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Unruly Patients Challenge Health Care Workers

  • Article by: Nancy Crotti
  • Star Tribune Sales and Marketing
  • June 29, 2011 - 8:45 AM

Warm weather brings lots of opportunities for Minnesotans to be outdoors and have fun. Unfortunately, some take it too far and end up at hospital emergency departments.

Physical injuries spike in warm weather, and so do episodes of unruly behavior by patients, according to Jeff Miller, a registered nurse in the Emergency Care Center of Maple Grove Hospital (maplegrovehospital.org). "People start to get more active, and do dumb things," Miller said. "There's more alcohol."

Hospital staff must be ready to treat patients with psychiatric illness, drug and alcohol dependency and anxiety so they don't hurt themselves or others. Maple Grove Hospital's mental health and security staff train emergency department employees on how best to handle unruly patients. Most of the time, Miller said, these patients just want someone to listen.

"People aren't in their right state of mind; they're in a crisis situation," he said. "You want to treat every patient the same. Treat them like they're a family member. Anything can happen to anybody. You just treat them with respect and don't take things personally."

Patients who threaten staff with physical harm may have to be restrained, under physician's orders, and hospital staff must make sure restraints do not restrict circulation, Miller said.

Training is key in ensuring patient and staff safety in these situations. Mental health and emergency department staff from United Hospital in St. Paul and emergency department staff from St. Francis Hospital in Shakopee last year took part in a training program that may be implemented throughout the Allina Hospitals & Clinics system ( allina.com ).

The Barbara Schneider Foundation, which provides training in mental health and de-escalation for law enforcement and health care organizations, provided actors to portray patients in mental health crises. That was an improvement over role-playing with colleagues, according to Diane Brusius, a licensed clinical social worker and manager for Mental Health Services at United.

"These actors pick up on the nonverbal cues," she said. "You may get that 'Oh, my gosh' panic, and they don't let you just stop, which is really beneficial for our staff."

The eight-hour training included proper restraint techniques, including use of a seclusion room where an unruly patient can calm down. Allina is collecting data on whether the numbers of restraining, seclusion and staff injury episodes have changed as a result of the training.

"Anecdotally, I think the staff really liked the training we did," Brusius said.

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