This morning I had the assignment of performing a task on a lady in our psychiatric hospital. Based on her name, I am pretty sure she was Muslim (although you never know, of course). However, when I was working with her, I noticed she was not wearing a hijab, or the head covering many Muslim wear. Now, I'm pretty sure not all female Muslims wear the covering, nor am I confident that this particular patient was, in fact, Muslim. However, it got me thinking...do they allow these patients to wear their head coverings while in the psychiatric hospital? It seems like a silly question, but if the patient is in their for suicidal ideation, it seems like they might not want them to have it since they could possibly use it to hang themselves or strangle themselves. Our psychiatric hospital is very strict and anything that could possibly be used to attempt suicide is banned. At the same time, if you do not allow these patients to wear them, you are not respecting their religious beliefs. My thought is that their safety is more important than their religious beliefs, but, obviously, they might not agree. What are your thoughts?
Specializes in Hospice, corrections, psychiatry, rehab, LTC.
A t-shirt or even a pillowcase can just as easily be used to attempt a suicide, as a head covering could. I see no reason to single out head coverings and ban them as a general rule, there are many other clothing items that can be used for self-harm/suicide.
One of the most serious attempts I ever witnessed was done with a hospital bed sheet. The plumbing for the toilet entered the wall relatively high off the floor, and the patient tied the sheet around her neck and the water supply pipe, and made several twists in it before sitting down on the bathroom floor.. We had a very hard time getting her out of the sheet because it was so tight.
I was an inpatient psych nurse. Yes. We allowed the patients to keep their head coverings for religious reasons. If there was any concern about their immediate safety, they would be put on a 1:1... as would anyone that had special reasons (whatever they might be) that required an allowance outside the norm.
There was a case where doctor was strangled to death with her own scarf.
Personally I don't think singling out the head covering when there is bedding, clothing and what it are allowed.
I don't work mental health in a medical context but I do deal with mental health from time to time in a jail (I'm a Detention Officer)
We get people who are suicidal because they might be expirencing their first time being arrested or whatever. Anyway you would be surprised what a person can use to do the job if that's what they want to do. Shirts, sheets underoos you name it.
If the head covering is used for something like hiding meds of sharp objects they should be taking that away for that reason but only for that.
Like some of the others said you can't judge a book by the cover. During my CNA days I work with a RN that was of Lebanese decent (her dad was from there) had the middle eastern look and name but she was far far away from being an observant Muslim lol.
Jesus. Even among psych nurses/health care workers, there appears to be a stigma with such phrasing as "happy to ... remove items of clothing."
When I take an admission, religious preference/accommodation is taking into account. Even document it into Epic and everything. A patients clothing is removed during (a.) an initial body check, where I can document bruises, scars, etc and (b.) if a patient goes on AWOL precautions. The patient then changes to hospital wear so as to identify him or her if s/he goes charging out of the building. Otherwise, the patients clothing is discreetly searched during the body check; their belongings searched at the nursing station/security.
Shoelaces? Not allowed. But religious wear is indeed allowed under supervision for rosaries (and handed back), not head coverings.
If a patient is truly suicidal, they're on continuous 1:1 supervision, which is a staff member no more than 5 feet away from them at all times, 24 hrs/day. Then you have 5 minute or 15 minute checks.
Believe me, if someone is suicidal ... anything goes despite your best intentions. Wearing a head covering isn't going to do a damn thing ... but your CONTINUOUS supervision (1:1, no more than 5 feet away for example) and team communication and compassion is what's key.
Not taking everyone's identity away willy nilly at the door.
Exactly, so when we do know that someone is having a psych crisis, we prepare for the worst possible scenario. Every patient gets stripped down. No sharp cutlery, no aluminum cans. No clothes.
Often, no they do not have that right. Involuntary psych holds are a thing.
And this, my friends, are why anyone who's having a really tough time with depression, anxiety, bipolar disorder ... basically ANYONE voluntarily thinking about seeking help about such a stigmatized illness ... DON'T seek out that help.
The fear of this ^^^.
I work at a psych hospital. We are always on our toes, yes. Safety is paramount. But each patient is an *individual.* We don't treat the mom who came in with severe major depression (no SI/HI or hallucinations) the same as the pedophile bigger man who just happens to also be schizophrenic and hearing voices. Not.at.all.
Specializes in LTC, assisted living, med-surg, psych.
And this, my friends, are why anyone who's having a really tough time with depression, anxiety, bipolar disorder ... basically ANYONE voluntarily thinking about seeking help about such a stigmatized illness ... DON'T seek out that help.
The fear of this ^^^.
I work at a psych hospital. We are always on our toes, yes. Safety is paramount. But each patient is an *individual.* We don't treat the mom who came in with severe major depression (no SI/HI or hallucinations) the same as the pedophile bigger man who just happens to also be schizophrenic and hearing voices. Not.at.all.
Exactly why I almost waited till it was too late to get help 2 1/2 years ago when I was suicidal and desperate. I was *that* scared of being treated roughly---no dignity, no say in what happened to me, no recourse.
Thankfully I was just a little less afraid of the "inside" than I was of the outside where I wasn't safe, and I did get the help I needed. I was also treated with care and compassion at the ER, and that made what could have been a terrible experience tolerable. I was not forced to strip or go hungry while waiting to be transported to the psych hospital; I was allowed to have my husband in the "suicide room" with me and only had to give up my purse (which was a good thing because I had a bottle of Klonopin in it). I was also given lunch, and a ham sandwich was packed to go with me in case I got to the hospital too late for dinner.
Being hospitalized psychiatrically is no one's idea of a good time, but it doesn't have to mean being treated like a criminal. I understand the importance of protecting everyone involved with the patient along with the patient him/herself, but psych is not a prison (although it can feel like it when you're the one who's locked up). I think the one-size-fits-all approach to patients is unnecessarily harsh. But that's just my opinion.
Patients admitted to psychiatric hospitals for acute psychiatric care are entitled to practice their religious beliefs as long as those beliefs do not endanger themselves, other patients, or prevents the facility from providing medical treatment.
If a patient was of Muslim faith and practiced wearing a hijab the decision to allow the patient to do so would be on a case by case basis.
What is the diagnosis, symptoms, suicide assessment, command hallucinations, homicidal intent, are they AOx4 or impaired and to what degree?
Every patient would require a contraband search so for a brief period of time the patient would not be wearing their hijab to check their skin, rule out infestation, and check to see if their are any hidden weapons.
If a patient was admitted for Major Depressive disorder and was not at risk for Suicide, why would you prevent the patient to practice their religious faith? A doctors order may be required per the hospitals policy depending on the hospital.
If the patient was at risk for Suicide, what is their plan, intent, hx of past attempts, family history, mood, thought content...ect?
Just because the patient is Suicidal it does not mean that all patients want to asphyxiate themselves. Some of the comments posted have asked, if the patient was suicidal wouldn't you automatically place the patient on a 1:1. When the patient has transferred from a Med-Surg Hospital to a Psychiatric hospital, assessing for 1:1 status is more complicated. The amount of access and means generally is reduced. Facilities will not have call lights, long phone cords, shoe laces, or belts. In a Med-Surg environment you have an increased risk and access to harm (oxygen lines, call lights, telephone cords). In a Psychiatric Hospital you have to assess all of the positive or negative factors for placing a patient on a 1:1.
Does the patient have a personality disorder? Is the patient feeding off attention? Does the risk require a 1:1 observation, generally meaning, "In arms reach." If the patient is homicidal and suicidal do you always want a 1:1, If the patient feels that they are gaining status from having a 1:1?
Yes a Hijab can be a tool used to asphyxiate themselves. It is generally considered clothing. If a patient did attempt to asphyxiate themselves with clothing, then the decision to remove all clothing and linens would need to be made. Depending on the psychiatric hospital, patients who do use their clothing to self harm can be ordered specific self harming attire to wear, and have a blanket to use. The ordered clothing and blanket are very durable, difficult to cut, and they are not be able to be manipulated to constrict blood flow.
If the concern is to prevent the Hijab due to not being able to trust other patients, I have to ask how are you preventing those high risk patients from taking other patient's linens/clothing?
Psychiatric patients can be very creative, whether it is braiding toilet paper to hand themselves or ripping out a light fixture to electrocute themselves. It is important to remember that every patient is different and a complete assessment needs to be made.
If the decision to is made to prevent the patient from wearing their religious garment/item then their needs to be substantial documentation providing evidence to support that decision.
The same scenario applies to a catholic and a rosary, or a Jewish patient and a Yarmulke...ect. The answer is never just black and white and the expectation is that as soon as the patient is safe and understands the unit rules, you would allow them access.
Specializes in Psych, Addictions, SOL (Student of Life).
There is nothing in the Quran that requires Muslim women to wear a hijab or head covering of any kind. It simply states that both men and women be dressed modestly.
We have addressed this in two ways on our units. The first most logical answer is to admit the patient to an all female unit. the second is to offer a hooded garment that has no strings, chords or ends that can be used for self harm. It has never been a big issue.
I was wondering about that too. When I was IP we had straws for the water pitchers.
Our IP units have straws for the water pitchers. The patients even have free access to straws if theirs fell on the ground or whatnot. Curious about this as well.
No utensils, and when utensils are used we need to count them and have them returned. But straws?
Specializes in Psych, Addictions, SOL (Student of Life).
If a patient is truly suicidal, they're on continuous 1:1 supervision, which is a staff member no more than 5 feet away from them at all times, 24 hrs/day. Then you have 5 minute or 15 minute checks.
Wow in psych facility 1:1 means within arm's reach at all times including while patient is in the shower and on the toilet. With the charge nurse checking in with the 1:1 staff every 15 minutes.
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Orca, ADN, ASN, RN
2,066 Posts
One of the most serious attempts I ever witnessed was done with a hospital bed sheet. The plumbing for the toilet entered the wall relatively high off the floor, and the patient tied the sheet around her neck and the water supply pipe, and made several twists in it before sitting down on the bathroom floor.. We had a very hard time getting her out of the sheet because it was so tight.