Letting a pt on suicide precautions out of their room to ambulate.

[november17]

I had a patient on suicide precautions that wanted to walk around the facility ad lib with their friend and the sitter with them. I said no; she needed to stay in the room. They all protested; arguing with me about it. The aide that was sitting even argued with me about it (in front of the patient, I wanted to kill her). I stood firm.

What do you guys think?

[leslie :-D]

i 'think' i would have let her walk around the nurse's station or a public area on the floor where she could be eyeballed.

but then again, i may be somewhat projecting my own desistance to being confined.

i'd really have to check the pt out before offering anything concrete.

leslie

[pagandeva2000, LPN]

I don't think you were being unreasonable. This patient could have done anything, and you would have had to explain why you allowed this to happen. I can see walking the floor-maybe. However, walk outside? Leave the floor? What if the patient knocked the aide out? Nope, you did the right thing.

[casi, ASN, RN]

It really depends on the patient if you let them up or not. If your gut is telling you no, don't let them up. As an aide I've ambulated a people on suicide percautions around the nurses station a few time. On the same note I have sat for psych patients on med-surg floors that made me nervous everytime they got out of bed.

Under no circumstances should the aide have argued with you.

[PICNICRN, BSN, RN]

You absolutely were NOT wrong........ it is YOU who is responsible for that pt! Not the sitter/ not the friend!!! You totally did the right thing!

About 5 years ago, I worked in a community hospital and there was a new mom suffering post partum depression(I guess she had it with her first too) Anyway, her OB held her discharge to "monitor" her for a while. She was not on suicide watch or anything, just not bonding with the baby. Anyway, she went for a walk and jumped off the 2nd floor atrium into the lobby of the hospital! Some poor guy on the first floor broke her fall( and his wrist). She was not hurt(physically).

I sure wouldn't want to be the nurse who sent her on a stroll!

[smoke over fire]

Again...you were correct.

Don't forget that some of those with psych issues are masters at manipulation. I would have debriefed the sitter about manipulative behaviors after I found someone to relieve her. At the point when she undermined you in front of the patient, she was no longer effective to keep the patient safe. (This makes me so frustrated! Why can't we give even training on the way to perform constant observation to our staff!). It's ridiculous to presume that a person will "automatically" know what to do in these types of situations.

One of my friends had a sitter manipulated as well as a nurse on the shift prior to hers. The patient was so pretty & young, who would have thought?! Any who, pt. was on physician ordered rights restriction (no phone) because she was refusing meals (eating disorder with symptomatic starvation). Pleaded to sitter on a "walk just down the hall", ie. I-miss-my-mom-so-much-can't I please use the phone, those mean nurses don't understand. blah, blah, blah they think they know it all, etc. Phone call ends up becoming "hey mom I'm going on a walk with this guy". My friend was chewed out by Mom, Dr., & Admin.

[northshore08]

Again...you were correct.

Don't forget that some of those with psych issues are masters at manipulation. I would have debriefed the sitter about manipulative behaviors after I found someone to relieve her. At the point when she undermined you in front of the patient, she was no longer effective to keep the patient safe. (This makes me so frustrated! Why can't we give even training on the way to perform constant observation to our staff!). It's ridiculous to presume that a person will "automatically" know what to do in these types of situations.

You are right, and the OP did the right thing. I agree completely with you that many sitters have no training; since this one was evidently not familiar with psych patients on suicide watch. The sitter lost all credibility and the nurse now has to watch both of them! Nursing supervisor needed to come in on this one, and visitor needed to go away.

[sofaraway04]

I think that I would have let the pateint walk around the ward and sit in the day room if they wanted, but I wouldn't have been happy about letting them go off the ward and wander around the hospital.

[nrsang97, BSN, RN]

I personally would have let the pt walk around in the hall near their room and maybe sit in the day room with sitter of course. This way you can see the pt as well. The aide was wrong for arguing with you especially in front of the patient. I think I would have gone crazy sitting in one room all day.