jana82

She had been seen by physician, btw. I thought I said that somewhere.

No, pt was not held naked for the duration. After taking her clothes, she was brought a gown - just as she would have been anyway, from what I know now. Her underwear would've been taken too. It's just I didn't know if it was necessary at the time. By anyway, I mean even if she hadn't attempted to leave. It had only been 10 minutes maybe. She didn't try to runaway screaming or anything, but she didn't go back to her to room either, so there was legitimate concern there, I feel. Like I said before, it was surreal because of how calm she was otherwise... I tried to help initiate her disrobing by taking her shoes off, myself and casually complimenting her on her bare feet as I did. I don't agree with the restraints either, but they didn't stay on that long. If she had been transfered to a facility instead of released, she would have left in restraints and only the gown she had on. I think the restraints were overkill, and I get not judging her by her appearance/calmness - just made it a little wierd in making her strip completely naked... ED is quite a bit different than psych from what I gather - which only seems logical to me.

Well, here are the details - good, bad, otherwise. Pt entered ED complaining of feeling depressed to receptionist. She sat in lobby (90 seconds maybe?) before being taken back to first stop to sign treatment consent, wristband, etc.. Then she was brought back to actual room. She was placed in the second room right across from station. This room is a regular treatment room with two large sliding glass doors with a curtain pulled all the way open facade. The first nurse who attended her was ending her shift. Anticipating taking over after her shift, I entered the room, with MD. I think this is the first time pt admitted sucidal ideation, and mentioned drinking. Blood draw occured within 30 min. BAL came back 0.00. Pt hadn't been medically cleared yet; all hell broke loose on unit; (fully clothed) pt walked out of her room and attempted to leave; and she was stopped at lobby threshold. I came upon the scene. I stayed with pt while MD was asked if she could leave on her own. He said no. We escorted her to seclusion and that is when pt stripped as ordered, as I described earlier. I was correct in my understanding that she was going to remain in seclusion, but the restraints had been ordered on the presumption that she was going back/staying in the treatment room she was in before. Not so, however, and the restraints came off later. Quite possibly within 15 minutes. (I said less than or equal to 20, but that's also including application and removal which takes a few minutes) I was surprised by the resrtraints - as was pt, but I would've found having to strip completely naked more unsetling, as I feel she did. I thought maybe her shoes should have been taken from the start, but it ended up being more than that. Pt had to wait 2 1/2 hours for eval - which by that time, things had settled down. Eval took 1/2 hour - 45 min. Pt would have likely ended up waiting the 45 min to hour it took for discharge without clothes if I hadn't took them to her as soon as she was cleared by psych evaluator. It had been over three hours that pt hadn't had any clothes. But she was moved to treatment for eval and was able to cover up then. Actually, I pt's shoes weren't in the bag with her clothes, but I got them to her on her way out. I don't know how pt's evaluation went (presumably well) and curtains were shut at that time, but pt always seemed calm and pleasant whenever in my pesence. I had a chance to talk to her in seclusion, but she was mostly quiet and very soft-spoken. It was a first for me.

Im not advocating her treatment one way or the other. I did think/have stated that I thought it may have been a bit overboard but that's a all. I agree the restraints didn't seem necessary, but they didn't stay on that long either, and I think it was partly due to lack of understanding if she was going to stay in that room or if it would be locked. She was considered higher risk at the point we took her clothes. That is what I actually found most unsettling/not necessarily necessary...Again there was some confusion on her underwear, she should have been able to keep that I think. But she had to stay that way for quite a while - up until she was allowed to leave. I felt bad for that.

She didn't have a plan, though.

Well, I can only hope it didn't. I tried to be as polite and friendly as I could. I commented on her (perfect) pedi when I was taking her shoes off. Not much opprotunity to say much else. But she said thanks and smiled a little. She was polite too, and was (obviously) appreciative - rather than rude or acting like it had been unnecessary - when she was finally given her clothes back to her to put on. Barefoot, and carrying her shoes in her hands as she walked through/out of the ED, I thought accentuated the defeated look one might thought her to have had - as I did anyway... But it had been extremely chaotic that night.

Padded leather humane type with locking connecting strap... ≤20 min... Unknown, at that time if door would be shut, or if pt would would be taken back to former room.

As for the drinking, she did not appear intoxicated at all. She had 4" spike heels on and could walk perfectly. She said she'd had 2 1/2 cocktails (whiskey) the last almost an hour before she came. She was 5'9" and thin.. 135... No BAL. She was cooperative, but became very less talkative as time went on - very soft spoken when she did, and difficult to hear if not paying close attention. Nothing threatening at all. I believe she was depressed, but didn't think she was a threat based on those things above. However, like I said, I wouldn't have wanted to see her leave before evaluation. I took her shoes off her feet, but she undressed herself. You could tell it was probably upsetting for her, but she did without argument and diligintly folded her jeans and blouse and neatly stacked them with her underwear on top. It seemed surreal to have someone (except for attempting to leave) cooperative, to be doing this so cooperatively... I felt bad at this point. I didn't apply the restraints, but watched. Just leather cuffs and connecting strap. She looked surprised/apprehensive, but cooperated fully and didn't say anything. I think she was glad to ge it all over with by the time the eval was finished.

I thought it was overboard. I wouldn't have wanted to see her leave, myself. But, it was a mad house and I even thought they may have influenced her decision to leave. She didn't stay in seclusion long, and the ankle restraints came off and moving her back for eval. Where her clothes hadn't been taken before, I thought it was unnecessary we did - esp since she was eventually allowed to go home.

Just curious how other hospitals might have handled the situation. Early 40's female pt self-referred to ED complaining of feeling depressed and suicidal ideation - no plan, however. It was a little surreal because pt appeared well-put-together - very calm and composed. However, pt admitted to drinking earlier. Pt attempted to leave before her psych eval could be conducted, saying she felt better and had changed her mind. At that point, pt was re-directed to a locked room, her clothing, underwear were taken, ankle to ankle restraints applied. She ended up being discharged after her eval. Didn't know what other hospital policies might be in similar situation.