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..
Where does anyone say it was an indwelling catheter? I had assumed this was an in-and-out cath from the beginning. What did I miss?
Read the writer's first entry. The girls at the desk ( in the nursing station) remarked that he was leaving with a "catheter" because he couldn't leave a specimen.
Read the writer's first entry. The girls at the desk ( in the nursing station) remarked that he was leaving with a "catheter" because he couldn't leave a specimen.
Yea, I was caught up in OP's "moment", and, like Anna, figured straight cath. Why does he need an indwelling cath?
Not all suicidal persons have the same level of risk to self harm. Unless the person is in severe psychosis, there is always ambivalence at play. Especially with someone who recognize their own feelings, determine that they need help and set about to seek that help. And that assessment ( of the risks to self harm) is done by simply talking with the person.
This cookie cutter approach used here implies that every person who thinks about suicide is a time-ticking bomb waiting to explode. Not so. A majority of depressed people are in fact non violent.
To insist on striping someone of his or her dignity, under the guise of safety, might precipitate a peaceful situation into possible violent acts. All this when said person only wanted to explore their own feelings with a professional therapist.
I will say it again, safety is not the end all be all. Comon sense must be applied.
Dany
The very definition of a "suicidal patient", is one who wants to end his/her life.
You do not need severe psychosis on board to be suicidal. Or violent.
Yes, there are varying levels of this- are they suicidal thoughts? or is the person swallowing a gun as we speak?
There are plenty of depressed patients that are NOT suicidal. The 2 terms are not interchangeable.
The guy's friends brought him in because he told them he was suicidal, right? He wasn't a depressed guy looking to explore his feelings. You don't go to the ED for that.
As far as this account? So, so, so, much seems so WRONG. I am cringing to think this seemingly non violent guy was put through this and treated like this.
What should we do with a patient like this, as nurses? Is a 72 hour hold standard? The naked, the cuffs?
Are there varying degrees of how we treat an unknown patient who reports to the ED as "suicidal"?
I'm asking because I don't work in the ED. I don't know.
The very definition of a "suicidal patient", is one who wants to end his/her life.
You do not need severe psychosis on board to be suicidal. Or violent.
Yes, there are varying levels of this- are they suicidal thoughts? or is the person swallowing a gun as we speak?
There are plenty of depressed patients that are NOT suicidal. The 2 terms are not interchangeable.
The guy's friends brought him in because he told them he was suicidal, right? He wasn't a depressed guy looking to explore his feelings. You don't go to the ED for that.
As far as this account? So, so, so, much seems so WRONG. I am cringing to think this seemingly non violent guy was put through this and treated like this.
What should we do with a patient like this, as nurses? Is a 72 hour hold standard? The naked, the cuffs?
Are there varying degrees of how we treat an unknown patient who reports to the ED as "suicidal"?
I'm asking because I don't work in the ED. I don't know.
Your points are well taken, Farawyn. I should have exercised a bit more caution. So let's narrow it down, for the sake of clarity.
Not every suicidal person will necessarily act on their intentions. Someone announcing he or she wants to commit suicide is a sign they are looking for options (they recognize killing themselves is least desireable option) Someone coming to the ER is a sign saying help me, not I want to die. Again, there is a lot of ambivalence at play. A good suicide intervention capitalize on this.
Assessing the risks will determine what actions need to be taken. Someone who is dragged in kicking and screaming, screaming threats to others and themselves is one thing. The threat is a lot higher and violence is a likely outcome. Someone coming to the ER of there own volition (with little to no convincing ), appears quiet and cooperative, is a different thing. The potential for violence is much reduced.
There is also the undeniable fact that forcing someone to remove there clothes (because ultimately that's what it will come down to), only heighten the distress a person will feel. It makes them more anxious and fearful of their immediate future. This is not helpful.
Often time a verbal agreement (or contract ) will be enough to keep a suicidal person calm, and composed, until a psych evaluation can be conducted.
Your points are well taken, Farawyn. I should have exercised a bit more caution. So let's narrow it down, for the sake of clarity.
Not every suicidal person will necessarily act on their intentions. Someone announcing he or she wants to commit suicide is a sign they are looking for options (they recognize killing themselves is least desireable option) Someone coming to the ER is a sign saying help me, not I want to die. Again, there is a lot of ambivalence at play. A good suicide intervention capitalize on this.
Assessing the risks will determine what actions need to be taken. Someone who is dragged in kicking and screaming, screaming threats to others and themselves is one thing. The threat is a lot higher and violence is a likely outcome. Someone coming to the ER of there own volition (with little to no convincing ), appears quiet and cooperative, is a different thing. The potential for violence is much reduced.
There is also the undeniable fact that forcing someone to remove there clothes (because ultimately that's what it will come down to), only heighten the distress a person will feel. It makes them more anxious and fearful of their immediate future. This is not helpful.
Often time a verbal agreement (or contract ) will be enough to keep a suicidal person calm, and composed, until a psych evaluation can be conducted.
Dany
Yep, we use "suicide contracts", both written and verbal in my high school often.
Specializes in psych, addictions, hospice, education.
I'm appalled by how this young man was treated when he was there for help, especially by what was policy and procedure for a suicidal patient. My comments may not be logical and are probably judgmental, but they are my thoughts anyway.
pt. elaborates (over-elaborates). What is the definition of over-elaboration?
Feel totally bad for him; want to tell him that he maybe making a mistake What is his mistake? coming to the hospital? What's your reason for thinking that, if you think it?
he's adorable. Lots of patients are adorable or otherwise push our emotional buttons. It's up to us to store those thoughts and feelings and do what we need to do without those thoughts and feelings impacting our work.
Male techs enter room and I tell them that they're not needed. In many facilities, it's standard procedure for same-gender staff to be present when there's a search done. It's also standard procedure for at least 2 staff to be present. Otherwise, the lone staff person can be accused of doing something inappropriate. It's a matter of patient AND staff safety.
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?!?! seems as if you're counter-transferring a bit here
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?because you knew there was something "off" in what you were asking him to do, or thinking about him?
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. Psych patients are not automatically a threat. We use care and remain vigilant, but don't assume they're dangerous!!
I begin to assist. He is a young, strong man. Was he too slow? Did you not have time to let him do things in his own time? Psych patients are often slow to respond. They have other things on their minds than following instructions.
I feel power. I feel embarrassed by - not the act- but for the power I'm feeling. definite countertransference here...beware when you feel this! Make it quick. Avoid eye contact. Start I step away, shifting my focus on fetching a gown from the corner basket. Pt. proceeds to undress himself.
Did not notice it was child's size. throw another over the first
He looks at me like I betrayed him. At least that's what it feels like. do you feel you betrayed him?
Stick around. for what reason?
Girls at desk commenting on pt. A catheter?!?! Can't go. Urine screen. Seriously?? can't give him several glasses of water and wait awhile?
While it definitely sounds like I'm questioning the motives and actions of the OP (because I am), I'm also questioning a policy that treated an ill patient like a prisoner with no rights. Where were the other staff when these things were going on? No one offered another gown to cover up his backside? No one gave him a blanket or let him have socks? He was foley-d???
I'm having trouble being coherent here, and hope my points are noted...so much was wrong in this situation! Surely others see this but are being nicer than me.
I too am extremely shocked at how this man was treated. As someone who's been hospitalised many many times for suicidal ideation and depression I have NEVER been treated like that! If you come to hospital in "office hours" you go direct to the psych unit, not the ED. Outside these hours? Yes, the ED, but it's counted as a triage cat 2 and they have to be reviewed by psych within 30 minutes (ideal world obviously). We only drug screen if obviously psychotic and we feel it's warranted, or if psych ask for it. But a catheter? Never, just give him a glass of water and wait for gods sake!! If admission is warranted, the removal of clothes is done on the psych floor. We are NOT allowed to put ANY patient in handcuffs or restrain them in any way, unless they actively become violent, then security will perform the restraint. Stripping someone of their clothes, inserting a foley and putting on a child's size hospital gown is extremely humiliating and I can imagine if this man ever feels suicidal again the last place he will go is his local ER.
I'm appalled by how this young man was treated when he was there for help, especially by what was policy and procedure for a suicidal patient. My comments may not be logical and are probably judgmental, but they are my thoughts anyway.
pt. elaborates (over-elaborates). What is the definition of over-elaboration?
Feel totally bad for him; want to tell him that he maybe making a mistake What is his mistake? coming to the hospital? What's your reason for thinking that, if you think it?
he's adorable. Lots of patients are adorable or otherwise push our emotional buttons. It's up to us to store those thoughts and feelings and do what we need to do without those thoughts and feelings impacting our work.
Male techs enter room and I tell them that they're not needed. In many facilities, it's standard procedure for same-gender staff to be present when there's a search done. It's also standard procedure for at least 2 staff to be present. Otherwise, the lone staff person can be accused of doing something inappropriate. It's a matter of patient AND staff safety.
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?!?! seems as if you're counter-transferring a bit here
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?because you knew there was something "off" in what you were asking him to do, or thinking about him?
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. Psych patients are not automatically a threat. We use care and remain vigilant, but don't assume they're dangerous!!
I begin to assist. He is a young, strong man. Was he too slow? Did you not have time to let him do things in his own time? Psych patients are often slow to respond. They have other things on their minds than following instructions.
I feel power. I feel embarrassed by - not the act- but for the power I'm feeling. definite countertransference here...beware when you feel this! Make it quick. Avoid eye contact. Start I step away, shifting my focus on fetching a gown from the corner basket. Pt. proceeds to undress himself.
Did not notice it was child's size. throw another over the first
He looks at me like I betrayed him. At least that's what it feels like. do you feel you betrayed him?
Stick around. for what reason?
Girls at desk commenting on pt. A catheter?!?! Can't go. Urine screen. Seriously?? can't give him several glasses of water and wait awhile?
While it definitely sounds like I'm questioning the motives and actions of the OP (because I am), I'm also questioning a policy that treated an ill patient like a prisoner with no rights. Where were the other staff when these things were going on? No one offered another gown to cover up his backside? No one gave him a blanket or let him have socks? He was foley-d???
I'm having trouble being coherent here, and hope my points are noted...so much was wrong in this situation! Surely others see this but are being nicer than me.
Whispera, if only I could like your post a hundred times... Thank you!
I have been a psych patient who has spent up to a week in the ER waiting for a psych bed to open up.
I have been stripped down by male officers and put into a gown (I'm female). I was suicidal and treated like some undesirable patient. I will never go to the ER again because of how I was treated during my last admission.
I can see how OP's treatment of her / his patient may cause the patient not to return either.
Yep, we use "suicide contracts", both written and verbal in my high school often.
ED RNs, do you utilize this?
So called "Suicide Contracts" should not be relied upon, as they are not evidence based. In fact, evidence points to the opposite- that they are unreliable and result in bad outcomes.
Not all suicidal persons have the same level of risk to self harm. Unless the person is in severe psychosis, there is always ambivalence at play. Especially with someone who recognize their own feelings, determine that they need help and set about to seek that help. And that assessment ( of the risks to self harm) is done by simply talking with the person.
This cookie cutter approach used here implies that every person who thinks about suicide is a time-ticking bomb waiting to explode. Not so. A majority of depressed people are in fact non violent.
To insist on striping someone of his or her dignity, under the guise of safety, might precipitate a peaceful situation into possible violent acts. All this when said person only wanted to explore their own feelings with a professional therapist.
I will say it again, safety is not the end all be all. Comon sense must be applied.
Dany
What is your experience working in the ER? With suicidal patients? Just curious....
Read the writer's first entry. The girls at the desk ( in the nursing station) remarked that he was leaving with a "catheter" because he couldn't leave a specimen.
I read it. It says:
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.
Again, it's not clear that an indwelling catheter has been placed. Time has been compressed by the narrative. We only have a sequence of events. The sequence of events occurred over a nonspecific period of time. In the real world, the urine results have to be back before the inpatient facility will accept the patient, so it's clear to me that at the very least, an hour has passed between the time of the catheterization and the time the patient left the ED (because it will take about 30 minutes for urine results to be posted, then another stretch of time for the physician to communicate, for the transportation arrangements to be made, and for secure transport to arrive - most likely more than 30 minutes, meaning that the period of time between the catheterization and the patient leaving the ED had to have been at the very least an hour). This completely ignores the fact that the qualified mental health professional who will assess the patient to determine the level of threat they pose to their own safety and whether this warrants inpatient admission may not assess the patient until after the urine results are back, so we could be talking a much longer period of time than one hour.
Since the original poster is clearly taking dramatic license and compressing time, we cannot reliably know that a foley catheter was placed. This is an assumption on the reader's part; an assumption that serves the writer well in her effort to paint the picture of inhumane treatment of a sympathetic individual at the hands of the medical establishment.
Loracs72
65 Posts