I work on a 19 bed unit at a large hospital. There is another psych ward on the same floor with 20 beds. Both are locked, adult, inpatient units. Our patient population varies in age and disorders. For example, we may have an 18 y.o acting out Borderline, a 40 y.o. male with depression and alcohol addiction, and an 85 y.o. male with severe depression. We usually have several older adults with depession and catatonia who are receiving ECT treatments. I work part time on the evening (3 -11) shift.
We always check any thing that visitors or family members bring in for the patient. Visiting hours are only for 2 hours a day, 1 in the afternoon and 1 in the evening, and the visits take place in a dayroom with a staff supervising. Of course, metal and glass objects cannot be kept in the pateints rooms, or belts, long straps, or scarves, etc. But until a few months ago visitors could bring in food or drinks such as soda. An incident occurred where a patient had a visitor smuggle in some cocaine, hidden in some food, although the details of that have never been shared with me.This patient shared the drug with a couple other patients, tox screens were done, the police as well as risk management were involved. I wasn't there when it happened, but, as bad as it was, I cannot think of another such incident in the past 20 years.
Anyway, management immediately instituted new rules: no food could be brought in for patients, not even a Pepsi in an unopened 20 oz. bottle. The patients could no longer keep a few dollars on the unit to purchase a soda from the machine, nor could they order a pizza or any food for delivery. At the time we were told that this was a temporary necessity and would be revisited, but it wasn't, until I brought it up right before the holidays. A young visitor wanted to bring in some homeade Christmas cookies for her Grandma, but was told no, no exceptions.
I was also concerned because we get quite a few older patients from other countries, such as Somalia, Cambodia, Nigeria, etc. and in the past, their families would bring in home cooked, familiar food for them. A lot of them will not eat our American food.
As an experienced psych nurse, I feel we should be able to use judgement on what is brought in and consumed by our patients. Of course we should pay extra attention to the patients with addiction issues, but these are the minority, not the majority of our population.
Since I brought it up, management has asked me to research best practices in this area, but I haven't found anything in a lit review. The other hospitals in our area don't restrict food, just caffeine. Please give me your feedback. Thanks!
Had an absolutely identical situation. I just told the managers they were stupid and carried on. I wouldn't suggest you try the same.
Whispera has the crux :
..but as we know... Ours is not to reason why.....
And go back to your original post:
There is no evidence to suggest one way or another and it is all based on historical subjective opinion.
1. How did the event come to the attention of staff? (ie it didn't go unnoticed - this is neither good nor bad -
2. What was the most extreme behavioural outcome - ie did someone murder everyone? Or just stay up all night long?
3. How bad was it really? A small amount of cocaine - they're not likely to share it far or OD someone else on it (having gone to that trouble to bring it in). What are the consequences of taking cocaine and having a mental episode - getting locked in a psych ward. So the 'risk management' strategy is in place - what are they further protecting against?
If it was a regular and highly prevalent issue with severe consequences - I'd accept a risk management initiative, but the issue is - they know these things might happen, hence having a security protocol to reduce - not eliminate - the risk.
Reacting by banning everyone is pejorative and is unusual and cruel treatment of those who do not have contraband issues/behaviour.
I would also give all information to the police about the visitor suspected of bringing the contraband in (if you have a VERY SURE idea - I've guessed wrong many times).
The individuals concerned do not care for everyone else's loss - so this punitive reactionary management strategy is of no use.
They would have been better off telling the identified patients they knew what they'd done... and leave it at that - they'd be more worried that no reaction came their way. And face it - what have they lost?
I would have those who tested positive on restricted 1:1 visits and restricted the items with them alone.
The alternate argument - denying culturally appropriate foods etc is discriminatory practice, as is the 'unreasonable' restriction of any 'pleasure' foods etc by this adminstrative action. The food is not the problem - just the contraband in it. So do as I did and tell the managers if they wish to 'control' the supply of such items then they need to arrange for their purchase and distribution.
If they are so worried about patients getting their hands on mind altering drugs - why do they keep letting the psychiatrist in there? S/He's the one bringing in the most.
You cannot legislate for every potential event - and trying to do so after the event is bizarre.
Often managment do this because they feel impotent and they are merely employing insitutional violence on the patient group as a 'lesson'.
I'm also concerned why they've got so many mixed up presentations in one unit. Is it not cruel (and counter therapeutic) to house a depressed elderly person with an emotionally dysregulated 18yo?
The rules should be rigid and enforced consistantly because of the structure need for the patient..
Hi Louise. I'm glad you brought that perspective as the dichotomy of control vs care is one that has long been debated in mental health. Some people call it 'custody vs care' but I think the term "control" better allows us to understand that most often, where firm rules and structure is applied that this is generally in the interests of operational management and not treatment.
Structure is only good for as long as it's applied. If it's a long term facility with little likelihood of discharge and high risk behaviours - then of course, structure has a valid place.
But if you apply it pervasively to every secure unit (high, medium, low) then you are not preparing the patient to move to a less structured environment and so they are 'set up to fail' when they leave.
As this is a unit that accepts elderly depressed patients I doubt it is a high secure facility.
To have rigid rules is one thing - to apply them consistently is another thing. But further - who decides those rules and on what basis do they make those decisions? Is there a structure for decision making and is that process consistently followed?
In the scenario for this thread it would seem that management don't have a structure or apply themselves consistently. There is no transparency to their process and blanket decisions are made on knee jerk reactions.
It's unfortunate that, most times, decisions are made for operational convenience and not for treatment need. Safety is important - but is it necessary to go overboard with it?
I find that most people that work under that ethos are not very flexible as people or empathic to the needs of the patient. They place their needs at the top - and the patients needs go nowhere.
They even go so far as to extend their needs to apply blanket rule to people who aren't even implicated in risk:
The rules should include visitors subject to random searches. If they refuse, they can simply leave the unit.
A random search of a visitor is a breach of civil liberties. Property and the person may be electronically scanned by 'consent' but to insist any right to lay hands on a person in a fashion not regulated under any law on the unfounded basis of 'safety concerns' is a little paranoiac.
Are you always this suspicious of everybody?
Does it involve a government agency?
If more than 5 visitors need searching - do you suspect a conspiracy and report it?
Are you sniffing crack?
No. Doing that sort of thing can make you paranoid.
Specializes in psych, addictions, hospice, education.
Regarding the "ours is not to reason why..." comment, that wasn't mine and I believe it was intended to be a bit sarcastic. It IS ours to reason why, as patient advocates. Rules are there for a reason but if they strike one as extremely wrong, I believe we should question them. I believe we should follow them until we know the rationale at least, however, since one person following and another not following just sets everyone up for problems---patients and staff alike.
Hi Louise. I'm glad you brought that perspective as the dichotomy of control vs care is one that has long been debated in mental health. Some people call it 'custody vs care' but I think the term "control" better allows us to understand that most often, where firm rules and structure is applied that this is generally in the interests of operational management and not treatment.
Structure is only good for as long as it's applied. If it's a long term facility with little likelihood of discharge and high risk behaviours - then of course, structure has a valid place.
But if you apply it pervasively to every secure unit (high, medium, low) then you are not preparing the patient to move to a less structured environment and so they are 'set up to fail' when they leave.
As this is a unit that accepts elderly depressed patients I doubt it is a high secure facility.
To have rigid rules is one thing - to apply them consistently is another thing. But further - who decides those rules and on what basis do they make those decisions? Is there a structure for decision making and is that process consistently followed?
In the scenario for this thread it would seem that management don't have a structure or apply themselves consistently. There is no transparency to their process and blanket decisions are made on knee jerk reactions.
It's unfortunate that, most times, decisions are made for operational convenience and not for treatment need. Safety is important - but is it necessary to go overboard with it?
I find that most people that work under that ethos are not very flexible as people or empathic to the needs of the patient. They place their needs at the top - and the patients needs go nowhere.
They even go so far as to extend their needs to apply blanket rule to people who aren't even implicated in risk:
A random search of a visitor is a breach of civil liberties. Property and the person may be electronically scanned by 'consent' but to insist any right to lay hands on a person in a fashion not regulated under any law on the unfounded basis of 'safety concerns' is a little paranoiac.
Are you always this suspicious of everybody?
Does it involve a government agency?
If more than 5 visitors need searching - do you suspect a conspiracy and report it?
No. Doing that sort of thing can make you paranoid.
If the facility houses "rehab" pt's, what does the term rehab apply. You seem intelligent enough to figure it out. Long term chronic is one thing but they need to be evaluated on that far more and in dept than is actually happening. . I don't think I need to cite a source for that ideal as it is a matter of common sense. Their cognitive capabilities are comprimised therefore their senses interpret information differently hence the bizzare behavior, I think. If they are instinctively driven they will try to exploit and all that other stuff that comes along with basic survival senses to gain the moment regardless of the consequences. No foresight, cerebral. They keep burning themselves on the stove lol It's definately an illness, but some of them can function in society if they had the proper help. Rather than deciding who gets help by insurance sound pretty apathetic to me
Who wants to voluntarily walk in and sign into prison? Having a mental illness is not breaking a law. Also, doesn't too much rigidity put patients at risk for institutionalization?
Hopefully none of us work in crack sniffing flophouses :lol_hitti
If the facility houses "rehab" pt's, what does the term rehab apply. You seem intelligent enough to figure it out. Long term chronic is one thing but they need to be evaluated on that far more and in dept than is actually happening. . I don't think I need to cite a source for that ideal as it is a matter of common sense. Their cognitive capabilities are comprimised therefore their senses interpret information differently hence the bizzare behavior, I think. If they are instinctively driven they will try to exploit and all that other stuff that comes along with basic survival senses to gain the moment regardless of the consequences. No foresight, cerebral. They keep burning themselves on the stove lol It's definately an illness, but some of them can function in society if they had the proper help. Rather than deciding who gets help by insurance sound pretty apathetic to me
On facility that I used to work, we checked all patient's belongings on admission. we bagged up contraband, and pts. got it when were discharged. No underwire bras, any products that contained alcohol had to be kept at nurses station in basket for the pt., no food or drink was allowed. However, they were allowed unlimited access to the drinks from the cafeteria.
Visitors were not allowed to bring any purses. They had to be locked in a locker up the front office before entering the unit. If they had anything to bring for family members(e.g. clothing,etc) , they were to drop off at nurses station first. We checked for contraband.
When pts. were admitted, we did a patdown to make sure they were not carrying any contraband. Females were done by female employees and males by male employees.
My adult unit at one time had a mixed population, and I did not like it. Mixing young adults with elderly psych pts. is not good. We tried to split them up into groups as much as possible.
I am a rule follower. And, it would be quite frustrating when others broke the rules. It surely contributes to staff splitting. And, some staff were lazy, cut corners and did not do the proper search on admission, or did not do the room check, but marked off they did. Other staff would find contraband in the room. Everyone really needs to be on the same page and follow the rules. Even if you do not agree with them.. There were some I did not agree with, but the rules were made for a reason.(and not to be broken)
When I first started working in psych, I was in for a big culture shock. I hated it. I felt incompetent, but as time went on, I looked for ways to improve my work. My improvement was noted by the directors of the units. It wasn't long before I was being requested to work on a specific unit.
I no longer work there. Actually, I have not worked for four years. I am just returning to nursing again. I would not return to my former employment for the reason that they no longer have an adult unit. I prefer to working with adults vs. adolescents and children.
Sounds much like the ones I've worked in. I do like that when there are rules (or I prefer "guidelines" - as "rules are made to be broken") that people apply them consistently and if someone wants them changed/reviewed then it's done fairly and transparently so the rationale is clear to all - staff, pts and visitors.
What I don't like is when rules are made arbitrarily, lack common sense or are simply and blatantly for operational convenience - I do not enforce any rules that simply breach the limitations of whatever MHAct you're regulated by without written direction from the big bosses and I absolutely loathe the use of such restrictions as a means of power or punitive leverage.
Such as:
Taking a patient for a walk over to the shop - buying a coke and walking back - never leaving each others side and talking away. You get back to the unit and security says "Sorry, can't take that in there".
An 80+ year old lady visiting her nephew having to be electronically scanned.
Sitting next to patients and eavesdropping on their private conversations because there's nowhere private to talk.
Not giving patients safe lockable places to store their property - then complaining because they report to staff they lost their cigarettes/money - telling them "You should take more care of your stuff"
Not giving a patient a light because you choose not to.
Controlling patient's money because staff don't like the things he chooses to buy.
One of my favourites - Taking lollies off a guy with schizophrenia because he was diabetic. Or only allowing him brown bread when he preferred white. He was perfectly capable of making that decision himself - even if it's a wrong one - but because he's "schizophrenic" - oh no ... he can't decide anything for himself.
Another fave was staff ordering in pizza for dinner - which they then ate in front of the patients who got toast or fruit and telling the patients - "no, you're not allowed to order pizza".
I made a rule that if staff are ordering in - every patient who has the cash (up front!) can order in with us too. I didn't have much problem enforcing it.... just told the patients what the "Staff Rule" was and they did the rest
LOUISTHETERRIBLE
7 Posts
Are you sniffing crack?