opinion needed

Hard to say. We have a one sided recollection. Was she suicidal, hearing voices, expressing threats or extreme delusions? What are the laws in that state?

Several possibilities

1. It's someone attempting fiction writing.

2. It's an egregious violation of patient rights.

3. It's written by a patient lacking in insight. I sometimes see patients who came in with extreme psychosis or acting out, and then days later minimizing and denying pathology.

Which is the truth?

I haven't a clue

It was a story a friend was sent who is a not a mental health nurse I am unsure where she got it offhand. but I believe it was written as a story. she sent it to me to read and I figured I would post it here for insight and opinions and sheer entertainment lol.

If it is the truth, I agree it is a violation of patient rights left and right. However, it sounds like a fabrication of someone who has watched "One Flew Over the Cookoos Nest" and "Girl Interrupted". Most places don't use tie down restraints anymore and giving a medication without physicians approval is grounds for termination of license.

I agree that I too believe this is full of stink. Unless the pt was a danger to themselves or others, they would not have been locked in a room, especially alone unless they were violent or suicidal. We line them all up in the waiting room unless they are brought in and are violent. Most places don't have enough rooms to put everyone who walks in the door in. Even in crisis there is a wait time to see the doc. Giving haldol without the doc at least laying eyes on the pt and asking allergies would be grounds for termination for sure. The banging on the door would be a good time for some therapeutic communication not a shot. Big needles are common for any pt to say, as most dislike getting IM's. Also, in crisis we wouldn't normally give just haldol to a pt who was becoming physical. They would get the coctail (ativan, benadryl, and haldol).

I don't necessarily think the whole story is fiction...It sounds like a typical scenario: If you are hitting walls/kicking or banging doors and cannot stop yourself you are at a risk of self harm and are escalating into severe agitation with some violent behavior. The woman may have escalated herself into a seclusion & restraint situation, because staff asked her to wait for the doctor, offered her medicine and she refused meds/was too agitated to wait. You're not allowed to hurt yourself inside of a locked psychiatric unit, so if you are banging/kicking walls/doors, and cannot stop yourself, then Seclusion/Restraint is appropriate. It is meant as an intervention to prevent self harm & assaultive behavior, and keep people from physical harm, exactly what the person describes doing.

People think that just because you walk into a psychiatric facility voluntarily that you will be released voluntarily at any time you wish,,,,,that is not the case if you become a danger to yourself or others while you are in the facility. The criteria for discharge is that the person is not a danger to themselves, to others or gravely disabled. Kicking/Hitting a door without stopping when staff asks, is dangerous to yourself and demonsrates physcially agitating/aggressive behavior.

You walked into an emergency psychiatric facility for a reason: you were in crisis. When you didn't get to see the doctor immediately, you flipped out and became psychotic enough to not be able to sit down and wait an hour for a doctor or take an a medicine orally that will help you relax until then. It's not burger king, and you don't get everything your way.

Tie down restraints are unlikely, they have proven to cause CSM issues and have been largely upgraded, so I see this story as an exaggeration of what may have happened. Often, the moments before you are restrained and given injected emergency medication, are very confusing and blurred for people, partly because of the haldol nap you referred to. I will say, that being physically restrained feels awful for people, and I don't doubt that she felt like the situation felt much worse then it may actually have been. Staff are legally able to apply restraints to people to contain their behavior for a very VERY short time while obtaining physician's orders for restraint {CA}. And by short time, I mean less then 5 minutes you are on the phone getting physicians orders.

Take the time to read up on your own facilities seclusion and restraint policies, as well as the state laws. What you do with your individual license may be where the blame falls during legal issues, and you want to be sure you have upheld patient rights and policy perfectly.