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.
There are two courses that I know of: 1) CPI or Crisis Prevention Institute course - see: http://www.crisisprevention.com/ and 2) Handle with Care - see http://www.handlewithcare.com. I have been trained in both. The courses' theory and skills are quite similar and seem great but I agree that one has to be conscientious in order to use them. Many times, the violence or aggressive behavior of the patient is unpredictable. I think the trick is that one has to know de-escalation verbal techniques so physical management can be avoided. It is important that you use the faciltiy's standards because if you don't and you accidentally injure a patient, then you can get in trouble (i.e., liability issue). The courses are taught not only to protect you but also to protect the patient. Joint Commission requires that staff are educated on de-escalation and behavioral/physical management course, again, for your own safety and patients' safety. I suggest that you take a course and the facility should mandate and pay for you to go.
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.
I couldn't agree more, it is really becoming more dangerous all the time and man , if you can't count on co-workers....!I recently had a co-worker lock me out of the nsg station after a mild mannered, meek, alert and oriented x 3 pt broke into the cabinet and took a fire extinguisher out on me!Ask how mad I was?
Specializes in telemetry, med-surg, home health, psych.
first prioity is to get all other pts. out of the area....call a code and we have several people there stat to bring the pt. down while he gets an injection....now if you are alone assessing a pt. and he acts out without warning I would get away as quick as possible...as one said "duck and cover" forget the judo, just get away and let the others take him down...charge nurse must be available to get med, call doc, etc....
Specializes in telemetry, med-surg, home health, psych.
just saw the CPI post....we just had that training at work and to tell you the truth, it is useless....gave us some ways to get away if someone grabs our hair, etc....common sense...just get away...
CPI is a complete joke. I suspect it was put together by corporate bean counters who have never had to be out from behind their desks in their entire career.
it is really becoming more dangerous all the time and man , if you can't count on co-workers....!I recently had a co-worker lock me out of the nsg station after a mild mannered, meek, alert and oriented x 3 pt broke into the cabinet and took a fire extinguisher out on me!Ask how mad I was? 
lcprnc
67 Posts
There are two courses that I know of: 1) CPI or Crisis Prevention Institute course - see: http://www.crisisprevention.com/ and 2) Handle with Care - see http://www.handlewithcare.com. I have been trained in both. The courses' theory and skills are quite similar and seem great but I agree that one has to be conscientious in order to use them. Many times, the violence or aggressive behavior of the patient is unpredictable. I think the trick is that one has to know de-escalation verbal techniques so physical management can be avoided. It is important that you use the faciltiy's standards because if you don't and you accidentally injure a patient, then you can get in trouble (i.e., liability issue). The courses are taught not only to protect you but also to protect the patient. Joint Commission requires that staff are educated on de-escalation and behavioral/physical management course, again, for your own safety and patients' safety. I suggest that you take a course and the facility should mandate and pay for you to go.