Crystal meth users can create “frightening, disruptive” climate in Emergency Room February 9, 2020 April Shea, Registered Nurse, Inpatient Psychiatric Unit; Psychiatric Nurse, Emergency Department; and Sexual Assault Nurse Examiner, Horizon’s Dr. Everett Chalmers Regional Hospital When I began my career in nursing nine years ago by taking a position in psychiatry at Horizon’s Dr. Everett Chalmers Hospital, I knew I was entering a nursing career that was different than most. Mental health nursing offers its own unique challenges. You’re at times caring for patients who are unable to recognize they have an illness and therefore refuse your efforts to help. In some situations, your attempts to care for an individual are met with hostility and aggression. As mental health nurses, we learn how to cope with these difficult behaviours in order to provide our patients with compassionate and dignified care. Quite often we’re fortunate enough to observe our patients make steps towards recovery. As every mental health nurse knows, the path to recovery isn’t always linear. Therefore, we celebrate every small step forward and we take pride in the fact that we’re there to support our patients when their path takes a few steps backwards. Overall, I’ve always felt that I was able to be there to help and support my patients and their families, regardless of their circumstance. In the past couple of years, I’ve noticed a change in the patients we’re caring for. We’ve seen an increase in patients experiencing symptoms related to the use of crystal methamphetamine, commonly known as “crystal meth.” These patients often present to the emergency department with symptoms such as hallucinations, paranoia, hyperactivity, lack of sleep, agitation, and aggression. While these are all symptoms we as mental health nurses are trained to help manage, we are now seeing them at an increased volume and intensity. Simply put, we’re seeing more patients experiencing these symptoms and they’re more severe than we’ve seen before. There are times when the medications we normally use to treat these symptoms are ineffective and provide minimal relief. At times all we can do to support these patients is to provide them with a safe space until the effects of the crystal meth wear off. Unfortunately, because the effects of crystal meth are so severe, providing a patient with a safe space can become a challenge as well. If a patient is experiencing paranoia, their fear may result in them becoming combative. This may require the use of restraints, seclusion rooms, and/or the intervention of security or police to maintain the safety of the patient, staff, and the community. This experience can be very upsetting and even traumatic to all involved. The patient often cannot understand that in this situation what is happening to them is to protect their safety. For the staff, we have become more fearful for our own safety as the symptom of aggression these patients experience is more than what we’re used to treating. For the other patients and visitors in the hospital, it can be a very frightening and disruptive experience. There are many times in the emergency department where I’ve witnessed families in the department with their sick child or dying loved one, only to have the constant yelling of a person under the influence of crystal meth in the next room. For the visitors and patients that experience this, they are often uncertain of what is happening and if they and their loved ones are safe. In these situations, we attempt to reassure them of their safety. This is just a brief glimpse into the effects of crystal meth use on our patients and community that I see as a mental health nurse. I struggle with putting into words the deep concern I have about the growing use of crystal meth and the effects on our community. It is my hope that with increased awareness, we as a community, will be able to tackle this issue together. For more information on crystal meth and where to get help in New Brunswick, click here. April Shea is a registered nurse with Horizon Health Network. During her nearly 10-year career, she has worked as a staff nurse on the inpatient psychiatric unit and as the ER psychiatric nurse. She is trained as a Sexual Assault Nurse Examiner. April is the clinical lead nurse on the inpatient psychiatric unit at Horizon’s Dr. Everett Chalmers Regional Hospital in Fredericton.