My thoughts. Literally. Catheter. Psych Pt. ED

Editorial Team / Moderator · Apr 9, 2016

Yes, his attractiveness definitely compounded the intimacy of the situation; but it was different from asking a patient to remove clothing, help them, or do it for them if they were unable when actual medical attention was required. Without the physical injury, it didn't feel natural, and (thinking back) I think it felt (to me) like asking him to completely undress created this superior/inferior contextâ€¦ Something like thatâ€¦ Like I either felt slightly dominant by doing so, or felt the need to distinguish myself in that role.

This is not a healthy nurse/patient interaction. You keep referring to "intimacy," which I find extremely disturbing in the context of patient care. My advice would be that if you EVER feel like this again with a patient, you should excuse yourself immediately from this care relationship. Period.

To say that I am horrified is putting it mildly.

However, as other ED nurses have indicated â€” safety of our suicidal patients is our priority. It is our policy to provide them with a gown, socks, etc. and to take their personal effects. There have been suicides in the ED setting, so these procedures are not negotiable. I attempt to maintain each patient's dignity to the utmost, but safety takes precedence. Working in the military setting, we see a lot of suicidal patients.

Altra, BSN, RN · Apr 9, 2016

More than one (three, I think) persons to reply has questioned why the patient wasn't given socks... The reason he wasn't, was the same reason his clothes were taken in the first place... I would think that would be obvious, too. Someone suggested that it was because I was still "admiring" his feet. True, they were nice, but my later mention (focus at the time) of his bare feet was in relation to his vulnerability.

I was talking about standard non-slip "hospital socks". No one walks around a hospital barefoot, for numerous reasons related to safety and hygiene.

Altra, BSN, RN · Apr 9, 2016

This thread is about treatment of suicidal patients in the ED. Not the woulda-coulda-shoulda that may or may not have occurred prior to the patient arriving in the ED, or the various modalities of mental health treatment across the entire spectrum of care ... just what happens once a patient presents to the ED expressing suicidality or at risk.

The baseline expectation is safety of the patient. Procedures are designed to maintain the physical safety of the patient, to allow for evaluation of what the best next steps are.

Anna Flaxis, BSN, RN · Apr 9, 2016

This thread is about treatment of suicidal patients in the ED. Not the woulda-coulda-shoulda that may or may not have occurred prior to the patient arriving in the ED, or the various modalities of mental health treatment across the entire spectrum of care ... just what happens once a patient presents to the ED expressing suicidality or at risk.
The baseline expectation is safety of the patient. Procedures are designed to maintain the physical safety of the patient, to allow for evaluation of what the best next steps are.

Agreed. I agree with some of the ideals expressed, but ideals are often not congruent with reality, as is the case here. I would love it if we treated mental health crises differently, but we don't.

Dany102 · Apr 10, 2016

This is not a healthy nurse/patient interaction. You keep referring to "intimacy," which I find extremely disturbing in the context of patient care. My advice would be that if you EVER feel like this again with a patient, you should excuse yourself immediately from this care relationship. Period.
To say that I am horrified is putting it mildly.
However, as other ED nurses have indicated â€” safety of our suicidal patients is our priority. It is our policy to provide them with a gown, socks, etc. and to take their personal effects. There have been suicides in the ED setting, so these procedures are not negotiable. I attempt to maintain each patient's dignity to the utmost, but safety takes precedence. Working in the military setting, we see a lot of suicidal patients.

Pixie.RN, I was getting the feeling that different standards were being applied in different areas so let me ask you the same question I ask Nonyvole: what happen when the person refuse to undress? How is that handled in your experience? Does the ED staff escalate?

Dany

Editorial Team / Moderator · Apr 10, 2016

Pixie.RN, I was getting the feeling that different standards were being applied in different areas so let me ask you the same question I ask Nonyvole: what happen when the person refuse to undress? How is that handled in your experience? Does the ED staff escalate?
Dany

I attempt to reason with the patient. I have only had one incident in recent memory in which we have had to involve law enforcement for a patient experiencing a psychotic break who had the potential to be bearing a weapon based on history and weapon ownership. As I said, our policy is what it is for a reason â€” shortly before I arrived at my Army hospital/duty station, a soldier presented to behavioral health with a complaint of suicidal ideation. The staff ignored protocols â€” undressing, line of sight â€” and put the patient in a closed room. That patient shot himself in the head with the weapon he brought with him. As a veteran who takes care of soldiers and veterans, I take complaints of suicidal ideation very seriously. We cannot afford to assume a patient doesn't really mean it.

Most of our behavioral health patients in the ED have been there before and know the process. If they are new to it, I explain that their safety is our first priority, and that all our protocols and procedures flow from that idea.

Dany102 · Apr 10, 2016

I attempt to reason with the patient. I have only had one incident in recent memory in which we have had to involve law enforcement for a patient experiencing a psychotic break who had the potential to be bearing a weapon based on history and weapon ownership. As I said, our policy is what it is for a reason â€” shortly before I arrived at my Army hospital/duty station, a soldier presented to behavioral health with a complaint of suicidal ideation. The staff ignored protocols â€” undressing, line of sight â€” and put the patient in a closed room. That patient shot himself in the head with the weapon he brought with him. As a veteran who takes care of soldiers and veterans, I take complaints of suicidal ideation very seriously. We cannot afford to assume a patient doesn't really mean it.
Most of our behavioral health patients in the ED have been there before and know the process. If they are new to it, I explain that their safety is our first priority, and that all our protocols and procedures flow from that idea.

Thank you for taking the time to answer my questions, Pixie.RN.

D.

Nurse Leigh · Apr 10, 2016

I attempt to reason with the patient. I have only had one incident in recent memory in which we have had to involve law enforcement for a patient experiencing a psychotic break who had the potential to be bearing a weapon based on history and weapon ownership. As I said, our policy is what it is for a reason â€” shortly before I arrived at my Army hospital/duty station, a soldier presented to behavioral health with a complaint of suicidal ideation. The staff ignored protocols â€” undressing, line of sight â€” and put the patient in a closed room. That patient shot himself in the head with the weapon he brought with him. As a veteran who takes care of soldiers and veterans, I take complaints of suicidal ideation very seriously. We cannot afford to assume a patient doesn't really mean it.
Most of our behavioral health patients in the ED have been there before and know the process. If they are new to it, I explain that their safety is our first priority, and that all our protocols and procedures flow from that idea.

Pixie, thank you for your service, and for caring for other veterans in their very vulnerable times. â˜†â™¡â˜†â™¡â˜†â™¡

NurseOnAMotorcycle, ASN, RN · Apr 10, 2016

I can't even. I've restarted this post and deleted it about 5 or 6 times already. Clearly the "over sharing" had a ton to do with what transpired as far as cuffs, and we don't know what was shared.

Changing a suicidal pt into a gown is mandatory at all of our local EDs. We have found needles, all kings of drugs and paraphernalia, screwdrivers or other heavy hitting tools, knives, etc, etc, etc.. The list goes on.

I agree with some of the above posters about pt and staff safety. HOWEVER, I can't even begin to fathom how much wrongness there is in not having two witnesses to document the personal belongings, giving the pt a gown and pants that fit! At least a sheet or blanket to cover up in? A straight cath?! I don't think so, Tim.