Keeping Yourself Safe

elkpark · Jul 18, 2006

I would add to your list

a) Avoid provocative clothing (low necklines, short skirts, etc.) In general, the less attention your attire draws, the better.

b)With paranoid clients, in addition to avoiding letting them get between you and the door, also avoid getting in between them and the door (i.e., be sure you both have a clear path to the door). Not having a clear path out increases the anxiety/agitation level of a paranoid client even more than it increases yours. :)

c) Day in and day out, never pass up an opportunity to build a little rapport and good will with the clients. You never know when your safety (or someone else's, or your life) is going to suddenly depend on whether or not someone feels good about your relationship with her/him, and it's the "little things" that you don't really think about that often mean the most to clients. Things like remembering that someone requested another blanket for her/his bed because the room was cold, and making sure they get it -- things as simple as that. I don't meant that you always say "yes" to any request and do whatever they want you to, but that you treat people with respect, courtesy and take a genuine interest (within the limits of healthy professional boundaries, that is) in them as human beings -- simply treat them the way you would want to be treated if you found yourself in their situation ... It's much easier to de-escalate a situation when you have good rapport with the clients in the situation to begin with. Also, I have worked with plenty of people over the years who did not do this, and I have seen staff who came across as cold, disinterested, and uncaring get assaulted by clients more frequently than other staff. I've also seen clients step in to protect me or other staff members from other clients (not that that was necessary or appropriate, but they meant well ...), warn us of impending problem situations on the unit, etc., because they liked us and didn't want us to get hurt.

I'm sure I could think of other things if I took some time, but I've got to go pull dinner out of the oven! Best wishes on your new position --

Morgan314 · Jul 19, 2006

Keep your hands to yourself. Sometimes this is hard because touching may be your natural response to a hurting person, but always ask if it is ok to touch them before you put that comforting hand on their shoulder. Sometimes a psychotic person may think you are attacking him. We had a very psychotic woman in our community mental health center one evening on emergency and a therapist thought she had a connection with the patient because they were both African-American. The therapist reached out to touch the patient, and the patient's response was to attack the therapist. And you wouldn't believe the physical strength of a 90 lb psychotic woman. The patient became so agitated, she got up out of her wheelchair, went into a nearby office and thoroughly trashed it. A person with mental illness misinterprets stimuli and their response to touch is unpredictable.

CharlieRN · Jul 19, 2006

I'd second morgans comment. Avoid unnecessary touching. Before I was a psych nurse I was a very "touchy-feely" type person. Now when a client is in distress, I offer them a kleenex. Gives me some physical way to express concern yet is unambiguos. Kleenex carry no sexual overtones.

With experience you learn how to fine tune it. I gave a young female patient a hug about a year ago. I had just finished doing a 3 hour admission with her in the middle of the night and had walked her to the unit. As I said good bye and turned her over to the unit staff she held her arms up for a hug. I did not feel I could possibly refuse. Oh yeah, she was 5 years old. However even with a young child I would not touch without a clear invitation, and in a clearly defined situation ie: saying good bye to somone you don't expect to see ever again, and in a public and witnessed situation.

I know you wern't thinking of this type of danger but its a real one even so.

Meerkat · Jul 21, 2006

I advise no dangly earrings. Good shoes with a heeled back. CPI training. I also think that in certain situations, it's good to have a 'script' for what to say. That way you don't get stuck in tough position. For example, when someone is feeling like they want to hurt themselves, I have a kind of general script like "I'm so sorry you are feeling badly right now. Why don't we open up the lines of communication and see what we can figure out together?"

That type of thing.

Patients who are hostile will often pick out personal characteristics to try to get you off guard. They might say something about your weight, or your hair, or that mole on your face. Don't even let that junk sink into your head. It's just a lame weapon they use to try to get to you.

Good Luck!

Morgan314 · Jul 22, 2006

Along with keeping your hands to yourself, keep your hands within view. If you approach a psychotic person with your hands behind your back or in your pockets, he may suspect you have something in your hands that could hurt him. Also, keep an eye on his hands for the same reason.

VickyRN, MSN, DNP, RN · Jul 24, 2006

Avoid wearing the color red or orange; blue-tones and blue-green are calming colors and should be worn instead.

TitaniaSidhe · Sep 28, 2006

Myself I just try to avoid skirts or dresses all together that way if I do have to struggle with anyone my underware isn't flashed to the world & it avoids issues with the sex offenders. Make sure you wear shoes you can run in & make sure you always have you keys readily avaliable in case you need to get off the unit fast. Always keep your word to a patient, if you say you will do something do it, positive or negative consequence. Be consistent.

psykrn · Sep 29, 2006

Safety Training, Crisis Intervention, Verbal De-escaltion and Behavioral Intervention Techniques (including the use of restraints) should be part of your orientation and competency process.

RN(MH) · Oct 13, 2006

Hi

I agree with the touching, not everyone wants to be touched even if you mean well. We all have a level at which we do not want our personal space invaded. I have worked with a nurse (RGN not RMN) who couldnt seem to understand why the elderly with dementia did not always seem to appreciate staff attending to them. To try and explain to her the reasons for this was nearly impossible !! With psychotic patients touching them can be threatening. Its a matter of building up a rapour with people, based on trust and empathy.

When I worked on an acute admission ward, even though the NAs would check everyone in at the start of the shift whilst the RMNs concentrated on the handover, I always made a point of going round as soon as I could to say morning or afternoon and introduce myself, particularly to new admissions. I found it helped a great deal, and in the time I worked in acute admissions I never found myself in a situation where C&R had to be used.