Pt threw a bedpan...

its_meee · Mar 10, 2015

Flying feces might qualify as a tornado.

oops...forgot to quote the post

heron, ASN, RN · Mar 10, 2015

I think we have absolutely no idea, and never will, whether the mental illness dx had anything to do with the behavior in the OP. We have no info re presenting complaint, comorbidities, meds, behavior leading up to the incident, staff responses to it, or anything else about the context.

I've noticed that most of the posts on the thread seem to assume that the patient in the OP is a manipulator using physical violence to intimidate staff. In that case, I think a rapid setting of limits, including immediate discharge or criminal charges is a brilliant idea.

I also agree that mental illness shouldn't be blamed for all bad behavior. But it can certainly complicate things when an incompetent approach triggers fear, panic or rage in someone with predictably fragile - or absent - impulse control.

How many times have we had to tell staff, do not argue with the patient?

Here's where I have a problem with the idea of automatically filing criminal charges. Putting a seriously mentally ill person in jail is likely to be severely damaging, even fatal. Sedation and four-points can also cause significant problems. I still think it's a good idea to learn ways to keep things from getting to that point.

Along with our right to our personal safety, don't we also have a duty to prevent harm to our patients?

Emergent, RN · Mar 11, 2015

I found house training easy with my dogs by using the crate method. Just get them used your their crate, which to them becomes akin to their den. Even a pup won't soil it's sleeping space. Frequent pottying with praise, careful watching when out of crate, then in the crate when you can't keep an eye on the little one.

SubSippi · Mar 11, 2015

Whether or not the patient was psychotic at the time of the behavior cannot be determined without more information. I just wish people would stop equating alert/oriented with the absence of psychosis.

But is psychosis not a departure from reality? I don't understand how someone can be both psychotic and oriented to person, place, time, and their situation.

Red Kryptonite · Mar 11, 2015

But is psychosis not a departure from reality? I don't understand how someone can be both psychotic and oriented to person, place, time, and their situation.

I thought the same thing, but held my tongue due to concern that I might have an educational deficit in this area......glad someone else wondered too.

Angeljho, MSN, NP · Mar 11, 2015

But is psychosis not a departure from reality? I don't understand how someone can be both psychotic and oriented to person, place, time, and their situation.

Patient: Hello, my name is Joe. It's March 11th, 2015. Obama is the president. I'm at so and so hospital. God is talking to me right now and is telling me that you're a nice person.

I have a patient who is bat-ship crazy. He often has thought blocking and can't always express himself when asked how he's feeling or what he's thinking. However, he is alert/oriented despite active psychosis. I have another one who's constantly hearing voices telling him to attack staff (I'm on the high acuity/assault unit), but he's completely alert/oriented. Psychosis and confusion are two different things.

Long Term Care Columnist / Guide · Mar 11, 2015

When I went to the hospital for suicidal ideation last fall, I was A & O x 4. I also saw black and grey cats running under the linen cart in the ER. So yes, one can be "with it" and still have some degree of psychosis. Like the above poster said, psychosis and confusion are not one and the same.

SubSippi · Mar 12, 2015

Patient: Hello, my name is Joe. It's March 11th, 2015. Obama is the president. I'm at so and so hospital. God is talking to me right now and is telling me that you're a nice person.
I have a patient who is bat-ship crazy. He often has thought blocking and can't always express himself when asked how he's feeling or what he's thinking. However, he is alert/oriented despite active psychosis. I have another one who's constantly hearing voices telling him to attack staff (I'm on the high acuity/assault unit), but he's completely alert/oriented. Psychosis and confusion are two different things.

Thanks...so is it likely that these people are likely to be schizophrenic?

klone, MSN, RN · Mar 12, 2015

Jeez, as I said, it takes once or twice. It's not animal abuse. And all sentient creatures learn from both positive and negative reinforcement.

Negative reinforcement does not mean DOING something bad/negative to them. It means removing something. And if you're trying to stop a behavior, that's not reinforcement.

klone, MSN, RN · Mar 12, 2015

Okay, we're going off topic here, but I couldn't help but comment. Yes, it is abusive, and clearly you lack an understanding of reinforcement theory. "Positive" and "Negative" do not refer to good or bad. They simply refer to the presence of or absence of a stimulus. So technically, rubbing the dog's nose in poop would be "positive" reinforcement because you are applying a stimulus.

No, it would be positive punishment. Because she's trying to stop a behavior. Positive reinforcement would be to try to encourage a behavior.

/psychgeek

Angeljho, MSN, NP · Mar 12, 2015

Thanks...so is it likely that these people are likely to be schizophrenic?

Most have schizoaffective disorder on my unit. But we have some schizophrenics, paranoid type.

Anna Flaxis, BSN, RN · Mar 12, 2015

No, it would be positive punishment. Because she's trying to stop a behavior. Positive reinforcement would be to try to encourage a behavior.
/psychgeek

Depends. Is she trying to decrease the behavior or pooping in the house, or increase the behavior of pooping outside? ;-P