Psychiatric emergency, crisis management, patient safety, caregiver well-being, relational care, chemical restraint, physical restraint, emotional boundaries, secondary trauma, nursing care
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Abstract
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Abstract
Analysis of caring for patients in crisis in a psychiatric emergency service, focusing on managing violence and ensuring safety.
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[...] Not giving in to the impulse to try to resolve everything at all costs allowed me to maintain control and offer Sofia a secure framework, even if that framework seemed restrictive at first. Question 1 : Psychological Impact Management on Caregivers This situation has also raised the question of the psychological impact of violent crises on caregivers. Being confronted with episodes of violence, particularly when a patient is in acute crisis, puts caregivers to the test. The psychological impact of such situations can lead to emotional and professional burnout if emotional boundaries are not properly managed. [...]
[...] He asks her to stay seated and breathe calmly, but she doesn't listen, responding with incomprehensible murmurs. At one point, she gets up and starts heading towards the door, but I prevent her from leaving by closing the access. It's a difficult moment, as the atmosphere is tense. I can feel the frustration in the air, the feeling that everything can tip over at any moment. Sofia seems to be in a state of emotional dissociation, where she no longer reacts in a rational way, but rather in an impulsive and uncontrollable manner. [...]
[...] Keywords : psychiatric disorders, violence, nurse/patient relationship, trust, communication. Introduction : The seventh five-week stage of my nursing training takes place in a psychiatric emergency department of a Parisian hospital, specializing in the care of patients in acute crisis. This service welcomes patients in states of great psychological distress, whether they are in a state of crisis, psychiatric decompensation or violent behavior. The service has several units dedicated to different types of care: an intensive care unit for the most vulnerable patients, a rapid assessment unit for orientation and a secure space for patients at risk of escape or violence. [...]
[...] Sofia suffers from borderline personality disorder, combined with episodes of dissociative identity disorder. Her emotions are extremely unstable, and she often reacts in a disproportionate manner to events, alternating between extreme agitation and emotional dissociation phases where she seems to 'lose touch' with reality. She is also diagnosed with severe mood disorder, making her even more vulnerable in situations of intense stress. We know that this patient can become very aggressive and has a strong tendency to flee as soon as she has the opportunity. [...]
[...] This experience highlights the importance of preserving one's mental health as a caregiver, while offering a respectful and secure therapeutic framework for patients in crisis. Self-assessment: My experience with Sofia during my internship in the psychiatric emergency service confronted me with key aspects of my nursing training, while highlighting several areas for improvement for a more comprehensive and effective approach to caring for patients in crisis. Firstly, this situation allowed me to mobilize certain of my relational and crisis management skills, acquired during my theoretical training, particularly those of UE 4.2 on relational care and UE 5.1 on crisis situation management. [...]
