Nakedness

[imapsychrn]

Situation:

Psychotic patient who continuously removes clothing and is walking around milieu. Not aggressive but not responding to verbal redirection. No meds available (already has had them or refused them)

How do you handle this?

[WillyNilly]

Are we talking underwear or full on birthday? Is it psychosis or dementia? Can this person follow commands or limits? If redirection, environment altered, and unable to follow commands has a PRN been utilized? Has the dr been notified of behavior?

For dementia or alzheimers there are certain clothing articles that are made and can be used with permission from family. They are similar to leotards or a button down shirt may be worn.

[Meriwhen, ASN, BSN, MSN, RN]

That's a good one. I know that in most of the facilities I've worked at, the MD would order an emergency med to be given.

Now, whether this is truly an "emergency" is debatable. If the patient is not aggressive and is no immediate threat to the safety of themselves and/or others, then there technically isn't much justification for forcing an emergency med on them. However, lest another patient be triggered in some way, shape or form by the sight of this naked patient, one could also argue that maintaining the safety and well-being of the overall milieu is more important than the right of one patient to drop trou; if the naked patient is refusing/resisting all other interventions, then they would consider the emergency med to be justified.

I'd be interested to hear what others think about this.

[Mandychelle79, ASN, RN]

I think when weve have someone who was prone to disrobe we had more often than normal checks, possibly a 1:1, and would continually just redress the patient or encourage them to dress themselves.

[302prince]

we would put them on a 1:1 and redress the patient as needed. we would try to avoid emergency meds if we can.

[morte, LPN, LVN]

why do they want to be naked? perhaps answering that would lead to a remedy.

[WillyNilly]

why do they want to be naked? perhaps answering that would lead to a remedy.

Who wouldn't want to walk around comfy in their undies if given a choice? 10:1 if it is asked it would be met with a "Because I want to!" or with a "Because I like it" or another oldie "Don't you want to see it?"

A 1:1 for naked? Cheese! There are places that have staff for that?

Can you continually chase behind saying "Breakfast is here. Put your pants on." "Would you like coffee? Put your pants on" "Heres your meds. Put your pants on" "Name and DOB? Put your pants on"

Realistically? No.

If the backwards shirts or suspender pants don't work annnnnd

When it disrupts the safety of the milieu, the PRNs would need to be assessed when other interventions have been exhausted and care has been discussed with the physician.

[imapsychrn]

The specific situation I am thinking of is a BPD with some psychosis. So it's partly a "look at me"

[Penholder]

We use one pieces. God bless a seamstress at work that made some out of real clothes.