r/nursing • u/strawbqu • 3d ago

Nursing Hacks Verbal approach to involuntary psych patients

I am a newer ER RN in Canada, I’m looking for advice on approaching patients that are placed on an involuntary hold. Specifically with approaching an individual with restraining and chemical sedation (I know.. seems brutal but if you know you know. I’m not sure if this is legally relevant in all countries but it’s how we do it here). I find it difficult particularly with paranoid and manic patients. What is your spiel for the reasoning of the intervention, when you especially know they need it and they are refusing (and ultimately will have no choice but to take the medication and/or be restrained)

I tend to start off with the fact that the doctor needs them to take sedation.. if they are compliant they will not need to be restrained etc..

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u/Additional_Draw_6483 ED Tech 3d ago

Can you elaborate on what you mean regarding approaching them to notify them of safety practices that include those? 

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u/strawbqu 3d ago

Basically yes.. like what is your spiel? When they say “I’m not taking that” or “I don’t need that”

How do you tell them basically you need to calm down because you’re manic/unwell/delusional and tell them that you can willingly take it or we will have to force it

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u/AlabasterPelican LPN 🍕 3d ago

Some respond to being given the choice between interventions. A lot of times it's easier with lubricant. Like for instance the doctor orders PO Ativan (lorazepam) for agitation. Bringing it to them and explaining that the doctor ordered something for their anxiety or nerves, or hell if they're displaying symptoms of anxiety via high blood pressure/heart rate and are concerned about that, explaining that the medication will help with those are often helpful too. You're not lying, an Ativan will help with all of those things. Never lie. Selective information is often more helpful than direct information though.

Also tailoring your approach to the cohort you're addressing is helpful. You can't talk to geri psych patients the same way as adult patients.They have different concerns and life experiences.

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u/strawbqu 3d ago

As a former LTC PSW and nurse I definitely agree! Geri psych is entirely different and I’ve mastered that lol Thanks for your advice!

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u/AlabasterPelican LPN 🍕 3d ago

Unfortunately in the ER you're not going to have much time for trouble shooting individually. But another tip is bring the medication to them in an unaltered package and a sealed drink. Paranoia is a bitch and makes people suspicious even when they know it's not rational. I've legitimately had to print out a patients MAR, their labeled baggie with the unopened or marked packages, a pill splitter, and an unopened bottle of water and lay it all out in front of a patient and match them up with them before administering them one at a time because I have to remind them what I'm giving. That usually falls under the patients in manic episodes who are also severely paranoid. The key that I've found with most patients is trust building.

There are however instances where "mom" voice is incredibly useful. Unfortunately I don't seem to be able to manifest this voice so I usually have to get my unit secretary (an mht for many decades). Being firm but kind and instead of choices telling them of actions and consequences "you need to take this med or we will have to put you in restraints" is a useful tact to take.

Also having male standby when a mom voice isn't available is extremely handy. I think a lot of people think that when I say this I mean have a macho-man stand behind you menacingly. No, they can be a skinny twerp just walking to the room and checking the supply's and it often changes behavior quickly. There is a perceived authority for some reason.

I'm trying to think of other tactics to help across a spectrum of patients so I may come back and add comments.