00:02
That brings us to
crisis prevention.
00:06
What do we mean by
crisis prevention?
Very often, there are people
who say a crisis is a crisis,
you never see a crisis coming.
00:15
And I'm going to beg to differ.
00:18
As people become really
good psychiatric nurses,
we realize that most crises have
little red flags that come up.
00:29
And if we are listening,
if we are in tune to our patients,
if we're into into
our environment,
we are able to identify
those situations
and behaviors that can
escalate to a crisis situation.
00:46
One of the important tenets to remember
is that aggression is not violence.
00:53
A person can demonstrate
some aggressive behavior.
00:58
For example,
they could yell at you.
01:01
That's aggressive,
but it's not violent.
01:07
If that aggression takes steps
and you see that the aggression
becomes more threatening,
then you're saying, "Oh,
we're going into a violent situation."
But when you first hear
that aggressive tone,
when you first see that stance,
when you first hear that stamping
of the feet or that fist,
"You better not come
anywhere closer to me."
That is not violent,
that's aggressive.
01:42
And we're able to
say to the person,
"Wow, I would really appreciate
if you just bring your hand down."
I'm not coming any closer.
01:54
But I need you to
relax your hand.
01:58
I'm going to suggest
you take a deep breath.
02:03
Even let it out with a sigh.
02:08
Relax your shoulders.
02:12
If you're going to put your hands
up, put them up gently.
02:17
Slow your voice down,
drop your voice down.
02:23
And when you have
someone who says to you,
"Take another step closer
and I'm gonna hit you."
I'm going to ask you to say,
"I see how angry
you are getting.
02:37
I'm not coming any closer.
02:41
I would really appreciate
if you just lower your hand.
02:45
I promise I won't come
another step closer.
02:50
This doesn't have
to be like that."
And if you notice, even now while I'm
talking and I won't keep talking like that,
because I don't want
anyone to go to sleep.
02:59
My slowing down, my dropping my voice
is going to calm the situation down.
03:07
It's going to reduce the
stress level in the room.
03:13
Situations that
go up into crisis,
or when you start seeing that stress
mounting and mounting and mounting.
03:20
When you have one person who says,
"What macaroni and cheese again?
I can't eat macaroni and cheese
again, this is ridiculous."
And you have a second person at the
table saying, "I agree with you.
03:31
I'm not eating macaroni
and cheese either."
You want to be able
to reduce that stress.
03:39
Now when we are in the unit,
we normally don't have to think
about a person using substances,
alcohol or other drugs.
03:53
However, there are times that someone
might get a hold of some gummies
or other substances in the unit.
04:05
More likely, when you see situations
that are escalating into violence,
because of use of substance,
it might be in a day program,
it might be in a group home,
it might be actually out on the street.
04:23
When a person is using substances,
their behavior becomes unpredictable.
04:28
And when you have unpredictable
behavior and you have mental illness
which also carries with it a
modicum of unpredictability,
then you have the
perfect storm for crisis.
04:43
There is nonsuicidal
self-injury.
04:47
We normally see it with
adolescents and that comes cutting.
04:53
Sometimes it is in the
form of burning yourself.
04:58
Sometimes it is in the form
of hanging or suffocation.
05:03
This is nonsuicidal,
meaning the person who is engaging in
this behavior does not want to die.
05:11
So, nonsuicidal self-injury
is definitely a crisis risk.
05:20
Because a person who is cutting
themselves might cut an artery.
05:25
A person who is trying to suffocate
themselves by hanging but not die
might lose their footing and
actually hang themselves.
05:36
So always consider nonsuicidal
self-injury as a potential crisis.
05:56
And then, medical emergencies.
05:59
If there's been a car accident,
if there's internal bleeding,
if there's external bleeding,
if a person is having crushing chest pain.
06:08
When you see a person who is
having a medical emergency,
the only thing to
do is call 911.
06:16
Or if you're in the hospital, you're going
to either call a code or a rapid response.
06:23
Those are crises situation.
06:27
Now, if we are able to be there
before it escalates into that crisis,
you want to engage in certain
de escalating techniques
like the one I
just demonstrated.
06:42
You,
yourself need to remain calm.
06:45
And sometimes, it's really hard.
06:48
If you're stepping into a situation
that is a potential crisis,
your heartbeat
might be going up,
you might be feeling
that surge of adrenaline.
07:00
You're assessing the situation,
you realize that the crisis is beginning,
you take a deep breath.
07:08
You want to make sure that you're not
stepping into someone's personal space.
07:13
If you feel that someone needs to be
restrained usually in the hospital,
there is a code that you can
call like a doctor strong.
07:23
And there is a group of individuals
who are specifically trained
in being able to calm down and
restrain a psychiatric patient
who is becoming violent.
07:39
Listen to what is being said.
07:42
Do not argue with the person.
07:44
If the person says everyone
here is listening to me,
they're listening in,
they've put something in my head.
07:51
And now I can't listen,
I can't breathe, I can't eat.
07:55
Don't judge the person.
07:57
Say, "Wow, it must be very hard to
have to deal with that kind of feeling.
08:04
I just want to talk
to you about it."
Listen without judging.
08:09
It's one of the hardest things
that you may have to do.
08:13
So we have to be really careful
that we are not becoming that person
who actually just by the tone of our voice,
the loudness and the speed of our delivery,
that we are actually getting
that person to react to us.
08:29
We also want to be really
careful about our body language.
08:33
Remember I said before,
walking in, hands open.
08:37
Iif you want someone to stop,
I usually have one hand up, one hand down,
so that they know that I'm
not just pushing them away,
but I'm somewhat open.
08:48
I really focus on my shoulders to
try and get my shoulders to relax.
08:54
I always make sure that I have
one foot back and one foot forward
just in case I have
to move quickly.
09:01
If I have two feet standing,
and someone's coming towards me,
it's going to be a little
bit harder for me to move.
09:07
So I just sort of give myself a stance that
gives me an ability to turn if I need to.
09:13
I very rarely will ever
walk into a room like this
because this body language
says I'm totally closed off.
09:21
We want to de-escalate.
09:23
So we need to be calm.
09:26
We need to know that there is a personal
space that should not be broached.
09:32
If you feel that you need to
get closer to that person,
to stop that person, you need to be
calling people who are specially trained.
09:41
Because otherwise that person
might reach out and hurt you.
09:45
You want to be able to hear
the person what they're saying.
09:48
Listen to them without passing
judgment on what they're saying.
09:53
Be in control of your own voice
and watch the body language.
10:01
Most of the time,
what my patients and what other people,
the way they are reacting
to me is not about me.
10:09
It's their life, it's their
difficulties, it's their stress level.
10:13
And I don't need
to react to them.
10:16
I need to act both in my best interest
as well as in my patient's best interest.
10:24
So not personalizing what is being
said to you, even if they insult you.
10:29
If your patient is calling
you an ugly so and so.