What are some methods to use when working on an inpatient psych unit to maintain a calm environment?
Remember to decrease stimuli. Get food report and do good assessments at the beginning of your shift. You can gauge a lot about what is going on with your patients that way. Stay ahead of patients exacerbations, talk to them and use deescalation techniques before they escalate and in tern change the milieu on your unit or end up in a code situation. Remind patients of coping skills and offer PRN’s before they become agitated or have a severe increase in behavior. Encourage group participation and maintain a schedule. Groups help tremendously, both activity and therapy groups. Yes, as said above TV and games do help in between to provide entertainment and something to keep them entertained and engaged but not restless.
Not ignoring the patients, keeping patients occupied with following the unit schedule activities, providing prn medications as needed and descalating and redirecting patients as needed
Soft voice easy reasoning slow steps of progression soft music when appropriate Positive psychology and reinforcement Allow the patient to participate in their own planning explain therapeutic intervention and support systems.
Keep the noise level down and engage the patients in activities. Talk to the patients, sit down with them when you got a minute.
Always remember to talk softly. Never argue with a psychotic person. They will just get more upset. If a patient tells you he is hearing voices ask him what are they telling you? Assure them that you will keep them safe, especially if the voices are telling him to harm himself or kill himself. Validate the situation. “I’m sure that must be difficult to deal with.” Offer to listen to the patient, even when you are busy with your paperwork. You’re here for the patient, not the paperwork. If you can’t stop to listen assure him you will be there for him as soon as you’re done with the doctor, or the discharge. Then don’t forget to talk to him and listen!
Besides decreasing stimuli, offering PRN medications, the most important factor that I found useful is quick thinking and actions. Know your patients, de-escalate quickly by removing the source of aggression. For example, if you have a patient who is agitated and you are trying to avoid physical restraint on that patient, simply ask the calm patients to move away from that area to reduce stimuli for the agitated client.
Many enjoy watching TV. If there is a TV room or a music room that helps keep their mind off other things. Arts and crafts for the artistic patients. Some have other ideas for the art materials. Must supervise while they are using the materials.
Set the mood with music not hip hop not opera of high intensity or let the patient develop the list have none TV TIMES
Use audio booklet for nap time. Many haves desire to read but some medications prevent them from doing so.
Music is a HUGE help, especially on adolescent units. On the adolescent units in particular, I always create a list of their requests (bc there are ALWAYS song requests from adolescent psych patients). It shows them you are including each of them and it shows that you are reliable and they can trust you.
For both adults & adolescents do your assessments early bc you can get a better picture of whom you will need to triage in regards to time/attn and PRNs that might be helpful.
Don’t hesitate to express your concerns to the doctor AND directly ask for PRN meds (orders).
Always treat the patient with respect. Remain calm and talk to them in a calm manner. Do not enter a room alone when the patient is agitated and remain by the door.
If possible on your unit, turn half the lights off so that it's not as stimulating for them. I worked night shift and found that if we did that around 8pm at med pass, then most (not all haha!) would be ready to go to bed shortly after.
