Control and Restraint Techniques

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    Hi there, am after some advice and help in this area. I work in forensics in the UK, currently working with mentally disordered offenders (ie are subject to the Mental Health Act and therefore remain in a medium secure environment for treatment rather than serving a sentence in prison)

    BAsically, we are constantly faced with violence and aggression and are taught control and restraint techniques to help us maintain a safe environment. I would welcome the opinion of others in this area. Should we be doing this?

    Anna
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  4. 7 Comments so far...

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    Hi,
    I work in a Forensic Unit. Basically it is a pysch unit. The patients are the insane who have commited henious crimes, but plead insanity and cannot be ajudicated of guilt, so they serve time in a mental hospital rather than in the State Prison... This "patients are dangerous. It seems to me from your posting you are in a similar situation. Take any self defense or protective classes you can. Protect yourself and your co workers.
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    I work as a community psychiatric nurse in New Zealand, specifically forensic clients. Prior to this I worked in a acute unit that also admitted forensic clients. It is essential that we have the ability to protect ourselves, collegues and other patients. We call it calming and restraint and it is taught to ensure and minimise harm to those involved in the restraint process, however the calming should occur before the restraint. As we know indicators are not always there to allow the calming to occur. If you didnt have the ability to implement this skill for the essence of safety you would be in a compromised situation. I guess its the balance between care and control.
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    I am with Thunderkat in her opinion. Protect yourself & your staff period. I do & therefore I am still around to work on this same unit. Have been there for the past 14 yrs. only assaulted once early on in my nursing career. Good suggestion is to listen to those who have been there a long time as often times they have many helpful hints on how to avoid being hurt & know many of the patients tell tale signs of working up to assaultive behavior. Always know where people are in relation to you, always know where your exits are, know your patients & know your meds-give them & if no orders then call MD & get orders for medicine. Don't fall down if you can help it even if you have been hit as if you fall you will be stomped. Don't go into situations that place you alone on the unit or alone with a patient EVER. *sigh* there are so many things...for example if you grab a man by his nuts, nose, ear he will basically follow where ever your hand goes. Sorry to be blunt but it is true & it often works. Many times on my unit esp. now with the shortage we are under staffed & basically it is just myself & 3 female nursing assistants with 24 men. One does what one has to to protect ones self. Mostly though it is awareness & common sense.
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    There are some very interesting and basic postings here about how to work with offenders in a Forensic Unit. I have worked with this population for the last 4 years and with psyche in general for the last 21. Keeping aware at all times is really the key and watching for the tell tale signs that most patients give that precede violence is very important. It is also important to keep calm in all situations if possible. If you show that you are fearful you show that you are not in charge. You are in charge at all times. It is most important to practice respectful, empathetic communication. I like the Nursing Theory of Peplau and use her methods most often. I find that information about the admitting patient comes to our facility, the staff read about the behavior of the patient before he comes in and makes assumptions about how he is going to act when he walks through the door. This is often a mistake. It is most important to be aware of past behaviors but not let it color your behaviors toward the patient when he comes in. Treat all patients when they come in like a stranger to you and accord the respect you would to him that you would accord to any stranger. Respect and Dignity. This works for our staff very well and we don't have very much acting out because of it. Safety is the first concern for all.
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    Hi,

    The best manual of techniques I have found on Control and Restraint is written by a New Zealander by the name of Geoff "Tank" Todd. He has over 20 years of training and experience in self defence, unarmed combat and control and restraint techniques.

    Tank has a website at:

    http://www.schoolofselfdefence.com/tacticalcr.htm

    Things I find of particular use to forensive nursing control and restraint situations include breaking up a fight techniques, two & three staff restraint techniques, and emergency room restraint techniques.

    Cheers,
    Graeme
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    I worked 7 years in a Max Security Forensic Hospital for the criminally insane. I worked primarily with the women but spent a few years with the personality disorder males. The salary for what I was doing was not worth it anymore when I decided to resign. It had gotten so out of hand with the aggression of the clients and the severe injuries of the employees that I had to get out. The Department of Mental Health has definate problems when it comes to running a Forensic Hospital and allowing clients to hurt people over and over and nothing be done about it. I went into Corrections and let me tell you, the women I work with are very well behaved and keep in line most of the time. They know if they do something wrong they get consequences for their behavior. And even if they have a mental illness, they still know not to hit a staff or an officer. BUT at the psych hospital for the criminally insane, they can hit, bite, scratch, spit, punch, kick, pull your hair out, break your arms or legs etc etc etc and they get NO punishment for their behaviors. The most that can happen to them at the time of their actions is to be put in restraints for up to 4 hours and they lose their privilege to smoke for 24 hours. WOW a real punishment for breaking your arm huh? The State tells staff that they are preparing these clients to be able to function in society again......how are these people going to learn their lesson if they don't get any punishment for what they do? I don't think society is going to allow a person to punch out an officer and the officer will just tell the person that they can't smoke for 24 hours!!!!!!!! The whole system is messed up. I know that some of these people are truly sick and they need help, but then there are the personality disorders...there isn't any medications that are going to help them. These individuals know what they are doing and can get away with anything because they are mentally ill and no one can touch them. I will tell you that in the Department of Mental Health, the client has more rights than any staff member working in that department. They actually listen to a mentally ill person over a staff member! Ok let me get off my soap box here. I am sorry but when I left my old job with the State, I left several of my friends and I worry about their safety everyday. There is absolutely no reason why staff should have to suffer being beaten on almost everyday just because these clients are mentally ill. Our State Hospital is trying to do away with restraints believe it or not. Something that will most definetly get someone killed. But they feel that restraints and seclusion is abuse to the clients. I have no idea what they plan on doing to control these people but I would never work in that place again for safety reasons. I left with 3 bulging discs in my back, 8 hernia repairs (from lifting and fighting so much in 7 years), arthritic knees that won't allow me to bend anymore, migraine headaches that got worse from being punched in the head numerous times and a huge scar on my leg from a human bite. A wound that will never go away. Restraints and seclusion are so necessary. There has to be consequences for bad behaviors. But this is just my opinion on the subject. I could write for hours on the stuff that went on in that horrible place I worked at, but I won't do that to you. Have a great weekend........
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    Hi

    I teach Control and Restraint and firmly believe that it is important for Nursing staff to be given the training required to maintain thier own and others safety.
    Dont forget that before Control and Restraint we used to get six or seven of the biggest people around to dive on the patient and pin them to the floor. The old philosophy was to restrict movement AND breathing ( cant breath cant fight is what I was origionally taught).

    I think that a good team can deal with most situations using Control and Restraint. Like everything else it is not infallable and can be abused, but I believe it is the best system we have at the moment.

    Hi by the way Im Taffy form Oxford Uk and I have Just joined the forum. Nice to see people here


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