Have you ever felt uneasy
during your psychiatry placement? And I don’t mean just when asking
your supervisor to sign your log book/attendance sheet or something
similar. Or even when negotiating with the ward manager to look at
notes, or help you locate the senior house officer (SHO) you’re
meant to be shadowing. I mean when you’re with a patient. Have you
ever felt unsafe or worried?
A survey of junior
psychiatrists1 found that up to 25% of us had
reported an episode of violence over the course of a year. There
isn’t a similar survey conducted on medical students, but since
some of you may become psychiatry trainees one day and all of you
will be on placement with us during training, it’s important that
you can keep yourself safe when you’re learning about psychiatry.
Many of these tips also apply to other environments
including emergency departments, general practice and
general medical and surgical wards where patients may present
as very disturbed. The skills that you learn in psychiatry may
help you deal with those situations more calmly.
Why is personal safety
and risk particularly important to psychiatry? Well, when you’re
talking to people who may be upset or anxious, have a paranoid
belief system or are disorientated, it’s easy to see how saying the
wrong thing could have a negative impact on them. The tips below
mostly relate to the situation of you, a medical student
interviewing a patient on a psychiatry ward.
They should give you
pointers to make sure you have a good experience in psychiatry.
They focus on personal safety. However, risk, including risk
assessment is important when keeping yourself safe.
I’ve looked in a couple of student textbooks2,3. (Mainly
the cramming revision tools but also the Oxford handbook used by
lots of SHOs [4]) and risk assessment can be
found in there. I would advise you to have a look at that too
before you interview a patient.
Dos and Don’ts to personal safety in
psychiatry
- Do look
in a mirror before you interview a patient. If you look smart and
professional, you’ll probably find people trust you more easily.
Wearing a name badge is always a good idea.
- Don’t
wear long scarves around your neck, leave hair loose and flowing,
or put anything around your neck that could be used by an
angry patient to harm or strangulate you. It may sound shocking but
it’s a practical, easy tip.
- Do ask
someone about the patient you’re going to see before you
see them. Have they ever hurt someone before? What happened? Are
they disorientated, suspicious or distressed at the moment? If the
answers to all these questions are yes, you may need to think
carefully about going to see them. And so…
- Don’t
feel scared to ask for advice on whether it’s appropriate for you
to interview any patient. Ask the ward manager, a senior nurse or
an SHO to help you risk assess them.
- Do this
in conjunction with reading the notes, incident forms, transfer
documents, medical reports etc. Make sure you’re informed!
- Don’t
be afraid to take a chaperone with you. This doesn’t include
relatives or carers of the patient as you don’t know how they may
be feeling at the time of interview. It could be your SHO, a nurse
or a fellow student though. I’d suggest this for most cases. Apart
from keeping yourself safe, you’ll get feedback on your
interviewing skills. And that’s always helpful. It’s harder to ask
someone what makes them think the world will end next week
tactfully than what precipitates their asthma. Feedback is
vital!
- Do tell
someone when you start an interview. Estimate how long you should
be so they can look for you if you take longer than that. Ward
staff, your SHO, or your team secretary are good choices. And
remember to tell them when you’ve finished. It’s not a good plan
for the whole building to be searching frantically for you while
you’re tucked up in the mess scoffing tea and toast. Especially if
it’s the last slice of bread.
- Do choose an interview room
close to main staff areas.
- Don’t forget to set up the
interview room in a safe way before you start. This includes:
- Making sure the room is clutter free
(anything can hurt when it’s flung in your general direction)
- The “internal inspection window” (the window
in the door that allows you to spy on the occupants) is open.
- Ensuring the room is well lit so you can be
spied on via the said internal inspection window.
- Position the chairs so both you and the
patient have easy, unblocked access to the door.
- Position the chairs with a good amount of
space between you and the patient.
- Do wear
a personal alarm. Check the batteries before you start (a rooky
error to omit this) and don’t forget it. If these aren’t available,
sit near the alarm button in the interview room. If this isn’t
available discuss with your team where, how and when you can
interview patients safely.
- Don’t
forget your manners! It makes it much easier to establish a
rapport, get the information you need and have an enjoyable
interview. If you see your patient is becoming agitated or upset by
a line of questioning, it may be advisable to drop the issue. You’d
show the same consideration to anyone else, wouldn’t you? If not,
you may need to think about this now!
- Do end
the interview politely, ask for help or leave the room if you don’t
feel safe. It’s as simple as that.
- Don’t
keep it to yourself if there is an incident compromising your
safety, however trivial you think it is. It needs to be
documented on an incident form if it involves violence and you and
the team involved may need to be debriefed. If you’re not sure what
needs to happen, talk to your team and ward staff about it and get
some advice.
I hope these tips haven’t
scared your off psychiatry. For more information I’d refer you to
the Royal College of Psychiatry website5 and
it’s publications6.
Psychiatry is an
interesting, fun and holistic speciality. Some would say the best
speciality. I wouldn’t want to pressure you, though, by pushing
this point. But I hope these dos and don’t help you have a really
good placement or career in psychiatry.
Enjoy!
- Health and Services Advisory Committee (1997) Violence and
Aggression to Staff in health Services. Guidance on Assessment and
Management (2nd Edition) Sudbury; HSE Books.
- Cameron AD. Crash Course Psychiatry
(2004). Second Edition. Mosby.
- Katona C, Cooper C, Robertson M.
Psychiatry at a Glance (2008). Wiley-Blackwell.
- Gelder M, Harrison P, Cowen P. The
Shorter Oxford Textbook of Psychiatry 2007. 5th
Edition Oxford University Press.
- www.rcpysch.ac.uk
- Safety in Psychiatry. Royal
Colllege Pscychiatrists 2000. Gaskell production.
Dr Deepti Desai
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Page last updated on 16 May 2010 by E
Baker-Glenn