Psych Pts Are Found Throughout the Hospital: 5 Quick Tips

TXMedPsych, BSN, RN

You scare them more.

That's been my experience both in and out of inpatient psychiatry. Reality is patients with psychiatric disorders appear on any unit. Nursing care staffers often unintentionally let their uncertainties affect their practice in caring for this population.

Stories abound of nurses who sustain serious injuries when a psychiatric patient decompensates on a non-psych unit. Scary, to be sure, for the patient involved as well as others, their families and staff. How many 1:1 sitters receive specific training for redirecting, de-escalating or removing themselves from a disoriented or psychotic patient?

After a move from psychiatry to general medicine I discovered some habits and practices second nature to a psych nurse could help other staff stay safe and our patients to have more positive outcomes.

Here are my top 5...

#5. Suicidal thoughts, attempts or violent acts require unique environmental awareness.

Meal trays should be ordered with plastics not silver and the utensils counted and removed from the room after the patient eats, not put in the trash inside the room. A historically violent patient's plate and tray can be replaced with a to-go box. A broken anything becomes a potential weapon, usable to inflict harm on self or others. Basic maintenance requests might require a request from the boss to expedite repairs in these patients' rooms. The same is true for extraneous medical equipment, bedside tables and even trash cans. Added safety can come from removing these items particularly prior to removing restraints after an episode of aggression.

#4. Communicate. Communicate. Communicate.

Explaining and educating must be elevated to a higher level than the usual priority. Don't touch or attempt to medicate a paranoid,disoriented or hallucinating patient without calmly announcing your intentions.Nobody likes surprises. I've seen more than one scared nurse bolt from doorway to IV with a syringe without so much as knocking to announce their presence. One of them caught a knee to her jaw leaning over to push the medication, though the patient appeared sedated.

#3. Reorient and redirect simply, calmly and often.

Know that many psych patients have short term memory impairment and don't recall or can't process what you told them when you were in the room an hour ago, or even five minutes ago. Unintentional confrontation comes when a provider or caregiver is insistent about convincing a patient that their perception of reality is inaccurate. Patiently accept that until their symptoms are better managed, their reality is the only reality. We're not going to fix that no matter how therapeutic we think we're trying to be. Reorientation can wait if attempting it is agitating the patient or provokes a confrontational response from them.

#2. Special empathy required.

Aggression is often symptomatic of fear Simply put, imagine being a tachycardic patient paranoid that people are chasing you and trying to kill you. Now imagine how that patient might feel after somebody ties them down in four-point restraints. Consider the possible source of the fear. Your reassuring voice verbally confirming the patient's safety in a hospital and the identities of people actually in the room could be the most therapeutic thing you do for that patient that day.

#1. Stay geographically safe.

Whenever possible don't position yourself with the historically aggressive patient between you and the door. We all move from side to side of the bed for care-related tasks without thinking. It's second nature for a sitter to sit bedside away from the door with the good intention of staying out of the way of doctors and nurses. This one thing can be the habit that saves staff from injury. Don't inadvertently make yourself a convenient target. Leave yourself an escape route and don't be ashamed to use it.