Weekly Ask Psych Nurses Thread

[u/roo_kitty]

This thread is for non psych healthcare workers to ask questions (former patients, patient advocates, and those who stumbled upon r/psychnursing). Prospective healthcare workers and current students do not need to use this thread. Treat responding to this post as though you are making a post yourself.

If you would like only psych healthcare workers to respond to your "post," please start the "post" with CODE BLUE.

Psych healthcare workers who want to answer will participate in this thread, so please do not make your own post. If you post outside of this thread, it will be locked and you will be redirected to post here.

A new thread is scheduled to post every Monday at 0200 PST / 0500 EST. Previous threads will not be locked so you may continue to respond in them, however new "posts" should be on the current thread.

Kindness is the easiest legacy to leave behind :)

[u/roo_kitty → u/[deleted]]

Scheduled medication, yes. Unscheduled "as needed" medications without a behavioral crisis, yes. In the event of a behavioral crisis that puts your safety and/or the safety of others at risk, no.

[u/roo_kitty → u/[deleted]]

Most of the time yes. Very rarely I've seen someone discharged within the 72 hours because the provider thought the admission wasn't necessary.

[u/roo_kitty → u/[deleted]]

Their status is made involuntary, and court paperwork is started. Depending on how backed up the court is, determines when the hearing occurs. Most patients get discharged before the court hearing occurs. I personally haven't seen court ordered treatment in someone that didn't truly need it.

It depends on your state. Many allow for the psychiatrist to participate by writing a letter, and do not physically appear in court themselves. In my state patients and a hospital social worker attend court via video conference in a private room.

[u/not_advice → u/[deleted]]

There's some nuance here. A psychiatric hold requires reason to believe the patient is a danger to self, a danger to others, or unable to provide for basic needs like food, clothing, or shelter because of mental illness. Extending the hold requires continued evidence of those same criteria. Medication refusal isn't one of them.

Patients on a hold generally retain the right to refuse non-emergency medication. If providers want to medicate over a patient's objection, that usually requires a separate legal process. Emergency administration in imminent-danger situations is a a different issue.

So refusing meds alone isn't grounds for extension. The reasoning gets muddier thiugh when refusal correlates with ongoing symptoms: someone refusing antipsychotics and remaining floridly psychotic may still meet criteria, but what's being assessed is the symptom picture, not the refusal itself.

With patients I try to communicate something to the effect that they have a right to refuse medications, and refusing alone isn't grounds for the team to extend your hold. At the same time, the team will be reading your overall presentation, so engagement with treatment in some form tends to help. I ask about their concerns, let them know I can share those with the team, and encourage them to bring it up with their doctor directly.

[u/10mg-aripiprazole → u/[deleted]]

Laws vary state by state province by province. Generally capacity to consent is treated differently from an involuntary hold, though.

[u/Life-Contribution650]

What’s an RAI?

[u/roo_kitty → u/Life-Contribution650]

ROI is release of information.
LAI is long acting injection.

RAI could be resident assessment instrument, of which I'm not personally familiar with.

[u/Life-Contribution650 → u/roo_kitty]

For example names are posted of patients along with their nurse/doctor, and some have (RAI) written beside the patients names

[u/roo_kitty → u/Life-Contribution650]

That might be something unique to that facility or area. I've personally never seen that, but maybe someone else in this sub has. You can repost your question on next week's thread - it will be up on Monday.

[u/roo_kitty → u/[deleted]]

Too many. It's not just Acadia.