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what to do when patient is trying to harm self?

Posted

Specializes in Med/Surg.

i was just having a discussion with some friends about scenarios that we may encounter in a psych setting, and we are dumbfounded as to what we would do first if we ever came into a patient room and saw that they were hurting themselves. we know we should always be thinking about patient safety and starting from the least restrictive form of restraint, but we are not sure exactly what to do first particularly if the patient is bigger/taller than us. so what is the logical way to go about it that will ensure patient safety as well as that of ours?

try to talk to them first and calm them down? call for help or try to handle it on our own first? use physical restraint like on the wrists? then chemical restraint?

confuseddddddd

PAERRN20

Specializes in ER. Has 3 years experience.

Rule #1 when dealing with psych patients- always get help. Never try to do it all on your own. Your or the patient or possibly both can get hurt. Never go in a room alone if the patient has a weapon or other dangerous object. Always have an escape route in the back of your mind. Don't get trapped up against a wall. And always tell your coworkers where you are going. Follow these rules and that should keep you safe.

If it is a psych facility it should have policies about this very situation because believe me it happens. I have run into literature about this subject several times but I can't exactly remember where. It shouldn't be to difficult looking it up.

november17, ASN, RN

Specializes in Ortho, Case Management, blabla. Has 9 years experience.

i was just having a discussion with some friends about scenarios that we may encounter in a psych setting, and we are dumbfounded as to what we would do first if we ever came into a patient room and saw that they were hurting themselves. we know we should always be thinking about patient safety and starting from the least restrictive form of restraint, but we are not sure exactly what to do first particularly if the patient is bigger/taller than us. so what is the logical way to go about it that will ensure patient safety as well as that of ours?

try to talk to them first and calm them down? call for help or try to handle it on our own first? use physical restraint like on the wrists? then chemical restraint?

confuseddddddd

I think if they are cutting their wrists or trying to hang themselves its probably okay to skip the least restrictive form of restraint and go straight to something...uhh..a little more restrictive. Its not like you're trying to stop a 90 year old from pulling their IV out...you're trying to stop someone from seriously hurting themselves.

aura_of_laura

Specializes in mental health, military nursing. Has 8 years experience.

Good question!

I used to be a psych nursing supervisor - we had Therapeutic Crisis Intervention training biannually (almost a week-long course) before we could even touch a patient. Your hospital probably has very clear policies on when and how to intervene with a patient... If you're in a med-surg capacity, you aren't usually authorized to physically restrain a patient - does your facility have security guards?

Remember - protect yourself first. Don't approach a violent patient who is larger than yourself, especially if they have a weapon.

When you're in an anxious mode, you typically shut down and cannot really hear what is being said to you, just the tone in which it was said.

So depending on the person, talking may not help. But be sure to isolate the patient, with help of course.

noreenl

Specializes in school RN, CNA Instructor, M/S.

I am a crisis intervention instructor and all the advice you received so far is absolutely correct. You can't help a patient if you are incapacitated yourself so NEVER approach anyone in crisis alone. Even if the patient usually knows you, someone in crisis may have made a break with reality and suddenly to him/her you are not a "FRIEND" with good intentions ,but a 500 lb enemy and they may strike out without ANY Warning. Your best tool is your voice and you use it to call for help. Don't leave the patient out of view but do not go in alone. See if your facility has crisis training. keep in touch if you need to ,but remember to be safe.