We Can Do More to Prevent Patient Self-Harm in the Hospital

“Phone cords, plasticware, and pens – all items found on a typical hospital unit and all seemingly benign.  Yet unchecked, each can be used by a patient to cause self-harm.”

As our health care system jettisons more and more psychiatric inpatient beds, it seems that the old “medical psych” units are becoming a thing of the past. These were the units where a person with significant mental health problems stayed after surgery, or after a medical event. The fact that these patients had at least two serious health challenges—one mental, the other physical—was routinely acknowledged, and medical psych units were staffed with nurses expert in both types of care.

Self-harm on nonpsychiatric units: a closer look at who and how.

Today, patients with serious mental illness are routinely “housed” on medical or surgical inpatient units. Some of these patients have a history of self-harm, and nonpsychiatric hospital units are not designed to keep them safe.

In “Preventing Self-Harm in the Nonpsychiatric Health Care Setting” in this month’s AJN (free until December 10), Kim Liberatore from the Pennsylvania Patient Safety Authority shares some of her organization’s data on patient self-harm events in nonpsychiatric settings. […]

2019-11-22T09:47:57-05:00November 22nd, 2019|mental illness, Nursing|1 Comment
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A Dream of Horses: An Aging Veteran’s Healing Encounter

“Let’s go for a ride,” I said to Joe as he lay expressionless on his bed, covered in blankets and staring at the ceiling. The room was stuffy with hot, stale air. No bigger than a walk-in closet, the space held the lifetime possessions, many of them scattered on the bed, floor, and windowsill, of a 75-year-old veteran residing in an assisted living facility. Joe appeared frail and bored in the silence of the room.

Illustration by Janet Hamlin for AJN.

That’s the start of the Reflections column, “A Dream of Horses,” in the January issue of AJN. Written by a nurse at the Department of Veterans Affairs, the short, moving essay describes a series of healing encounters between a frail older man, who seems to have given up on life, and the horses at a therapeutic equestrian barn.

The here and now.

The story told here reminds us how much we humans can cocoon ourselves against the more elemental forces of the natural world, and how healing it can be to encounter a magnificent animal that asks only that we be present in the here and now. The senses awaken. We look beyond our own habitual ways of […]

2018-01-16T10:00:35-05:00January 16th, 2018|Nursing, nursing stories, Patients|0 Comments
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Antipsychotics: Understanding These Increasingly Prescribed Medications

As AJN‘s June issue CE article on antipsychotic medications makes clear, the history of the treatment of mental illness provides many cautionary tales:

Theories about the causes of mental illness have included the belief that a person is possessed by spirits, demons, or the devil; that she or he has a weakness of character; or that the person had a “refrigerator” mother, someone whose coldness led to the child developing insanity. Those with mental health issues were treated with . . . therapies that are now considered to be questionable and inhumane: being chained . . . in institutions . . . and put into insulin-induced comas; having a lobotomy; being subjected to malarial therapy, exorcism, and prayer; being placed into ice water baths . . .

Images courtesy of the estate of Bryan Charnley. Full image caption below.

In the past century, as our understanding of various aspects of mental illness has increased (there’s still a long way to go), so has the range of available treatments, from psychotherapy to a constantly expanding arsenal of first- and later-generation drugs, many with substantial adverse […]

2017-07-27T11:30:53-04:00June 5th, 2017|Nursing|0 Comments
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Nurse Helps Prepare Police for Encounters with the Mentally Ill

Jeannine Loucks, MSN, RN-BC, PMH, with Captain Dan Cahill (left) and Chief Robert H. Gustafson at the Orange County Police Department in Orange California. Photo courtesy of the Orange Police Department. Jeannine Loucks, MSN, RN-BC, PMH, with Captain Dan Cahill (left) and Chief Robert H. Gustafson at the Orange County Police Department in Orange, California. Photo courtesy of the Orange Police Department.

By Shawn Kennedy, AJN editor-in-chief

Nurses—especially those in the ED—often interact with law enforcement in the course of their work. However, few go outside of their setting to get involved in the training of police officers. But that’s exactly what one mental health nurse, Jeannine Loucks, MSN, RN-BC, PMH, did when she noticed that state hospitals were releasing patients with mental illness into the community and felt officers needed more tools in their arsenal in order to handle their potential encounters with these people.

“Officers today have a difficult job managing crime fighting, community relations, and safety,” Loucks said. “They’re also expected to be mediators and therapists.” She wanted to help both the officers and the patients, and so developed a training program not only for the local police, but eventually for people who worked security throughout her city of Orange, California. What started off as a local community initiative eventually grew, and through the use of training videos the program is now being used by police departments throughout her state and is also available by request to departments across the country.

In […]

2016-11-21T13:01:26-05:00February 22nd, 2016|nursing perspective|0 Comments
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The Delicate Dance for Stability

By Patricia O’Brien

Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons Loïe Fuller sketched by Henri de Toulouse-Lautrec/via Wikimedia Commons

In college I got a part-time job as a companion to an elderly widow named Fran, driving her around town and assisting with errands: post office, hairdresser, the market, her psychiatrist. The routine was set, and all was well for many months.

But one day, something unusual happened. Fran opened her door with a grand flourish, eyes shining. The television, radio, and blender were blasting. “Shall we go,” I asked, hurrying to turn off the noisy electronics.

“Fran,” I observed, “the blender’s empty.”

“Let’s not bother with tiresome details. I’m out of my head today,” she said, with purposeful excitement. At the pharmacy, this time, I took notice of the medication I picked up for her: lithium.

“What’s lithium for?” I asked, sliding into the car.

“A bipolar disorder. Not to worry. I’ve navigated these choppy seas half my life.”

We did errands. All the while, she acted like she was on the campaign trail for mayor, laughing, waving to friends, and smoking up a storm. At the market she hugged the meat manager, who was arranging Italian sausages. He looked confused, but smiled and told her there was a special on calf’s liver.

“I’ll take it all,” she declared, making […]

2016-11-21T13:02:57-05:00February 23rd, 2015|Nursing, patient experience, Patients|1 Comment
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