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/torturedDaisy RN-Trauma 🍕 3d ago

For the extreme out of control/combative situations, you need a game plan and your team members involved. Having to get a pt chemically restrained/sedated is as coordinated as a code situation. You preplan (rapidly) who will go where. What med you’re using and where you specifically inject. Someone to distract, someone to hold the extremity, etc.

These are extreme cases though. In my experience talking and therapeutic communication go a long way. True psych pts seem to actually want the help 9/10. You just have to use communication skills to convey that you’re there to help not harm. I typically use the fact that the medicine will help them feel a lot better.

Oh and never walk directly at them with your hands behind your back.

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u/strawbqu 3d ago

I totally agree, my main goal is to improve my therapeutic communication to avoid the last resort of chemical/physical restraints; while also being prepared for worst case scenario. In my area, we have a lot of substance induced psychosis which unfortunately require these interventions. Thanks for your help!

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u/Grump_NP 3d ago

Substance induced psychosis aka “meth”. There isn’t a lot therapeutic communication can do here. Therapeutic communication works on suicidal patients, extremely anxious, emotional distress, manic but not psychotic, etc. But, a psychotic patient under the influence of meth or other stimulant needs to be treated with antipsychotics or benzo’s every time. There is no talking them down. Give some Zyprexa, let them sleep it off, and when they wake up you have a decent chance of having a human patient instead of a meth monster.