ER nurses deal with an incredible variety of cases every shift, and not every medical problem causes visible signs. There is an increasing trend toward behavioral health patients seeking emergency room care, simply because they have nowhere else to turn or because their family members brought them to the ER when the mental disorder became unmanageable. Behavioral health patients can present an array of challenges, which may include delusions, aggression and suicide ideation. Every emergency care nurse should know how to handle behavioral health patients. You can gain the knowledge and skills you need via an RN to BSN degree program and continuing education courses.
Follow established protocols for de-escalation
Behavioral health patients in your ER may become agitated and aggressive because they are out of medication, withdrawing from addictive substances or simply frustrated about trying to get the help they need. Whenever possible, rely on verbal techniques to de-escalate these patients. These include:
- Remain calm and respectful.
- Avoid arguing or provoking the patient.
- Listen actively.
- Identify and verbally acknowledge needs and wants.
- Speak concisely, and repeat yourself when necessary.
- Offer choices.
Only when it’s absolutely necessary, you should defer to the established protocols for physical de-escalation. Combative patients may require physical or chemical restraining. Always follow your hospital’s guidelines, which should be the same as the de-escalation guidelines of the Centers for Medicare and Medicaid Services or The Joint Commission.
Ensure the safety of all
Identify and manage potential threats to the safety of yourself, your colleagues and all of your patients. Don’t hesitate to call hospital security if needed. Patients who have expressed a desire to harm themselves, and those who have already attempted self-harm, need to be in a safe space that lacks any objects a patient could use for self-harm. These patients should be given a gown or paper scrubs to wear, and all personal possessions, including clothing and shoes, should be secured.
Use respectful language
Mental health crises are very hard for the patients. Remind yourself that the patient’s behavior is being caused by a mental health disorder—it isn’t a personal attack on you. Always use respectful language, even if the patient is berating you. Keep your tone of voice calm and your speaking volume low. Address the patient by the name he or she wants to be called, and reassure the patient that you want to help.
Consider medical clearance
Metabolic and physical ailments can cause or exacerbate mental health disorders. Every patient who arrives at your ER with evidence of behavioral health problems should be evaluated for an underlying cause, such as head trauma. Only after a patient has been cleared should you start the search for a bed in the psychiatric wing.
Nursing students at Grand Canyon University can choose from online and on-campus options. Our College of Nursing and Health Care Professions invites you to click on the Request More Information button to explore our popular RN to BSN program.
The views and opinions expressed in this article are those of the author’s and do not necessarily reflect the official policy or position of Grand Canyon University.