residents with violent behaviors and there is little we can do for them in the nursing home setting because they have their "Rights" you know. I've been told it's only going to get worse with Psych Institutions closing......

[ok2bme]

It's not. I'm sure my unit and facility in general is less violent than average, but I'm not sure posters that talk about "patients swinging at you all the time" are being completely honest. I think some of the rhetoric is defensive talk towards nurses in other specialties who accuse us of working in an easy field.

[wonderbee, BSN, RN]

Several factors I can think of. Not holding on to patients beyond the window for a good DC, especially true in teaching hospitals. There is a window of opportunity. I've seen many decompensate and become more violent when that window was missed. Staffing, of course; providing a physical environment that doesn't look like a dump, has good lighting and provides for exposure to outdoors/sunshine. Sunshine is a wonder drug.