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/tarpalogica 3d ago
My approach is usually along these lines:
"Hey, I get that you don't want to be here, but there are a lot of people who are worried for you and want to help you. And we know this is a really awful environment, with lots of sudden noises and bright lights and that can be really stressful. A lot of people get stressed out just by being here, even if they're only visiting someone. You seem a bit stressed out to me, given you've just been yelling etc etc.
Is there anything we could get you? Food, drink, an extra blanket, a nicotine patch? (They're often withdrawing)
I'd also like to help you by giving you some medicine to help you deal with the stress. I don't want to just knock you out! After all we're waiting for the mental health team to talk to you! But it might help you deal with being here, as much as that sucks. Now, you can choose between a pill, a wafer that will dissolve away, or a needle that's one and done." "No! I don't want any medicine!" "That's not a choice you have right now. You had that choice before you started yelling/running away/punching. Now you have to have some medicine. I'll give you half a minute to choose, otherwise I'll choose for you, and I'll choose the needle." "I DON'T WANT A NEEDLE" "That's ok, but then you have to choose a wafer or a tablet medicine. Which one do you want?"
And then we go around for a round or two more and they take something or they get an IM injection.
And yes, this is how I approach paediatric patients who don't want me to listen to their chest. I don't mean that in a cruel or demeaning way. But I think a lot of people return to the mental state of frightened/cranky toddlers when they're sick or afraid and being the boundary -setting, appropriate autonomy giving parent-figure works well for me in these settings.