# 174 August 2015

"The philosophies of one age have become the absurdities of the next, and the foolishness of yesterday has become the wisdom of tomorrow."

William James
American Philosopher

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# 174 August 2015

Easing the Pain for a Patient Who is Involuntarily Committed

TISA Description of the Problem: Involuntarily admitting a patient, in my opinion, sometimes truly saves lives by preventing suicides, homicides, and other acts of violence. Never the less, when I do so, I always try to remember that such an intervention is an extreme one and has lasting ramifications for the patient. It is imperative to do everything to help lessen the pain and stigmatization that a patient may experience during such a hospitalization (as well as the stresses and pains upon family members). To this end, Michael Sokolyk provides an elegant set of tips. It is best to simply let Michael speak for himself, including his opening paragraph regarding our Tip of the Month feature here at TISA, for which I thank him for his graciousness.

Tip: Thanks so much for the Tip of the Month collection. I use it frequently when I am helping new nursing students through their first mental health rotation. I find that this collection of tips and techniques is a real life example of how every message we communicate can be intentional and calculated to bring about the best result, for our patients.

I am a registered nurse who works in a specialized psychiatry hospital in Manitoba, Canada. I am often the first person who sees a patient, when they are brought into the hospital. As you know, sometimes patients are brought to the hospital against their will to receive help that they are too ill to ask for, themselves. Sometimes, patients are seen by psychiatrists and told that they need to be admitted to our facility to receive help, even if they don't feel they need it. When faced with these involuntary admissions, patients often express feelings of frustration with the system, anger at whoever it was that made the call to get them help, and feelings of having been victimized, in some way. These thoughts and feelings are very troublesome, when I am trying to establish a working relationship with them.
The first step in my intake interview is usually to ask a large open ended question like "what happened", or "the ER nurse told me a bit about what happened, but can you tell me, in your own words what happened?". Once the patient has told me factually what has happened, I ask them to value the day, in some way. This may take the form of:

"That sounds like a terrible day/week/experience. Would you say that was the worst day/week/experience you have ever had?", or "lots of people I talk to say that the day they were admitted to hospital was the worst day of their life, is that the case, for you?".

If the patient answers "Yes. That was the worst day/experience of my life", I move into more motivational type of counsel. Sometimes, I find that, if a patient can recognize that this is the worst day of their life, they may recognize that things just may get better tomorrow. I can also use this as a way to communicate that my job is to make sure that I work at making sure they won't have that experience again. Further, by my acknowledging that this is the worst day of my patient's life, I can communicate empathy and make my patient feel heard.

If the patient answers "no, that is not even close to the worst day of my life. Way worse has happened to me", I will allow time to talk about that (which is usually valuable information, anyway). By providing the patient with time and opportunity to talk about the "worst days", it gives me an opportunity to position myself as an actual helper who will make time to talk about the traumas that have befallen my patients.

TISA Follow-up: This is a nuanced and sophisticated interview strategy of which I have nothing to add. Note that Michael calls this interviewing approach the, "Worst Day of Your Life Question". Thanks again Michael for an outstanding set of clinical interviewing tips.

Tip provided by:

Michael Sokolyk, RN

TISA is a site dedicated to advancing the science and art of preventing suicide and teaching clinical interviewing