Psych Nurses... Problem

[BlueTexas89]

So, right now I am furious with the psych nursing staff at a local hospital. My grandmother was admitted to a psych unit because she had a change in mental status r/t no sleep. The only way they could get her an appointment with a psychiatrist was to admit her there. Well anyway, in the middle of the night my grandmother gets up to go to the bathroom and accidentially hits the fire alarm. Well the nurse on duty at night came in there and told her she was sick and tired of dealing with her and that she was keeping everyone awake. So the nurse made the decision to restrain her with wrist restraints into a chair. Keep in mind my grandmother just had spinal surgery r/t 2 spinal fractures. Forced her into the bed with 3 people and now my grandmother is in so much pain. We took her AMA because the tx she was receiving was not appropriate. What do you guys think about this situation? Am I in the right to be furiated with the nursing staff?

Thanks a lot.

Kris, SN

[Fiona59]

My first thought is there are four versions of the story. Your granny's, the staffs, yours and what really happened.

I've worked with geri-psych patients and have seen behaviours that the family wouldn't believe.

How can you honestly say the treatment was not appropriate? The staff were there, saw what was happening and dealt with it. Nurses just don't go around restraining people at random or for their convenience. It requires an order.

[nurse lala, BSN, RN]

I am sorry that your grandmother had a difficult time at the hospital. It is very frustrating when our loved ones are not treated as they should be. And it is hurtful when the people we love come to harm as a result of trying to get them help.

MH changes because of a lack of sleep is really not a reason to see a psychiatrist, so I have to wonder what else was going on. You need to ask some questions:

Was Grandma alert and oriented (it is hard to "accidently" pull a fire alarm)?

Did the nursing staff try less intrusive measures without success (offer medication, distraction, redirection)?

Was Grandma compliant with medications?

Is it possible that her behavior did warrant physical intervention (you need to be very careful making a judgement based

soley on the subjective report of the person with MH changes)?

What I would do is get a copy of the medical record and then check with the Patients Rights office regarding criteria in your state for restraint use. If the documentation does not support the nurses action, you have reason to lodge a complaint.

[lpnflorida]

I never recall a patient being admitted to an in patient psych unit for lack of sleep and altered mental status unless related to example bipolar in manic phase.

I am sorry that your grandmother needed hospitalization. She does need a work up of some sort. If she does not have a prior psych history I do not think that is where it should begin though.

I agree you may not have the full picture of what occured on that psych unit. No one restrains anyone without cause.

Talk with your grandmothers primary care doctor. That would be where I would start. A neurologist might be another idea to help rule out dementia. There are many things that can cause altered mental status in our elderly population such as uti's, low sodium level etc.

[RochesterRN-BSN, BSN, RN]

Its has been a while since I have been inpatient--am now in psych ER--but When I was I worked with a doc who covered a few nursing homes--and generally had a large geriatric patient load..........we did a lot of admits of patients of his for "observation" to see if the mental status changes were organic in nature-- ie. alzheimers, dementia, medical as in an infection like a UTI, or other medical cause vs. purely psychiatric in nature or a little of both-- I had to explain this process to family member often-- it is often hard to rule in and out things unless they can be observed by Nurses and trained geriatric psychiatrists around the clock for a period of time. There is also various trials of medications--different kinds, combinations and doses and you have to go slow with doses and start low with this population to be safe. So because of all this these things can take time to sort of the basis of the behavioral and/or cognitive changes. The other thing that is hard is that so often the staff sees behaviors that the family may not have seen before. Another poster pointed this out as well.....so try to keep in mind that though there are a few, lets just say not so compassionate nurses out there, MOST nurses are very kind and caring and take really good care of these patients, and would certainly never restrain a patient unless they felt as though it was needed to keep the patient safe........maybe a bed alarm might hve been a better idea....but I have had patients that get worse with these as the loud noises scare them and they just freak out. So they are not the best for all geriatric patients. Also hearing about a situation from the patient is not always the most reliable--I know that may be hard to hear, but more then in any other place in the hospital, these patients are here for a reason. They are not 100% mentally. I have seen patients that will retell an incident that I was present for....retell it to family totally different then actually occured.........a patient who was very gently assisted back to her room as she had wandered and seemed to think her neighbors room was hers and she was getting into another patients room........I assisted and three of us were very gentle and patient with her and got her back to her room and tucked her into bed. The next day she told family that we had yelled at her, and "thrown" her into her bed. This was not had occured as I would never allow for this.....but in the patients view, with her cognitive impairments, this was what happened. Or I've told a family that a patient needed to get medications and be restrained for a period after assulting a staff person trying to help they were shocked and had no idea their loved one was capable of this behavior...........

So.....yes, now and then--thank god not too often--patients are mistreated, I am not so nieve to not realize this happens-- and of course it is possible that your mom did have that rare nurse that doens't love every patient, not matter how much time they take-- and that is unfortunate. I love geri-psych patients!

But keep in mind the things I have shared and try remeber that like another poster said--several sides to every story and your moms illness may not make her the most reliable--and sleep deprivation can really distort reality for patients--it really can change cognitive function--even cause some temporary psychosis......

Well good luck to you and I hope you are able to get to the bottom of what is going on with your mom.

I do have to ask how she was able to be discharged AMA-- we never do this as there are there involuntarily generally.......and have to take the psychiatrist to court to get a discharge-- interesting......

[laketrash]

I agree with the other nurses and double ditto with PsychRNinNY.Most places I have worked have a system in place to where a pt such as your grandmother can be referred to a outpt mental health clinic and thus to a psychiatrist, so I agree there must have been more to this story,Our initial assessments require us to answer if there is any physical issues which could interfere with the potential use of restraints and no nurse I know would place your grandmother in a chair with wrist restraints or in a bed with 3 people. I'm very sorry you and your grandmother and family are going thru this rough time but please think about what the other posters said about there being more to the story. Good luck and God bless you and your grandmother.

[BabyLady, BSN, RN]

Infuriated? I would be REPORTING that nurse!!!!!

What she did was assault. It was not an emergency situation and I would be willing to bet that "accidently" hitting the fire alarm doesn't legally qualify as grounds to put someone in restraints.

[lpnflorida]

Infuriated? I would be REPORTING that nurse!!!!!

What she did was assault. It was not an emergency situation and I would be willing to bet that "accidently" hitting the fire alarm doesn't legally qualify as grounds to put someone in restraints.

Fire alarms on a psych unit are almost impossible to hit accidently. Ours were purposely protected just to protect that from happening.

Please remember there are always two sides to every story. I am sure the documentation of the nurse would support why things evolved as they did. Least restrictive means are to be used first. I am willing to believe that the nurse would follow the policy on it. No one on a pysch unit enjoys putting anyone in restraints let alone an elderly patient.

[ghillbert, MSN, NP]

It's impossible to second-guess the staff who were actually looking after her, via the internet. If you have complaints about the care, follow the correct channels to submit them. Hope she gets better.

[missjennmb]

IMO if your family can watch your grandmother 24/7 until she gets to see a psychiatrist, then I don't see any reason not to take her out. BUT, while I don't know if the nurse was good or bad, I have to agree that the idea that a fire alarm can be accidentally pulled on a psych unit kinda seems like not enough of the story. If those alarms were pull-able by anyone at any time, psych patients would do it often.

Although, if she was still during her eval period, and it really was a normal psych ward, can the family still take her out AMA? I thought the doctor had to eval her to decide if she was a danger to herself or others ect before that could happen?

[lpnflorida]

Voluntary patient can in fact sign out AMA. Yes, a doctor usually assesses them first to make sure they are not a danger to themselves or others. It was never indicated that this patient was suicidal or homicidal so I do not think that enters into it.

[Fiona59]

The OP hasn't responded. Is it a case of she's working or just didn't like working nurses responses?