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..
I've been in many psych settings as the family member taking in or getting there after the police and EMTs transferred. Depending on what behavior occurred w/the suicidal threat or attempt might determine the need for cuffs in the hospital setting. It eats at me that my family member undergoes this kind of experience but on the other hand, I've been there to see the destruction and sometimes violent outbursts that preceded the admission, I know in his cognitive moments my person would never hurt someone else. But I've also seen him hurt people and I would not want staff endangered. As nurses we have all probably been injured by someone as we attempted to care for them whether demented, drug induced, psychotic. But as the person who knows that when my family member truly wants to commit suicide, I want you to restrain him so you don't go down too. This is rambling but as nurses we work so hard to care and sometimes jeopardize ourselves but sometimes the police who have just left the scene know the right thing to do. As a mom, I don't want your child to be motherless because my child was more determined. Just please care for your patient, but protect yourself as well.
Why is there still such a stigma with patients who have psych disorders or are HIV + ,etc.? Medical personnel should be educated on how to treat them, as any other patient, with dignity. I can understand handcuffs if the patient was combative or trying to hurt himself. The person feels bad enough about her/himself and to put them into that position ? That is so wrong ! People with suicidal ideation need compassion not more embarrassment !
Why couldn't the police officer or hospital security be close by in case the patient decides to hurt himself or staff ? That way there is backup for the hospital employee ? And the patient's safety is paramount.
I don't think I caught most of the stream-of-consciousness part of the story, but why the handcuffs?
Secure Transport taking the patient from the ED to the inpatient psych unit. They will sometimes use handcuffs if they don't feel they can safely monitor the patient and drive the vehicle simultaneously.
Because the patient couldn't provide a urine specimen. A urine specimen is required by the inpatient psych facility, to rule out drug intoxication. The inpatient unit will not take the patient until the results are back.
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.
I was just writing how I felt, then and still later.
Do you have Psych on board in your ED? No.
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.
Yes, there was an element of attraction. The unusual/intimate circumstances definitely impacted the situation.
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?
No. The patient was not handcuffed until transportation to facility. Procedure.
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 realized?
After he told me what he everything, we just sort of stared at each other, not saying anything. For a moment everything seemed still. That was broken by the first male techs checking to see if they were needed. I went back to my notes, briefly, then told him to undress. I think it may have caught him off guard. The first time, I was extra polite about it. Meek, maybe... The second, a little more matter-of-fact. Then, I thought I was going to have to undress him myself. But, this was all in seconds. I could have just caught him off guard. I know he was not expecting it. Maybe he expected me to leave, and was waiting for that. But, I do not think my presence made him uncomfortable, though. As soon as he started, I went to the corner to get a gown. I was not watching, and a tech came to escort us to a safe room. My patient was taking his boxers off at that point, stopped for a second, then went ahead. Like it was obvious it was not a big deal for him when it was just me in the room, but now with the big male tech staring right at him, I think it humiliated him some. I did not want him to have to sit there naked so I hurried and handed him a gown. I thought they were all adult sizes. I had just finished asking him three times to undress; did not want to again; did not want to ask him to in front of tech. Possible error on my part.
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?
I felt like his attractiveness would be noticed, and if I looked at them, they would think I was checking to see if they were looking, and assume I felt the same... Idk... The gown was not much – even by ED standards – so, yeah... The safe room reminds me of a prison cell, and I just hated leaving him there. I think you would hate leaving anyone there, alone. I kept thinking about him in there. I am not sure if he really felt like I betrayed him or not. I just felt like I had in some way, even though I know I had not. Like by confiding in me, he got himself into this unpleasant situation. I think with him being naked and only having the gown (any hospital gown) that he just looked like he had been feminized and made so vulnerable. That is the way he had to leave too.
I've heard it happens to everybody eventually. Being I did mostly geriatrics, I guess I've been insulated. My mentor once told me it happened to him, but he had to excuse himself when he lost the ability to enunciate!
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.
I was just writing how I felt, then and still later.
Do you have Psych on board in your ED? No.
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.
Yes, there was an element of attraction. The unusual/intimate circumstances definitely impacted the situation.
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?
No. The patient was not handcuffed until transportation to facility. Procedure.
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 realized?
After he told me what he everything, we just sort of stared at each other, not saying anything. For a moment everything seemed still. That was broken by the first male techs checking to see if they were needed. I went back to my notes, briefly, then told him to undress. I think it may have caught him off guard. The first time, I was extra polite about it. Meek, maybe... The second, a little more matter-of-fact. Then, I thought I was going to have to undress him myself. But, this was all in seconds. I could have just caught him off guard. I know he was not expecting it. Maybe he expected me to leave, and was waiting for that. But, I do not think my presence made him uncomfortable, though. As soon as he started, I went to the corner to get a gown. I was not watching, and a tech came to escort us to a safe room. My patient was taking his boxers off at that point, stopped for a second, then went ahead. Like it was obvious it was not a big deal for him when it was just me in the room, but now with the big male tech staring right at him, I think it humiliated him some. I did not want him to have to sit there naked so I hurried and handed him a gown. I thought they were all adult sizes. I had just finished asking him three times to undress; did not want to again; did not want to ask him to in front of tech. Possible error on my part.
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?
I felt like his attractiveness would be noticed, and if I looked at them, they would think I was checking to see if they were looking, and assume I felt the same... Idk... The gown was not much – even by ED standards – so, yeah... The safe room reminds me of a prison cell, and I just hated leaving him there. I think you would hate leaving anyone there, alone. I kept thinking about him in there. I am not sure if he really felt like I betrayed him or not. I just felt like I had in some way, even though I know I had not. Like by confiding in me, he got himself into this unpleasant situation. I think with him being naked and only having the gown (any hospital gown) that he just looked like he had been feminized and made so vulnerable. That is the way he had to leave too.
How do you think you would react if he was an older, unattractive man, or a woman?
I did give you the benefit of the doubt, thinking you were stressing about a patient being treated this way, but the more you say I'm thinking it wasn't the patient, I'm thinking it was, in fact, this patient.
If you are preoccupied with your personal response and you want to gain insight into your feelings and how you could have handled this patient's situation better, suggest you seek short term counselling through EAP if it is available .
kidsmakingmecrazy
5 Posts
I've been in many psych settings as the family member taking in or getting there after the police and EMTs transferred. Depending on what behavior occurred w/the suicidal threat or attempt might determine the need for cuffs in the hospital setting. It eats at me that my family member undergoes this kind of experience but on the other hand, I've been there to see the destruction and sometimes violent outbursts that preceded the admission, I know in his cognitive moments my person would never hurt someone else. But I've also seen him hurt people and I would not want staff endangered. As nurses we have all probably been injured by someone as we attempted to care for them whether demented, drug induced, psychotic. But as the person who knows that when my family member truly wants to commit suicide, I want you to restrain him so you don't go down too. This is rambling but as nurses we work so hard to care and sometimes jeopardize ourselves but sometimes the police who have just left the scene know the right thing to do. As a mom, I don't want your child to be motherless because my child was more determined. Just please care for your patient, but protect yourself as well.