Dr. Bennett Poss is one of our stellar psychiatry residents and he delivered a very thorough Clinical Problems in Consultation Psychiatry (CPCP) the other day, on the use of physical restraints in the hospital. Violence against health providers is, unfortunately, a common problem in many hospitals.
At our hospital, we have a specialized Code Green team which the psychiatry consultation service is a part of under these circumstances when medically ill patients become threatening or physically violent to nurses, residents, staff physicians, and others. This happens most often when patients are so sick they become delirious. It’s ironic because delirium is a medical emergency and they are as dangerous to themselves as they may be to others because of the disorganized state of their brains leading them to be so agitated that urgent medical care is virtually impossible to provide. The Code Green team is specifically trained in nonviolent management of violent behavior to maximize safety for all persons in the vicinity of the event.
As Dr. Poss points out, it’s vital to present a respectful, listening posture and to demonstrate a willingness to listen to patients as long as they are able to participate meaningfully in a dialogue. Using the “yes, and” approach instead of “yes, butting” someone who is liable to feel further interfered with by simply hearing the word “but” can work. Agreeing to disagree without insisting on being right can be the safest way to get beyond an impasse.
Dr. Poss is a tireless and inspiring teacher according to the medical students–and me. And like any good psychiatric consultant, he’s pretty good at putting out fires in the general hospital.
But he doesn’t have a little red firetruck like I do 😉
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