Mental health is the most dangerous branch of nursing?

If a patient becomes violent then the staff should be able to bring them down without risking injury to themselves. Having worked in both fields I can say that imo there is no significant difference between the two branches in general. Though if you've ever spent time in casualty with a load of drunks then you are far more likely to be assaulted than you are in an efficiently run mental unit.

Reply 3

GodspeedGehenna

I would have thought assault is more common in A&E than a MH unit. Spending time in both, I'd probably say MH is certainly quieter, although naturally it's going to depend on what kind of unit.

Reply 4

('',)

My mum works in MH and she's always coming home with tales of patients hitting and spitting at the nurses. She once had a giant bruise on her shin and bit marks on her arm....

Reply 5

mental ill health effects everyone, in every walk of life... therefore the risk is present.
having worked in acute mental health setting there is an element you are constantly aware of its potential, you have training... and you know how to deal with it.
But then again, you could be working in a respiratory ward with TB present? thats dangerous... Dealing with violent drunks in A&E... dangerous!! There is danger in life!!

One thing for sure... it is an amazing career!

Reply 6

puddlejumper

I have told people on here, at least three or four times, that I'm qualified in both fields. So a lot more than 'work experience'!

unless you are on the ward with the nursing staff... you can't really say imo... it is when a patient is demanding PRN loraz and they are not written up for it, and you cannot get a duty SHO over to talk to them... they are literally banging on the doors, screaming, verbally abusing staff and other patients.... thats when it can be dangerous

Reply 7

louise_1229

But in reality how often does that happen?

The vast majority of patients are no different to those seen in general wards. If a patient is kicking off then as a nurse you have to use all your skills of persuasion and empathy to help them calm down.

Reply 8

I work on an open adult acute ward in mental health and I can tell you that the risks are huge! On a forensic ward the staff and unit are equipped with many of the necessary things to minimise the risk... on an open ward you're at risk of so much as patients have access to far more and their movements are much less limited. You're at risk of violence and aggression from the staff, patients brandishing weapons, all sorts. I've heard of people being stabbed with a pen up the nose and losing their sight, people being bitten by patients, span on, slapped, punched, kicked, etc etc... but then again I guess you get a lot of that kind of stuff on friday night in A&E! It's true you are supposed to be equipped with the necessary training to deal with restraining patients, but I have had to wait months and months to get on the long waiting list for that, and sometimes there are not enough staff that are trained in restraint to be able to restrain a patient with a 3-man team. Etc etc.

Reply 9

Yes, because skills of persuasion and empathy are really effective when the person you are dealing with is 6 ft 7, built like a brick **** house and grossly paranoid, believing that you are out to kill them and so they are trying to attack you first. When someone has no insight into their illness, empathy and persuasion really has no use.

Reply 10

smilee172

If you really believe that, then I'm glad that I don't work with you.

Building a connection with a patient, especially those with a mental illness, is one of the most important skills a nurse can have. You must be able to gain the trust of your patients or how can you help them? Every time you have to resort to aggressive techniques with a patient then you have failed.

No-one becomes grossly paranoid overnight. They have been events which led up to it. So unless you are speaking about a newly admitted patient then there really is no justification for not being able to get them to trust you. And even in that case you would wonder why the community mental nurse had allowed the situation to deteriorate to that extent before bringing the patient in for treatment.

And I don't find that there are that many 6ft 7 paranoid patients in my neck of the woods.

Reply 11

kamc

I doubt there is much difference tbh. People with mental health problems end up in general wards so it not like an adult trained nurse would only encounter "dangerous" people, etc. Plus unis (I know ARU do this anyway) give MH and LD branch training to deal with aggressive behaviour but not Adult branch so you could argue you're less likely to get attacked as you have more training to be able to deal with dangerous situations.

Reply 12

puddlejumper

haha!! everyday... when they don't get what they want they kick off in the way a child would but with the force of an adult. And yeah you use persuasian and empathy, but if you are talking to a patient who has displayed signed of drug abuse in the past... they are not gona take empathy, in truth you just gotta let it get to a stage, and C&R/Restrain them... for their own safety. Similar to a paranoid patient that believes staff are trying to poision them, when u give them PRN lorazepam because they are becoming distressed they can become quite aggressive....
I think truthfully it depends on a patient, but the main danger in a acute MH ward is the patients bounce off each other, when one plays up others will join in or encourage them. The will wind each other up... that is when the issue becomes dangerous

Reply 13

puddlejumper

yeah patients came become grossly paranoid over night... psychosis!! esp on some of these legal highs... but in truth somebody who is paranoid in relation to staff can very rarely be 'talked' down when they are so fixed in their ideals... and typically lose all rationale.

Reply 14

puddlejumper

So you're saying that you're able to build up the perfect positive therapeutic relationship with every single one of your patients? There are some cases where no matter how perfect your relationship with that patient, if they're experiencing a command hallucination that overpowers whatever relationship you have with them and they go for you... well then what? Mental health nursing is in no way perfect. Nothing works exactly as it does in a text book.

And yes people do become grossly paranoid overnight, some very easily. And your point about wondering why a CMHT nurse had allowed a situation to deteriorate to the extent that a patient needs to be brought into hospital is absurd... if you're looking at it that way then what is the point in the extistence of any acute mental health wards? Surely by that reasoning all patients should be able to be managed in the community?

In the past I have had a patient develop a delusional belief system whereby she thought I was her mother. Her mother had sexually abused her in the past. At times we had a good relationship but there were times when she could not bare to look at me because of who she thought I was, and many times attempted to strangle me. No matter my skills as a nurse there was no way I could gain her trust due to how little insight she had.

EDIT: If you are referring to 'restraint' as an aggressive technique then consider this... a patient experiencing command hallucinations to harm themself with an implement, be it a knife, a razor, whatever. Talking techniques/de-escalation fails and as a last resort you use minimal restraint to prevent the patient from harming themself with that implement. They are prevented from self harming. Have you still failed? You may have negatively impacted the relationship you had but I would happily risk that if it meant preventing a patient harming themself.

Reply 15

I still believe that you are both over-egging the pudding and the examples you give are the exceptions rather than the norm.

Of course if your intention is to show how dangerous the job is and what super people you must be to work in that area then consider it a job well done.

Reply 16