Psych Nurses. Do you hug your patients?

[Yahni]

Hey Everyone,

I am finishing up my very last clinical for nursing school. 180 hour preceptorship on a psych unit. We have a mix between addicts, mood and thought disorders, depression, Suicidal and Homicidal Ideations, Auditory and Visual Hallucinations and everything in between. It's a VERY busy unit. Some of the patients have some serious mental health issues. Some get involuntarily committed because they were deemed to be a threat to themselves, some were admitted because of overdoses.

I have worked on a med surge, Tele, Neuro unit for almost 2 years now. When patients get discharged, it isn't out of the ordinary for them to try to give us a thankful hug. Hugs are amazing. As humans, we crave touch. Hugging releases all the "feel good" feelings and is a healthy action to have in your life.

So, my question is. Why is it so taboo, so to speak, to hug a patient that is on a psych unit?

Now I understand that looking out for your safety is important. Being a good judge of character is vital and taking your safety and the safety of others into consideration is of utmost importance. On a psych unit especially, there is always a chance of having pedophiles, rapists, murderers, stalkers, etc but isn't that a chance you take on any unit? Shouldn't safety precautions be taken on every unit?

Why do health professionals add to the stigma of mental health by avoiding touching their patients at all costs? As if they have a invisible plague that encapsulates their body and the only way to pass it is through touching?

I had a young patient that was all smiles for 2 weeks. He never complained. He never showed any other emotion other than happiness. An overdose scared the crap out of him and he realized how lucky he was to be alive. The last day I worked with him, he had a moment of clarity. He realized all the bad he'd done. All the people he hurt. All the damage he'd done and he broke down sobbing in the middle of the unit. As a human being, he needed a hug. I gave him a hug, asked him of he wanted to walk with me and talk to help him calm down. It helped. 20 minutes later, he had calmed down and put a few things in perspective.

I was immediately reprimanded for being "too close" with a patient.

But isn't that the point of being a psych nurse? To help your patients with coping skills? Show them a healthy way to calm down and react? I dont want to be a conveyer belt nurse. Just passing out meds, patient after patient and asking the generic assessment questions every day. I want to help. I want to make a difference. I want my patients to know that someone cares about them and is rooting for them to succeed.

So, I'd like to know. Do you hug your patients?

All the nurses I've asked so far have said that they either don't or that there's a grey area and while they shouldnt, they either give side hugs or just don't make a habit of it.

What are your thoughts?

[Nature_walker, ASN, BSN, RN]

I do not hug my patients. Quite often we see the same pts over and over and we have to maintain strict boundaries with them. This does not mean I don't care about my patients, I do. I want them to succeed.

I have spent countless nights sitting up with my pts who need to talk it out, played games to distract them while they are detoxing, or just sit and color with them so they know someone is there. I have had students who see us playing games, or talking and think we aren't doing as much as say a med-surg floor when you can see the healing. Psych is about the subtle nuances that we see.

I will talk with them, laugh with them and root for them, but always from a therapeutic standpoint. I just don't hug them.

Working in psych, the one thing I can tell you is people are unpredictable. This time it's a hug, the next it could be pulling me to punch me in the gut. In psych there are is nothing but yourself as the method to healing and that means that those boundaries you put in place are for a reason. They protect you and your own mental health. You can be therapeutic without hugging.

You may have been told that you were being too close depending on how you were standing (where was the exit in relation to you), where the pt was in relation to you (again, blocking your exit, not visible to staff), what topics you were talking about (just general or personal), or how much personal info you were sharing. Also was your conversation in the milieu or a room? First thing I tell students when they are on my floor is head on a swivel, stay where I can see you, and do not share personal details.

Psych can be very rewarding if it's something you are interested in. I love it and am happy that I work with this population.

[NightNerd, MSN, RN]

While we're there to support our patients and guide them toward better coping skills, we have to be careful about trying to meet EVERY need. As a psych nurse, it is not my job to meet a patient's need of physical affection, even with something as seemingly innocuous as a hug. This can create boundary issues and put you in a dangerous situation (a coworker recently got bitten by a patient she went to hug and had hugged in the past). No, that won't happen every time, but we have to be careful, even if it seems a little cold. I won't say that I haven't hugged patients and families in the past, but I am very wary of it now that I work with psych patients.

[hppygr8ful, ASN, RN, EMT-I]

Well considering a friend of mine just got a concussion when she stepped in to console a crying patient who was faking by the way - I usually keep a safe arm's length distance. It's not that I have never hugged a patient but I do see it as a breach of professional boundaries. Even in the most innocent time a patient can misconstrue the intention.

Still situational awareness is always key in the psych environment.

Hppy

[Marie_30]

I'm not a Psych nurse but I'm thinking about going to school to become one. I just graduated from Massage Therapy school. So I understand the importance of showing compassion and empathy towards others. I don't think there is anything wrong with hugging patients. Most people go into the nursing field for the money. They don't really care about people and that's the sad thing about it. As a nurse, you are supposed to have compassion for others. And that's something most people lack. But for the nurses who actually do have compassion, it sets them apart from the ones who are only in the field for money. If you want to hug your patients then do so don't worry about what other people think.

[Neo Soldier, BSN, RN]

Rare fist bumps. I do not touch my patients and I don't want them touching me. It's about boundaries and safety. I would definitely not recommend it.

[CanIcallmymom, BSN, RN]

5 hours ago, Mariex32 said:

I'm not a Psych nurse but I'm thinking about going to school to become one. I just graduated from Massage Therapy school. So I understand the importance of showing compassion and empathy towards others. I don't think there is anything wrong with hugging patients. Most people go into the nursing field for the money. They don't really care about people and that's the sad thing about it. As a nurse, you are supposed to have compassion for others. And that's something most people lack. But for the nurses who actually do have compassion, it sets them apart from the ones who are only in the field for money. If you want to hug your patients then do so don't worry about what other people think.

Wow, sorry you feel that way. I don't know any nurses that went into it for the money and I'm curious what makes you think that "most" do it for those reasons.

And you will learn, if you do go into nursing, that it's not a "worrying about what other people think" but moreso worrying about your safety and the others around you, in addition to other patients. Compassion can be shown in ways other than a hug.

[LikeTheDeadSea, MSN, RN]

I do not hug patients or family as any type of routine, this includes ones that I've been with for years in homecare or my school office. In 6 years I have hugged 2 people while at work. Both were children under the age of 9, at school, with anxiety playing on a high pain level who hugged me out of the blue as I walked by them or sat next to me. I like boundaries for everyone's safety.

[LikeTheDeadSea, MSN, RN]

Just now, LikeTheDeadSea said:

I do not hug patients or family as any type of routine, this includes ones that I've been with for years in homecare or my school office. In 6 years I have hugged 2 people while at work. Both were children under the age of 9, at school, with anxiety playing on a high pain level who hugged me out of the blue as I walked by them or sat next to me. I like boundaries for everyone's safety.

I worked almost exclusively with students who had psychiatric disorders early in my career and this shaped much of that thought process. Many staff were worried about the potential for being accused of inappropriate touching. (False accusations that would go through investigation would happen a few times a year when students would get mad at staff.)

[verene, MSN]

On 4/30/2019 at 7:53 AM, Mariex32 said:

I'm not a Psych nurse but I'm thinking about going to school to become one. I just graduated from Massage Therapy school. So I understand the importance of showing compassion and empathy towards others. I don't think there is anything wrong with hugging patients. Most people go into the nursing field for the money. They don't really care about people and that's the sad thing about it. As a nurse, you are supposed to have compassion for others. And that's something most people lack. But for the nurses who actually do have compassion, it sets them apart from the ones who are only in the field for money. If you want to hug your patients then do so don't worry about what other people think.

I am curious as to why you think most RNs are just in it for the money and don't have compassion for their patients?

As a psych RN I do NOT hug my patients, while touch is a normal part of human experience, when working with delusional and psychotic individuals you don't know how that touch will be perceived. Early in my mental health career (like week 2 as a CNA) I held the hand of a very sweet older woman in residential mental health care setting, who had high anxiety and was rather tearful about something or other. At the time I didn't think much of it. Unfortunately this played into some delusional thinking on her part and she became fixated on me - to the point of stalking me around the facility, actively interfering with my ability to provide care to other patients, and actively trying to corner and grab me - it was scary and very unsafe. What I had thought compassionate in my naivety resulted in a highly unsafe situation for myself and others, and took the concentrated efforts of a whole caregiving team to undo in-terms of reestablishing safety and healthy boundaries for both of us.

For many patients - for example those with histories of physical abuse or trauma - it can be more compassionate to avoid touch and to allow for extra physical space.

There are many ways to show compassion aside from touch and you learn to utilize those means effectively in this line of work.

To the OP: If an experienced psych RN tells you not to touch a particular patient or to maintain greater physical space than you think necessary - heed their advice. In all likelihood they are not being mean, but trying to protect you and/or the patient.

[TheMoonisMyLantern, ADN, LPN, RN]

Quite simply, no. I would really really advise against it.

[JKL33]

On 4/18/2019 at 10:21 AM, Yahni said:

As if they have a invisible plague that encapsulates their body and the only way to pass it is through touching?

This is a mischaracterization and misunderstanding of the reasons that a professional nurse trying to maintain a therapeutic relationship might have a general policy of not hugging.

On 4/18/2019 at 10:21 AM, Yahni said:

Now I understand that looking out for your safety is important. Being a good judge of character is vital and taking your safety and the safety of others into consideration is of utmost importance. On a psych unit especially, there is always a chance of having pedophiles, rapists, murderers, stalkers, etc but isn't that a chance you take on any unit? Shouldn't safety precautions be taken on every unit?

It isn't just about safety precautions, either.

On 4/18/2019 at 10:21 AM, Yahni said:

I dont want to be a conveyer belt nurse.  Just passing out meds, patient after patient and asking the generic assessment questions every day. I want to help.

Conveyor belt isn't the opposite of hugging.

On 4/18/2019 at 10:21 AM, Yahni said:

I was immediately reprimanded for being "too close" with a patient.

I think the spirit of your post is commendable. Just the same, it's possible that the reprimand has to do with your newness to all of this, and a question of whether or not you have understood some of the bigger picture stuff.

There are some major issues you haven't addressed at all - such as

- Whether or not a touch or hug would be received and perceived by a patient the way you intended it

- Whether or not it would be as therapeutic for any particular other person as you believe it to be generally, and

- Even if they enjoyed it, it might not be the therapeutic thing to do

- The fact that even present social boundaries would suggest that we use caution with others' personal space so as not to invade, threaten, violate, etc. These are things that you definitely don't want to risk in your professional/therapeutic relationships

- The fact that there are many other ways to convey caring, concern, understanding, affirmation, etc.

- The fact that nurse-patient relationships are temporary

- The problems that arise solely due to patients recognizing that you are willing to engage in ways that most other nurses in your area do not

- You are in a position that would be considered one of power in this context. You have to be above reproach, leaving as little room as humanly possible for others to question your choices and intentions

I mean this kindly: Your post is more about you than you might think. ? You aren't there to give every patient the exact things that you think you might want if you were in their shoes, or to provide them with the emotional experiences one might have in a healthy non-professional relationship. You are there to interact with them therapeutically, based on what they need. Said another way: What might be desirable and healthy in other contexts is frequently not healthy in professional nurse-patient relationships.

I would guess a case could be made for the rare hug when deemed appropriate through use of extreme discretion and a great deal of wisdom/experience. I'll let experienced psych nurses decide whether that's true or not.

I think you need to ponder all of this.