Self Defense Against Patients

[Jerry99]

Hey everybody. Just recently switched from ICU nursing to psych nursing. Since I've been here I've noticed (and so have a lot of other people) that the training they provide in order to safely take down a patient who is attacking pts or staff, while on paper it looks like it could work, but in real life situations is pretty much useless. Know what I mean? I'm all for trying to take down the patient without harming them, but at what cost? Am I supposed to allow myself and the other staff get hurt before letting the patient get hurt. Does anyone have some techniques that could be used to be more effective to take someone down. I've been thinking of trying to learn judo, but don't know if it would be too rough on the patients. I realize that the best thing to do would be to talk them down, but on those rare occasions that you cant talk them down, I want to know some ways to protect myself from getting hurt by some of the scarier patients.

Thanks for listening to me rant

j

[justpoorfect]

Using anything other than your facility's approved methods places you in legal jeopardy and the clients in physical danger. Be aware and leave yourself an avenue of escape, keep dangerous objects (weapons) out of reach, call and wait for help, and only lay hands on them as a last resort. If you and others can stay out of reach, the harshest attacks usually cannot be maintained for longer than 90 seconds. (Highlights from our own training.)

Focus on defense, not offense.

[hanjosan]

I am a trainer of defense techniche for many years in Denmark, and yes, many of the techniques are difficult to use. They must be trained a lot. People, that learned judo or jui jitsui learn a lot of balance and moving, that are useful with the authorised techniques. The main points though are to predicts risc of violence and make sure, that you have the neccesary manpower, then a superb technique is not so important.

[wonderbee, BSN, RN]

Using anything other than your facility's approved methods places you in legal jeopardy and the clients in physical danger. Be aware and leave yourself an avenue of escape, keep dangerous objects (weapons) out of reach, call and wait for help, and only lay hands on them as a last resort. If you and others can stay out of reach, the harshest attacks usually cannot be maintained for longer than 90 seconds. (Highlights from our own training.)

Focus on defense, not offense.

I've been in psych nursing 5 months and have been physically assaulted 4x. One of those times I saw it coming and was able to block the swing. Another was a slap in the face that came out of nowhere with no warning, the third time all I could do was turn my back to the flying fists and the fourth and final time I was thrown down to the floor by a patient who seemed calm.

It happens fast. It can happen without any signs of escalation. There's no time to think. The response is to react. The reaction is to duck and cover, not to hit back so I wouldn't worry about restraining. I'm pretty done with psych nursing. I went casual and work only a few shifts a month. Semi-retired so to speak and banged up from the experience.

[inthesky]

:sstrs:I would quit also, if I were assaulted like that! What type of facility did you work at RNKittyKat? I worked in a high acuity facility and assaults were rare. I'm a pretty small female and I was practically told to 'get out of the way' and call security in such an incident. My CIT instructor literally told me to block whatever comes at me, then run and get other patients out of the way. I'm very uncoordinated and have only taken short CIT sessions twice in 5 years..so yeah..:chair:

[medsurgrnco, BSN, RN]

RNKittyKat, where were your coworkers when these assaults happened? While attacks can come without warning, there's added safety in numbers. I've only worked in psych a few months, and have been spit on once by a pt who was on assault precautions. I make sure other staff are around when I'm in the area of pts known to be assault risks or when around pts for the first time. And I try not to go into isolated areas (like pt rooms). And if the pt has been aggressive with numerous staff, I never approach the pt without another staff member watching my back.

[wonderbee, BSN, RN]

As much as I would like to say where I work, it would be unprofessional and probably a breach of my confidentiality agreement with the facility. We have been inundated with violent patients on what I was led to believe was a mood disorder unit. MR autistic adults, patients with parts of their brains missing, traumatic brain injury... these are not psych patients! The state hospital in my area has closed in the spirit of integrating the mentally ill into the community, an experiment which has had disasterous repercussions. My coworkers were always nearby and security always intervened. The last incident occurred one day before I was scheduled to go casual. I came down hard on the floor and am now being followed by a physician for comp.

It happened on an evening we were working short one RN and there were multiple admissions and the milieu was tenuous.

I know not all psych units are like this. They can't be. Violent patients should be locked away from general mood disorders. There should be more staffing for the violent units, not less.

Sorry, did not mean to hijack this thread. The best way to keep yourself safe OP is safe staffing so you can stay aware of your patients conditions and intervene before someone gets hurt.

[wonderbee, BSN, RN]

:sstrs:I would quit also, if I were assaulted like that! What type of facility did you work at RNKittyKat? I worked in a high acuity facility and assaults were rare. I'm a pretty small female and I was practically told to 'get out of the way' and call security in such an incident. My CIT instructor literally told me to block whatever comes at me, then run and get other patients out of the way. I'm very uncoordinated and have only taken short CIT sessions twice in 5 years..so yeah..:chair:

I also work in a high acuity facility but because the state hospital has closed, we have long termers too.

[Jules A, MSN]

We have been inundated with violent patients on what I was led to believe was a mood disorder unit. MR autistic adults, patients with parts of their brains missing, traumatic brain injury... these are not psych patients!

Oh this is sounds like neuropsych. I've done work with this population in Peds and they are totally unpredictable. Its usually not like a violent, angry psych patient assaulting you but the punch in the face has the same result, I'm afraid.

I was also wondering why you weren't anticipating and the staff wasn't intervening as the clients escalated so you weren't getting hit so often but now it makes more sense. This is a speciality that requires extra training, a real committment to these special patients and shin guards if you are with the little ones, imo.

[medsurgrnco, BSN, RN]

When our psych patients are escalating and we are having difficulty redirecting them, we then have numerous staff stay in the area to monitor the situation for patient/staff safety. So far this approach has worked very well. To the OP, I suggest you observe how your coworkers de-escalate patients and ask others for techniques they have found that work well. And use PRN meds for those patients who will take meds voluntarily.

[Jules A, MSN]

When our psych patients are escalating and we are having difficulty redirecting them, we then have numerous staff stay in the area to monitor the situation for patient/staff safety. So far this approach has worked very well. To the OP, I suggest you observe how your coworkers de-escalate patients and ask others for techniques they have found that work well. And use PRN meds for those patients who will take meds voluntarily.

Neuropsych pts are different.

[medsurgrnco, BSN, RN]

Neuropsych pts are different.

Yes, they are. I was responding regarding psych pts, not neuropsych pts.