HELP!

  1. I just came across a psychiatric question! What a nurse should say to a Schizophrenia patient if the person wants to leave the hospital? The person is not admitted yet!
  2. Visit fathemarissa profile page

    About fathemarissa

    Joined: Jan '18; Posts: 4
    Specialty: 1 year(s) of experience

    10 Comments

  3. by   KelRN215
    There's not enough information presented here to say. Just because a patient has Schizophrenia doesn't mean he is incompetent. Unless he's been placed on a hold, he is likely free to go.
  4. by   fathemarissa
    The person has shown the symptoms of Schizophrenia( hallucination, delusions). She is brought to the emergency department and going to be admitted to Psychiatric Unit. She wants to leave and what should a nurse says to her?
  5. by   Meriwhen
    Quote from fathemarissa
    The person has shown the symptoms of Schizophrenia( hallucination, delusions). She is brought to the emergency department and going to be admitted to Psychiatric Unit. She wants to leave and what should a nurse says to her?
    Having schizophrenia in itself is not justification to automatically admit the patient against their will.

    To hold a patient in a psychiatric hospital against their will, one of three criteria needs to be met:

    1. They are a danger to themselves
    2. They are a danger to others
    3. They are gravely disabled, meaning that they unable to provide for their basic need such as food, clothing, shelter, hygiene. This doesn't mean they have to have these resources handy--they just have to know how to access and use them. Or they have someone--family, friend, caretaker--who can help them meet these needs. For example, if someone opts not to go to a shelter but to be homeless, and is otherwise taking care of their other needs, that doesn't necessarily mean they're gravely disabled.

    The call as to whether they should be admitted would be made by a psychiatrist. If she has hallucinations and delusions but is otherwise not a danger to herself/others and can meet her basic needs, they really can't force her to stay against her will. They can strongly encourage her to stay, but if she doesn't meet criteria for a hold, she can't stay.

    Again, having symptoms of schizophrenia in itself does not mean they're gravely disabled. A lot of people with chronic psychiatric illnesses will still experience symptoms such as hallucinations and delusions, but they are able to manage them and can continue functioning safely.

    If they do put her on a psychiatric hold, or if she came in to the ED on a psychiatric hold, that doesn't mean an automatic bed at Casa Psych. The hold means that she can be detained for psychiatric evaluation and treatment IF it is determined to be necessary. A psychiatrist may assess her in the ED and determine that she's not holdable, in which case she would be free to leave if she chooses.

    Let's say that she came in on a psych hold. Upon assessment, it's determined that she is in fact gravely disabled. So she's getting admitted like it or not.

    Exactly what you would say to her would be tweaked based on how she is currently presenting. But something along the lines of, "I'm sorry, I know you would like to leave. But the doctor feels you are not safe to leave at this time, and you need to come into the hospital for further evaluation" is appropriate. Keep it simple and honest. Don't try to argue, reason or negotiate--simply state what is going to happen. But do answer any questions she may have.

    Depending on her behavior, she may be offered or given medication to calm her down before transferring her to the psych unit. If she resists, security may have to get involved to get her over to psych.

    Also, involuntary admission doesn't mean she can't refuse treatment after she's admitted to the psych unit. As long as she's not a danger to herself or others, she does retain that right to refuse meds, participate in groups and the like. If they want to force meds on her, she either has to be an imminent danger to herself/others, or there has to be a court order.

    Hope this helps.
    Last edit by Meriwhen on Jan 27
  6. by   fathemarissa
    It helps! I am sort of getting the idea! Thank you so much!
  7. by   Meriwhen
    I forgot to add that when it comes to patients that are involuntarily admitted, the general idea is the same but each state may handle things differently. I spoke from the California point of view.
  8. by   NurseCard
    Goodbye and godspeed.
  9. by   Been there,done that
    This is a homework question. Do your own research , if you can't figure it out, ask your teacher.

    By the way, do you think someone that is hallucinating should be running around in public?
  10. by   FuturePsychNP21
    Quote from Been there,done that
    This is a homework question. Do your own research , if you can't figure it out, ask your teacher.

    By the way, do you think someone that is hallucinating should be running around in public?
    Just going to play devil's advocate here (since OP has already had their question answered) and say that there are likely many people you pass on the streets who are hallucinating and I would argue that if they are not a danger to themselves or anyone else and are coping well with their hallucinations/still able to function and take care of themselves, then yes they should absolutely be running around in public while hallucinating.
  11. by   Meriwhen
    Quote from FuturePsychNP21
    Just going to play devil's advocate here (since OP has already had their question answered) and say that there are likely many people you pass on the streets who are hallucinating and I would argue that if they are not a danger to themselves or anyone else and are coping well with their hallucinations/still able to function and take care of themselves, then yes they should absolutely be running around in public while hallucinating.
    Indeed. If we were to keep everyone hospitalized until they were 100% hallucination free, we'd have inpatients staying for years. Some patients can be entirely rid of hallucinations. But others will have to settle for getting them controlled to a safely manageable point.
  12. by   PeeWeeQ
    Depends on the laws in your state too. Even if YOU determine that they are harmful to themselves or others, its usually either a licensed psychiatric evaluator that has to make that call (to involuntarily admit them), OR, law enforcement personnel have to be involved and invoke whatever version of state law you may have that allows a temporary and involuntary hold until they can be evaluated by the aforementioned licensed practitioner.

    In our state (WI) the hold can be up to 24 hours (not including weekends and holidays--business days only--it used to be up to 72 hours!) by which time they either must be evaluated for detainment or released. Here is a link to the law in WI. The criteria are pretty specific...

    Wisconsin Legislature: 51.2
    Last edit by PeeWeeQ on Jan 30

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