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..

[macawake, MSN]

Pt. is cooperative; not violent. ---------> Led away. Handcuffs.

(partial, edited quote)

I agree with other posters. Why would ED staff handcuff a non-violent patient? Do healthcare professionals even use handcuffs or was he led away by security/law enforcement?

Your thoughts are a bit hard to follow. I've never felt anything similar to what you're describing so I'm finding it hard to mentally put myself in your shoes. What really got my attention was the following:

I begin to assist. I feel power. I feel embarrassed by - not the act- but for the power I'm feeling.

and this:

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?!?!

I think that if I ever experienced something similar with a patient, I'd ask a coworker to switch assignments with me. Your reaction to your patient or to your feelings for your patient seem to have gotten you quite rattled. The emotions you're describing of not daring to look and the relief when entering the safe room, what do you think that they are all about? Was it embarrassment for your patient's sake having to parade through the ED with his posterior on display or was it about your own thoughts/reactions? Anyway, with all the turmoil and rapid-fire inner dialogue that you're describing I don't think that you were the ideal person at that time to care for this patient.

I realize that I might sound a bit harsh, that isn't really my intention. Look, even if I can't personally understand your thoughts and reactions to this situation, most of us have had patients who for some reason or other got under our skin, distracted or flustered us somehow, thus having a negative effect on our ability to provide optimal care. If it happens I think that it's best for both the nurse and the patient to trade assignments with someone else.

I'd got him another gown, it's just that i didn't want to make him undress again...

Next time, if you notice that the gown is several sizes too small, just get or ask a coworker to get a new one for the patient. You don't have to make him undress again. Just say to him; "I just noticed that the gown I got you is too small, would you prefer a larger one, we'll fetch one for you". Chances are good that the patient would say yes, and there has to be no use of force or orders. Being barely clothed likely added to the patient's feelings of vulnerability.

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.

I'm sorry that you're feeling this way. I can understand your feelings. Well, what's done is done and this patient is no longer under your care. So you don't have a chance (and shouldn't) have contact with him at this point. I think that what you can do is mull it over for a bit and then file it away as a lesson learned. You can't change the past, but you can change how you'd handle another challenging situation in the future.

[dirtyhippiegirl, BSN, RN]

I have definitely been cuffed when transported either to the ED or from the ED to the psych unit for non-violent, non-psychotic suidical ideation. And once for anorexia. You usually have to undress and they do a skin check. They did cavity searchs on some of the adolescent units I was admitted to.

As someone with dozens of psych hospitalizations - I can look back and kinda shrug because it all seems so routine now but I do have very strong, very good memories of the healthcare and security/police providers who made it a point to keep some of my dignity intact.

[Dany102]

I have definitely been cuffed when transported either to the ED or from the ED to the psych unit for non-violent, non-psychotic suidical ideation. And once for anorexia. You usually have to undress and they do a skin check. They did cavity searchs on some of the adolescent units I was admitted to.

As someone with dozens of psych hospitalizations - I can look back and kinda shrug because it all seems so routine now but I do have very strong, very good memories of the healthcare and security/police providers who made it a point to keep some of my dignity intact.

I guess it is true that humans are resilient by nature. I suppose you can get used to just about anything, with enough exposure. How was some of you dignity kept intact?

Dany

[MunoRN, RN]

I have definitely been cuffed when transported either to the ED or from the ED to the psych unit for non-violent, non-psychotic suidical ideation. And once for anorexia. You usually have to undress and they do a skin check. They did cavity searchs on some of the adolescent units I was admitted to.

As someone with dozens of psych hospitalizations - I can look back and kinda shrug because it all seems so routine now but I do have very strong, very good memories of the healthcare and security/police providers who made it a point to keep some of my dignity intact.

There once was a time when this was true for suicidal patients, back when suicide was illegal which then supposedly justified some of these measures, but that hasn't been the case for more than a decade. In my state, a facility who placed a non-violent suicidal ideation patient in handcuffs would be subject to substantial fines.

[Farawyn]

My friend was cuffed. She's not in NY, and she was high and throwing punches.

My old hospital doesn't restrain unless the patient is violent, physically acting out to hurt himself or others. We, too, had a huge restraint overhaul about 10 years ago.

[Anna Flaxis, BSN, RN]

Wow. Projection much?

[Farawyn]

Wow. Projection much?

Who???

[Anna Flaxis, BSN, RN]

Who???

Sorry. The original post.

[gonzo1, ASN, RN]

Taking care of psyche patients in the ED is very hard. Staff isn't trained for these patients. We do make them strip naked and wear only a gown. Room has everything taken out of it. They may wait hours and hours for someone from mental health to come talk to them.

I always tell them I'm the medical nurse and we are going to do some medical tests first to make sure there isn't something medical wrong to be causing the problem. Then after the medical clearance a mental health professional will come to help them. This somehow made it feel better for me taking care of them.

If they want to talk to me about whats going on I will listen. But I always tell them they really need to talk to a mental health professional to get the best care.

I work part time on a locked psyche unit now and have learned a little. Sadly EDs are not set up in any way that's healthy for these patients.

[VANurse2010]

I think this story is a figment of the OP's imagination.

[VivaLasViejas, ASN, RN]

I'm so grateful that I wasn't put through that sort of thing when I went to the ER for suicidal ideation some time back. I was held for six hours in the "psych room", which was what we called it when I worked there, but I was allowed to put my pajama bottoms back on under a gown after being searched because it was so cold. I did have a few bad moments when it came time to be transferred to the psych unit in another town; I had to go by secure transport in the back of what had once been a police car with the barrier between front and back, and that awful claustrophobic sensation when I realized I couldn't open the door from the inside. No restraints however.

The whole process was made as dignified as possible under the circumstances, and I really appreciated it because I'm not sure I'd have had the courage to go through with getting the help I needed if I'd had to deal with being stripped and handcuffed. I was not a threat to anyone but myself, and even so, once I was safe in the "psych room" I couldn't have hurt myself even if I'd still wanted to. The point is, people who aren't dangerous should be able to come to the ER to get help without fearing they'll be put through painfully embarrassing and invasive procedures. One size definitely does not, and should not fit all.

[Dany102]

I'm so grateful that I wasn't put through that sort of thing when I went to the ER for suicidal ideation some time back. I was held for six hours in the "psych room", which was what we called it when I worked there, but I was allowed to put my pajama bottoms back on under a gown after being searched because it was so cold. I did have a few bad moments when it came time to be transferred to the psych unit in another town; I had to go by secure transport in the back of what had once been a police car with the barrier between front and back, and that awful claustrophobic sensation when I realized I couldn't open the door from the inside. No restraints however.

The whole process was made as dignified as possible under the circumstances, and I really appreciated it because I'm not sure I'd have had the courage to go through with getting the help I needed if I'd had to deal with being stripped and handcuffed. I was not a threat to anyone but myself, and even so, once I was safe in the "psych room" I couldn't have hurt myself even if I'd still wanted to. The point is, people who aren't dangerous should be able to come to the ER to get help without fearing they'll be put through painfully embarrassing and invasive procedures. One size definitely does not, and should not fit all.

Thank you, VivaLasViejas, for expressing far more eloquently what I was struggling with in my own reply. The thought of being put through something like that without any justifiable reason (base on the specific circumstances of what Randa posted) is aberrant. It also, unfortunately, act as a very effective deterrent from receiving psychological care. And then to learn this guy was catheterized to boot? No doubt being terrified and anxious about "what are they gonna do to me next?!?" had a lot to do with his inability to provide a urine sample. Something that easily could have been avoided by simply... Waiting.

I can accept that, in some cases, certain precautions are necessary. I am less willing to accept it in a situation like this one. A lot of it was, in my opinion, not necessary and abusive in nature. Perhaps this young man was kept "safe" but I seriously doubt he'll keep fond memories of the quality care he received while in this ED. In all likelihood, he'll think twice before returning there willingly. I know I would.

Dany