00:01
Potential for self-harm is always in our minds on a
psychiatric unit.
00:07
This is a level of safety, safety for the patient that we
must always be aware of.
00:15
It may be reflective of that person's thought process of
wanting to die by suicide
or to cause self-harm as the only solution to their current
problem.
00:30
I usually say suicide is a permanent solution to a temporary
problem.
00:37
And so, we need to find other solutions that will help this
person get through this current problem.
00:46
And the best way to start is providing that safe
environment.
00:50
You may be getting tired of hearing me say provide a safe
environment,
but safety is our priority in psychiatric nursing.
00:59
We want to make sure that we are actively listening to all
of our patients.
01:04
That we're not giving advice. We are not telling people what
they should do.
01:09
Leave should at the door and embrace what I hear you saying
is.
01:17
When you are able to repeat what a person is saying without
judgment, that person may,
or the first time, actually be hearing their own words.
01:29
We then want to assist them in identifying thoughts and
feelings that what make them feel more insecure
or perhaps increasing their desire to harm themselves in
some way or to kill themselves.
01:45
Now, for some people, they say,
why would we want them to be more aware of those thoughts or
feelings
that increase their feelings of desire for self-harm or
killing themselves?
Well, if you are not aware of those thoughts, then there's
no way that we can combat them.
02:07
If we don't know that we have a bacterial infection,
there's no way we're going to know what kind of antibiotic
is going to help us to combat it.
02:18
If we start thinking about the idea that these diagnoses
and these feelings are the symptoms of a much deeper
diagnosis,
then knowing those feelings gives us the arsenal for us
to be able to help them to avoid this potential for
self-harm.
02:44
And if they have that increased desire to hurt themselves or
to kill themselves,
and they can tell us I'm having those thoughts again,
then we can help them engage in better coping mechanisms.
02:58
And that allows us then to discuss those strategies.
03:02
How to reduce those behaviors of hurting themselves and how
to increase the behaviors
that will allow them to engage in positive coping skills.
03:15
It's very important for us to have this therapeutic
communication.
03:18
This therapeutic communication is what opens the door for
our patients
to notify us whenever they are having thoughts of self-harm.
03:28
With many of my clients, I actually have them fill out a
paper with a promise me
that if they are thinking of killing themselves,
before they do anything, they will call me, 911,
tell their parents that they will not worry alone
because if they do not share that with someone, no one can
intervene.
03:54
We want to make sure that each of our patients,
when they are no longer in our units, understand that there
are community resources for them.
04:04
Not every nurse works in a hospital.
04:07
Some of us are going to be working in the community, some of
us will be working in doctor's offices.
04:13
Our patients have a potential for self-harm
and if we can identify what the community resources are that
are available,
and educate our clients, educate their families,
educate our in-patients on that - the idea that there is
support for them in the community,
we are helping reduce that potential for self-harm.
04:40
The risk for violence for patients with psychiatric
disorders,
that is another very common nursing diagnosis you might be
using.
04:50
And that might be reflective of the client's emotional
instability
that can result in anger or frustration. And also reflects
their poor coping skills.
05:02
So, what's the first thing we want to do? You're right,
provide a safe environment.
05:10
We also want to encourage that person to express their
feelings,
and to express their feelings and feel as though they are in
a safe environment.
05:22
Because of the risk for violence, we have to establish clear
limits.
05:27
Boundary setting is very important. You are not to go behind
the nurse's desk.
05:34
If you are in the room and you were part of the community
meeting
and you start having these very angry moments, tell
somebody, remove yourself,
work with someone to reduce that anger.
05:51
We want to offer them choices so that they have an alternate
non-violent behavior.
05:57
When those frustrations occur, when those feelings of anger
occur,
they need to know that maybe they need to go for a run if
they are able to go for a run
if we're in the community. Maybe they need to just be able
to talk to someone.
06:16
They need to have an alternate non-violent behavior that
they can utilize.
06:22
Also, we want to develop plans for strategies, alternate
strategies,
that will be able to help them remove themselves.
06:30
And if necessary, for us to remove them from the presence of
others
if we feel that violence is impending or if it occurs.
06:41
And we don't do this in secret. We will talk to our clients.
06:47
We will say, I notice that there are times that your anger
gets ahead of you.
06:53
And this is what's going to happen if in the community
meeting,
we see that your anger starts building, we're going to have
one of the techs coming in and walking you out.
07:06
Not because we are ashamed of you, but because we want to
protect you and everyone else.
07:12
Because that tech will take you out and will help you walk
in the hallways
and allow you to verbalize your anger or frustration.
07:21
Because getting angry in community meeting is not
appropriate
and we want to help you move towards your recovery.
07:30
So, we share the plans with the client.
07:33
In many places, if you are working in a psychiatric hospital
or in a psychiatric unit,
we have a code that we can call.
07:44
And that code will bring in specifically trained individuals
who can help diffuse a violent situation.
07:53
If you have that in your hospital, do not step into a
violent situation.
08:00
Safety is not just safety for the client. In psychiatric
nursing, safety is also safety for us.
08:06
It's safety for our environment. It's safety for the other
people in the environment.
08:11
And so, if a person does become violent, we need to be able
to take that person out of the situation
and not put our own lives at risk in doing so.