Strip searching and removing jewelry

oceanblue52 · Feb 9, 2017

Metal detectors are not perfect, so it is a necessary to check for errant weapons that could be used for self harm and to hurt others. Jewelry can be a very effective tool with all the little sharp bits. Have never worked in an ED, but having opposite sex workers doing the searches would NEVER fly at my places of work (in patient Psych). Always same sex workers doing the check. And it was never full cavity or anything. Best method I have seen is to check first the top part (while draping bottom with a sheet), and then vice versa. And for females we have always held up a visual barrier in front of the breasts. And do make sure you check underwear, it is amazing what people can stash in there.

KathyDay · Feb 9, 2017

I guess a futher question would be, why would male security guards only remove nipple and belly button piercings from a woman and not other piercings. This seems like sexual assault to me.

KathyDay · Feb 9, 2017

If a patient refuses to remove jewelry, what is the next step. Is it OK for male security to brutally remove it? Or does a professional nurse come and explain the reason and help to remove it gently? Or if a professional nurse makes a further assessment and decides it is not important to remove the jewelry, can she just document that this was her assessment and state that the patient refuses to remove her/his jewelry?

oceanblue52 · Feb 10, 2017

Again, I have not worked in an ED setting, only inpatient, so don't know how helpful my experience is...We often have had patients come in with jewelry from an ED though so I am guessing it is not a top priority for area EDs. For adolescents we always remove everything, risk of self harm is just too high. On units with more mood disorders/less psychosis I have seen some policy changes where patients are allowed to keep studs, belly button studs (not hoops) or wedding rings on. Depends on provider's leniency.

Communication is really key key to encouraging compliance. Most people will rightfully be resistant to removing jewelry if that command is conveyed in an authoritarian tone. Being respectful and conveying the issue as a matter of safety often helps. If you are having issues beyond this I would talk to your unit manager about how to proceed.

pixierose, BSN, RN · Mar 23, 2018

I am absolutely appalled at the treatment of mental health patients in the ER. It absolutely shakes me to my core that these people are actually forced to remove their clothing, just because they came to the hospital for help. It is dehumanizing, degrading, and abusive in every way. Would you treat a patient with chest pains like this??? The stigma placed on mental health issues is largely due to the fact that they are treated as absolute criminals in hospitals- all of their belongings are taken from them, they no longer have any rights, they are strip-searched and physically violated, and they are either put in restraints or in some way not allowed to leave the hospital...why? Because they asked for "help." Treating them in this way only discourages them from ever seeking "help" again because you have in fact violated them and harmed them in a way that is far worse than whatever prompted them to come in. Because there is nothing more devastating than being abused, violated, and dehumanized by the people who are supposed to "help" you. Whether or not you mean to harm these people is another discussion entirely. The fact of the matter is that you ARE psychologically harming them, whether you mean to or not. Mental health patients should have just as many rights as any other patient. if they don't want something done to them, it should not be done. If they refuse to disrobe and put on a gown, that should be respected as patients have every right to refuse ANYTHING they are not comfortable with. Treat these people as HUMAN BEINGS. Treat them as equal to any other patient. Many of you claim this is a safety issue...I could not disagree more. Because you have NO IDEA what the patient with the chest pain next door is capable of. He could be a registered sex offender for all you know...yet you don't treat him like a criminal. Why marginalize mental health patients? These needs to STOP! And FYI, there's a good chance that a mental health patient who doesn't want to disrobe or be physically examined has survived some sort of sexual assault. Do you really think strip-searching or forcing them to disrobe and put on a thin little gown is a good idea? This would be sexual assault all over again for them and it just might cause somebody with suicidal ideation to go ahead and pull the trigger. STOP DOING THIS. YOU ARE CAUSING IRREPRESSIBLE HARM.

I work in a psych ED.

I don't work with the patient with chest pain next door, so I'm not going to treat him like he has a knife or sex offender because I don't treat that population.

I treat every single patient I interact with with dignity and respect. As someone diagnosed with bipolar disorder herself, I get it - this could be me. My daughter is diagnosed with depression and anxiety - that could be her. Clothing changes are done humanely; no one is strip searched but they are wanded.

I had a patient come in with razor blades hidden in her bra for her OWN self injurious behavior. She was a cutter with active suicidal ideation and we almost didn't find them. Another patient came in with a lighter hidden in his underwear (to light US up) and yet another with a knife to hurt himself. I could go on and on.

If my patient with the razors decided not to disrobe ... a very different outcome could have happened. Instead of moving on to inpatient and succeeding in care, she could have succeeded in killing herself.

I have yet to force someone to disrobe.

My job is to keep my patient safe and supported. This person is in crisis. And yes, this person IS different than someone coming in with chest pain. A heart attack is observable; someone who is determined to hurt themselves? It's not black and white.

From the tone of your post, you seem to have personal experience with MH. You need to check your personal experience at the door and look at it from different viewpoints. Our country's MH system is seriously broken, yes, in that there is not enough treatment placements. But just because you may not be actively trying to hurt yourself (for example) in the ED doesn't mean the next patient isn't.

GeminiNurse29 · Mar 29, 2018

I worked in patient forensic psych. And geriatric psych. Majority of my patients came from jail or were there because of court orders. Patients are searched because you'd be amazed at what they can use for weapons on themselves and/or staff if you haven't worked psych before. Pens, pencils, razors, jewelry, laces from shoes, pill bottles, you name it. They can be hidden in any crevice. And sometimes, restraints are necessary. I've seen old people come in with restraints bc they attacked and will actively attack officers and staff. I've seen people go straight into seclusion because they posed an immediate threat to safety and security of the unit. Sometimes, to get people to the talk therapy and stability stage, you have to get their acuity down first. Yes, this country's mental health system is a wreck.

Meriwhen, ASN, BSN, MSN, RN · Apr 4, 2018

If it's a regular ER, no. Usually they're wanded or go through a metal detector and that's it.

If it's a psych ER, then in most cases, yes, because it's a bonafide safety issue. Patients have to be searched for any items that they may use to cause harm to themselves and/or others. Those items have to be taken from the patient and returned upon discharge.

As far as who does the searches, nursing staff or mental health techs--not security, not random floor personnel--do the searches. The staff is of the same gender as the patient...though if there aren't any male staff available, two female staff members may do the safety search for a male patients. That sometimes has to happen because there's often more female staff than male staff around.

There's no reason for staff to accompany a patient in the bathroom unless the patient is on a 1:1 watch for imminent danger to themselves and/or others. Again, the staff assigned to the 1:1 is of the same gender if possible.

We do ask the patient to give up their jewelry, especially if they at high risk for harming self or others, and lock it up in our safe. If they refuse or are unable to (e.g, can't get the ring off or the piercing out), the MD can evaluate the situation and if necessary write an order allowing them to keep their jewelry on them. However, they do that at their own risk--if their jewelry is lost or damaged, we're not held liable..

Honestly, what you've posted sounds like it came from a B movie plot. I would seriously question the source of your information, because if that ED is TRULY conducting itself in such a way, it's going to be a hotbed for lawsuits, bad publicity, and loss of accreditation. And given how litigation-happy society is, plus the increased scrutiny that medical (including psychiatric) facilities are coming under, especially from human rights groups, such behaviors would not go unchecked for long.

Laurean · May 6, 2018

A psychiatric patient has just as many rights as any other patient. If females are being followed into the bathroom by males then I would say something because I would not want that done to me! I work in a psych er and we automatically aquire patient belongings and secure it so the property does not get lost. The patient is at a psych hospital because they do not feel safe so I am ok with securing property. However, I won't take a wedding ring or religious artifacts. Again that is the patient right. The reason why psych patients are treated differently than medical is lack of knowledge from the caretaker. But thats my opinion.