Isastorm

with the patients I was writing about...everyone is at a loss...

yes offering food is often a go to...though the patients I'm thinking of have definitely eaten in the last few hours and yes! food being thought as 'poisoned' or lately 'laced with AIDs' is common... thanks for your input

Thanks for your response. I don't feel there's any reason to remove the words 'chemical restraint' from my vocabulary. Though I would never use this term in charting because I understand the politics, I have seen Emergency Medications used both as a 'therapeutic intervention' and as 'chemical restraint' and sometimes the boundary between 'sedating' a patient & 'decreasing distress' is a little (or completely) fuzzy. words are to be used to communicate ideas and there are times that medications Are being used to restrain someone. there's data showing that allowing someone to exist in a state of psychosis causes grey matter damage so of course it is therapeutic to intervene in such a way that will calm the but also there's a lot of data which shows how many of the medications we (at the place I work) utilize as 'therapeutic' also cause grey matter damage hence my question regarding non-pharmaceutical interventions be them 'chemical restraints' or 'therapeutic interventions'. with the exception of seclusion (which the facility where I work doesn't allow) we have tried all of your suggestions. well maybe not 'time out' which for some of our current patient would require a mechanical restraint. … thanks for the links I'll check them out.

hi all, just wondering if any of you have personal experience utilizing interventions other than restraint (chemical or mechanical) to assist patients through a psychiatric emergency. Just sorting through a bit of personal cognitive dissonance, wanting to do the best for the people I'm caring for but not certain I"m making the right choices. Want to keep all safe, myself included but feel like maybe there's too much medication being tossed around. Lot's of grey area and often decisions that happen so quickly without much time to process afterwards. For those of you who are masters of verbal de-escalation can you point me to any good resources?

I am a new grad who sought out a psych RN position....been on the job 3 months. I currently work in a state psych facility and yes, there is frequent violence. I have already been rattled a couple of times and there have been a few people (staff) who needed to be sent to the hospital, plus patient to patient violence a few times a week. We have, in my opinion, a few patients who do not belong in our unit and not a lot of support to manage their behavior. Also staffing can often times be a joke. However, the place where I did my psychiatric nursing clinical rotation for school was a much calmer and therapeutic place where violence is a very rare occurrence, but they don't hire new grads...so I'm doing my time. On the upside there is a lot to learn, we have some of the sickest patients with complicated issues and the majority are not violent, in fact they are far more likely to be victims of violence. It's a shame to have them in the same facility with the few and very disruptive people who have no business being there in the first place. So it depends, but mostly I think unless you are in a poorly run, underfunded state facility (like where I am!) violence should not be an issue :)

I had a patient read my thoughts, or so it seemed at the time. I sat down next to him in the morning and noticed that he had brushed his hair. I thought (in my head) 'he brushed his hair it looks really nice' and as soon as those words ran through my mind the patient started mumbling under his breath (he would do this throughout the day) 'she's sitting there thinking, well (insert patient's name) you brushed your hair and it looks real nice.' I said, Yes your hair does look nice.' at the time it spooked me a bit especially when later the MD was interviewing a patient to assess him for psychosis and one of the questions was 'do you ever think people can read your mind?' :) I decided that I think a part of mental illness may cause some to be acutely, maybe too acutely, aware of cues and expressions that usually pass right over most people's heads. (or maybe some people can read my mind!) I like to think about these sort of things both in a scientific and magical way...but I try to keep the magical thinking type stuff hush hush when I'm at work cause I definitely don't want a bed at our facility!

Thank you VivaLasViejas for describing your personal experience with auditory hallucinations. I find it to be very interesting. Are any of these songs stored in your memory, as in can you recall the tunes when you are no longer manic? I have been spending some time today trying to understand the subjective experience of what others might be hearing in their minds (hallucinating or not). Led me to this: Diversity of Voices Nev Jones: Madness Radio â€" Beyond Meds and this: https://www.dur.ac.uk/hearingthevoice/

Also, just found this which looks like a good place to start.... http://www.neomed.edu/academics/bestcenter/list-of-60-coping-strategies-for-hallucinations.pdf

Hello all....Do any of you have ideas for assisting patients with auditory hallucinations? I'm looking for things patients can do on their own.. She is a 20 something female who is tortured by almost constant auditory hallucinations. She has stated that listening to music doesn't really help. Talking to someone does help and it would be awesome if we actually had talk therapy available but...we don't. I can usually give her 15 minutes of time where I mostly listen, and she says it helps just to talk, but of course there are 20+ other people who require my attention. She is currently compliant with her medications but they don't seem to be alleviating the voices. I have been doing a little research and it seems that vocalizing (humming,singing, talking ---I'd rather not encourage screaming) may help to diminish the AHs or concentrating on something enjoyable to the person...say scrapbooking (something she has said she likes). Anyone know of anything else that would be reasonable to try in a sort of chaotic state psych facility? Thanks for your input !

As a new grad who has just started working as a psych nurse there have been opportunities to do blood draws, TB tests, IMs, SQs, wound care, neuro checks, change colostomy bags, interpret labs, consult w/ med clinic, dentist...we've had a heart attacks, fainting, HTN crisis, seizures, fake seizures, a woman 38 weeks pregnant and acutely psychotic....and of course this is in addition to the primary thought, mood, and emotional disturbances/illnesses. Sure I guess you could lose all your medical skills if you want to be a psych nurse that disregards the physical body that your patient is living in (and hopefully still connected to), but that seems a little silly. :)

I have my badge clipped to my shirt and then also connected to a breakaway lanyard around my neck. I don't like the feeling of having something hanging around my neck all day hence the clipping to my shirt (takes the weight off but the lanyard provides more security so the badge doesn't fall off). My keys are kept in my right pocket and I use them about every 10 minutes it seems (unlocking and re-locking doors) I have a small pad and pen in the other pocket, pair of gloves in the back pocket....

Thanks Mandychelle79 I agree with you in regards to standing up to bullies and that some of these people need some interventions which are not exactly what we normally accept as therapeutic. Management hasn't been very supportive and upper management is actually in the process of trying to get the place to be restraint free as it looks good for their Patient Centered Recovery model...which is frankly nuts with the current environment and population. I'm new...only 2 months and a new grad so I'm still trying to find my way as a RN and to gain experience. Haven;t made much of a fuss, but want to know my rights and definitely want to avoid a head injury! thanks for your support!

Thanks Davey Do I'll look into the laws here. I have just moved to the state where I currently reside for this new job and admittedly am not aware of all the laws, but am quite motivated to do some research. I'm hoping it is a felony where I am because being able to say this: "You know- it's a felony to harm a Hospital employee." He said, "I've been in prison before. " I said, "If you hit me, you'll be going back." would be awesome and I think for most of them it would work well thanks for the support!

Thanks for the responses everyone, I really appreciate it. Lots's of good advice and tips. I am okay with the acutely psychotic and those with mood and thought disorders, even detoxing and violent is manageable. Our current problem seems to be too many patients with personality disorders who are also violent (and maybe bored?). Currently the unit where I work has 3 male patients who will punch someone in the head at least once a day, either staff or other patients. Two people were sent to the hospital last week. We are understaffed and even when these patients are on 1:1 they still manage to strike, either because the person observing them is intimidated by them or they just wait for the right moment. Afterwards they will either laugh or deny that it happened, emergency meds don't seem to do much and unfortunately we do not have padded seclusion rooms. If it were up to me these people would be sent to jail (especially after the 5th head punch in a week!) but I guess this is not how it works and the place where extremely violent (and basically untreatable d/t PD) patients used to be sent is now full and not accepting new admits. It makes the whole unit tense, with more and more violence, everyone is on edge. Not a therapeutic environment for anyone, especially the other patients. Guess I'm just venting now....this too will pass. Thanks for listening. :)

Hello brave souls. I am a new grad RN who has just started working at an adult acute inpatient state psych facility. I chose psych, not the other way around, and most days I quite like it. However, yesterday I had my first nightmare shift where it felt like the place was on fire and I was in the middle trying to keep the flames at bay with nothing but a tiny little spray bottle. Needles to say having too many of those shifts will certainly cause burn out (maybe pun intended). I know there were many elements that caused the chaos, some things out of my control, but the day of utter chaos made me realize how important it is to start putting out flames before the fire is too big. Obviously this will take time to get good at, observing, assessing, intervening ..noticing which patients are escalating before they blow, but I'm wondering if any of you seasoned psych nurses have tips and tricks for keeping the unit calm and as chaos free as possible? Thank you!