My thoughts. Literally. Catheter. Psych Pt. ED

[Ronda89]

My head is still spinning. Working ED, when a 25 y/o male is referred (by his friends) for suicidal ideation. I walk pt. back after initial screening. Complaints? As pt. elaborates (over-elaborates) My jaw almost drops! Nothing he's done, but what has happened to him in the past 24/48hrs/week of his life is CRAZY! Feel totally bad for him; want to tell him that he maybe making a mistake - but it's not as though he's reporting himself...others are concerned... Yeah, sometimes it doesn't go unnoticed, but in this particular instance it would be impossible not to notice/to ignore: he's adorable. Male techs enter room and I tell them that they're not needed. Pt. is cooperative; not violent. They leave. Vocabulary is very intelligent; pronunciation (although soft and somewhat monotone) is clean/sheer; very pleasant voice. All the more so making it surreal when it is time to tell pt to disrobe. I actually say "undress." "Everything," I say, "including socks and underwear." Why did that feel so awkward?!?! This is my profession! Why am I even reminding myself of this, I wonder. I'm not being sadistic - it's not even a word in my vocabulary. So why do I feel this way? Why is it the only thing that comes to mind then/now?? Nothing. Did he hear me?? For goodness sakes (all occurring in split seconds') but it was hard enough (awkward, compelling?) for me to say it once already, now I have to repeat myself?!?! Remember: Logic over emotion. I say it again. This time: "I need you to to..." Stressing the "I need" part while staring directly into his eyes. I detached while doing so. Logic over emotion. If this sounds crazy, not two minutes ago, this individual bore his soul to me, and now I'm ordering him to strip naked with all the conviction of a Starbucks employee asking a person for their order... Yeah, it's my job. No, I'm not a psych nurse. And no, either I've not had enough experience to automatically (in my mind) consider this person a threat, or I just don't believe he is, but it's protocol. I begin to assist. I feel power. I feel embarrassed by - not the act- but for the power I'm feeling. Make it quick. Avoid eye contact. Start with non-intimate. Shoes, socks. Wow! Nice feet! Is that a pedicure?? Seriously!?! Anything to take my mind off, I guess... Why?? Because this is so surreal?? The socks must've made a connection to "socks and underwear" that I muttered moments earlier. "Oh...sorry" he said. "What?!?!" Another lightbulb/total realization. I repeat for a third time: "....everything...underwear...it's for your safety...it's our policy..." I explain. I step away, shifting my focus on fetching a gown from the corner basket. Pt. proceeds to undress himself. Male tech enters; looks at pt, then to me, then back to pt. Monumentous moment. I look at pt. Pt. had paused, momentarily, then as if succumbing/accepting the humiliation of it, continued to undress. Safe room. That's what the tech had to say. That pt needed moved to a safe room - as he grappled with his captivation. Again, I turn my attention. Look for gown, grab one, hand to pt in a manner consistent with wanting to end show. Did not notice it was child's size. CRAP!! The three of us walking through ED, down hall to safe room. Feel all eyes on pt; feel eyes on me; don't dare look. Safe room. Finally. Relief. Nothing. Empty room. Sad. Lonely. Isolation. Too small gown. Leave. It's over. Finally. Yeah, right.... Can't get my mind off. Nervous. Shaky. WHAT IS WRONG WITH ME?!?! 15 minutes. A lifetime. Look in on Pt. Why am I staring at his bare soles? Conveyance of something... Feminization?? No, that's the damn gown! Something...something... Vulnerability?? That must be it. "Hi...how are you doing?" Feel stupid. He looks at me like I betrayed him. At least that's what it feels like. "Ok" he says. Leaving room, he stops me. "What's going to happen?" I tell him a professional, evaluation, blah, blah... "Then what?" "I don't know." "Just be honest." Later. F-you eyes with following checks. "You think I'm crazy?" "No." Off duty. Stick around. Girls at desk commenting on pt. A catheter?!?! Can't go. Urine screen. Seriously?? A damn catheter?!?! Yes! Going to facility. Led away. Handcuffs. Barefoot. Open back, too short/tight/small gown. Near naked. Still on my mind. Still thinking of him. Wondering what will happen to him..

[AnnieOaklyRN, BSN, RN, EMT-P]

???????????

[Davey Do]

We are human beings with emotions and physical drives. We sometimes have feelings and thoughts toward those we serve which, if we acted upon those thoughts and feelings, inappropriate things could happen. When our feelings get the best of us, we struggle to remain focused.

A staff member the same gender of the Patient in the room during uncomfortable moments is always a good idea.

When a Patient pours out their heart, a feedback summary in the listener's own words affirms that the patient has been heard. One of our roles is to inform the Patient what to expect. Often times, we are merely stepping stones to those who actually deal directly with the Patient's problem.

The most we can ever be, in a lot of cases, is a strong link in a chain.

[Dany102]

And that post has just reconfirmed my conviction that I will never seek help at an hospital should I have suicidal tendencies. And I am certain many person struggling with depression/suicide ideation wouldn't either, if only they knew what was in store for them. This is not good care. This is humiliating. Beyond what could be conveyed by simple words. No wonder this young man gave you that look.

What you felt, Ronda, is your conscience calling out to you. Telling you that what you've been trained to do didn't quite match the reality you were dealing with. Safety does not trump everything. Every situation is different and must be taken into account.

It's pretty sad, really...

Dany

[Farawyn]

Hospitals, the nurses in particular, have saved one of my best friends from suicide multiple times in the last 3 years.

OP, I would hope your post doesn't put anyone else off, like it has Dany102.

Yes, there are attractive patients and unattractive patients, but as nurses, we have to get those feelings in check. Especially a suicidal patient, who is at his/her most vulnerable point. This read like a prelude to a bodice ripper.

I hope you were simply venting and you can shake this off.

ETA: Okay, I read this again. My initial gut reaction may have been overprotective. My own thoughts got in the way of yours.

It sounds like you "acted" correctly. I hope the patient is okay, too.

[Farawyn]

As far as what hospitals put suicidal patients through to keep them "safe", I can imagine your horror as a nurse, especially a new nurse.

Restraints (of any kind) are rough.

[Ronda89]

Hospitals, the nurses in particular, have saved one of my best friends from suicide multiple times in the last 3 years.

OP, I would hope your post doesn't put anyone else off, like it has Dany102.

Yes, there are attractive patients and unattractive patients, but as nurses, we have to get those feelings in check. Especially a suicidal patient, who is at his/her most vulnerable point. This read like a prelude to a bodice ripper.

I hope you were simply venting and you can shake this off.

ETA: Okay, I read this again. My initial gut reaction may have been overprotective. My own thoughts got in the way of yours.

It sounds like you "acted" correctly. I hope the patient is okay, too.

Thanks. Yeah, I didn't think there was anything that incorrect or inappropriate about my actual actions. I didn't mean to sound like a romance novel, I just remember everything so vividly. I had thought I'd felt something from him when he was telling me all this that had happened. I know it's part of my job, but it was pretty personal stuff. I think he felt like he could trust me, and then with his clothes and the humiliation, I feel like he felt like I had betrayed him. I felt really bad. But I agree with all of the precautions. I'd got him another gown, it's just thati didn't want to make him undress again... I'd just like for him to know I feel bad for him. That I'm on his side. Only wanted to help/do my job. That and I don't think he's really suicidal, just needing someone to talk to. From that to being led away in handcuffs and in an ill-fitting gown... I wish there was something I could do.

[Farawyn]

Thanks. Yeah, I didn't think there was anything that incorrect or inappropriate about my actual actions. I didn't mean to sound like a romance novel, I just remember everything so vividly. I had thought I'd felt something from him when he was telling me all this that had happened. I know it's part of my job, but it was pretty personal stuff. I think he felt like he could trust me, and then with his clothes and the humiliation, I feel like he felt like I had betrayed him. I felt really bad. But I agree with all of the precautions. I'd got him another gown, it's just thati didn't want to make him undress again... I'd just like for him to know I feel bad for him. That I'm on his side. Only wanted to help/do my job. That and I don't think he's really suicidal, just needing someone to talk to. From that to being led away in handcuffs and in an ill-fitting gown... I wish there was something I could do.

No. I get that. I was distracted by the style, I guess.

ETA: Did you do that purposely to distract yourself from your own discomfort of the situation? Because truly, at first blush, I thought your post was about attraction, and had to do with boundaries.

[Farawyn]

Do you have Psych on board in your ED?

[MunoRN, RN]

I don't think I caught most of the stream-of-consciousness part of the story, but why the handcuffs?

[Farawyn]

I don't think I caught most of the stream-of-consciousness part of the story, but why the handcuffs?

And the cath?

This is what I mean by restraints of any kind.

[Hollybobs]

You are obviously quite stunned and still trying to piece together your feelings as evidenced by the fragmented narrative, I hope you are okay, it sounds like it deeply affected you.

My gut reaction on first read was also there was an element of attraction between you or from you. I don't know if this was real or just a side-effect of the writing style or the unusual and intimate circumstances.

I had a few queries too. Is suicidal ideation such a high risk that it's necessary to remove all underwear with handcuffs on? Surely one would struggle to injure oneself with underwear if handcuffed?

Did he have to be fully naked at any point? Could he not have covered himself with a towel whilst waiting for a gown?

Did you transition from him telling you his inner feelings to asking him to strip in any way or was it as abrupt as it sounds?

And why couldn't he have been given the correct size gown when you realised?

I know these questions sound critical- I don't mean it that way, it's just that obviously it is difficult to put all the details in the original post and I wanted to ask for more information.