knock it off or i'm going to put you in restraints!

[celery_juice]

Experienced Psych Nurses....

Especially in a crisis unit, there comes a time when a patient is being a danger to themselves or others, and the need for restraint is necessary. For a psychotic person, I will typically say something like "I am going to put you in restraints right now to keep everyone safe and help you stay in control until the medicine starts working." Is this appropriate?

Now, for someone who is more aware of their actions, say, a behavioral group home adolescent or a medication seeker or personality disordered patient, how do you set limits and expectations without directly threatening them? It would not be therapeutic nor appropriate (or, I'm guessing, legal) to storm in the room with security and scream "STOP THIS NONSENSE RIGHT NOW OR I'M PUTTING YOU IN RESTRAINTS" ... so, how would I say it?

Always looking for ways to improve my communication skills so any input is appreciated!

[Whispera, MSN, RN]

The only legally ok reasons for restraints are that a patient is acutely dangerous to self or others.

If that's the case in the first scenario, and talking/listening, isolation, show of strength (gathering of staff to show you, as a group, won't let any harm happen), medication, and other things I can't remember right now have failed, saying what you wrote is probably ok. I say probably because I can't know the whole situation from a few sentences.

In the second scenario, first, you can't restrain because the patient is med-seeking or has a personality disorder unless he's dangerous, right then, to self or others. You also can't threaten or it's assault. Don't do it. You can try lots of other things before you get to the point of needing restraints.

[celery_juice]

Thank you for your response. I think I didn't articulate my question right...I know that threatening restraints is assault, so if it has gotten to the point where restraints are imminent how do you tell the patient without it becoming an ultimatum/threat/assault?

[excited1]

Not an experienced psych nurse, but just finished my psych rotation. So this is an opportunity to state what I have learned and then in turn, you can help me learn.

Start with the non-threatening approach and use de-escalation techniques in the pre-assaultive stage. Explore feelings, concerns, problem solving techniques and do some boundary setting to avoid assaultive phase. Document the interventions and response.

Move on to the interventions for the assaultive phase, if necessary, document interventions and response.

Once the post assaultive phase has arrived, talk to the patient, other staff and re-evaluate where the patient is. Set further boundaries and have them "start over" so to speak.

Setting boundaries can still be therapeutic. Just keep it short and simple so it is clear.

With that said, I realize there is textbook and real world, but psych nursing revolves mostly around the "art" of nursing. I watched many nurses on the BHU this semester set clear limits to patients that were DTS/DTO and interestingly, could roam the halls in peace with the others. Its fascinating to me, really.

[excited1]

Forgot to add, set limits to show that there may be consequences without stating the consequence, and if you really know restraints are really going to happen, form the "show of force" squad and see if they start communicating, etc.

[Davey Do]

Bottom Line: "You have Two Options- One: Make a Commitment to Safety, do Nothing in Word or Gesture that could be Interpreted as a Threat of Harm to Yourself or Anyone Else, or Two: Be Restricted of Your Right to Freely Move About."

[celery_juice]

""Bottom Line: "You have Two Options- One: Make a Commitment to Safety, do Nothing in Word or Gesture that could be Interpreted as a Threat of Harm to Yourself or Anyone Else, or Two: Be Restricted of Your Right to Freely Move About."""

thank you! thats more along the linea of what i was looking for.

[Davey Do]

thank you! thats more along the linea of what i was looking for.

You're Welcome, celery juice ! Rote Memory comes in Handy in Stressful Situations!

[Safety Coach RN]

Bottom Line: "You have Two Options- One: Make a Commitment to Safety, do Nothing in Word or Gesture that could be Interpreted as a Threat of Harm to Yourself or Anyone Else, or Two: Be Restricted of Your Right to Freely Move About."

And this gives the patient the autonomy of choice.

[Whispera, MSN, RN]

Keep in mind that the patient who is about to blow a gasket isn't likely to hear everything you say, so keep it short and simple. What they are likely to hear is any emotion in your voice. Your angry voice will probably escalate their anger. Your anger might ignite their "fight or flight" even more than it's already ignited. While you surely can be angry or afraid or feeling any other emotion, you have to keep that under control as much as you can for everyone's sake.

One last bunch of thoughts (for this group of paragraphs anyway), people can pick up your emotions by seeing your body language and facial expressions as well as your words. Your priority is to keep everyone safe, not punish the patient for mis-behavior that could be not within his control. If you need to restrain, keep that priority in mind. It's not about the surface emotions. It's about what's under it all.

I like what epitome and Davey wrote.

It's important to debrief with your peers and the patient if restraint becomes necessary. I've seen some awesome nurses be the epitome of caring and kindness to a patient in full restraints. It matters.

[elkpark]

I agree that, while it's unprofessional and a violation of state and Federal regulations to threaten people with restraints, I also feel that it's unfair to not at least make people aware that that is where they're heading (particularly people who are new to "the system" and may sincerely not realize that is a risk they are running). In those kinds of situations over the years, I have said to people, in a calm, reasonable tone of voice, something like, "I want you to understand that, if you aren't able to pull things together and change the path you're on right now, you're likely to end up in restraints. I don't want that to happen, and I want us to work together to figure out a way to keep that from happening." To me, that's v. different from threatening someone with restraints; I consider that providing useful information and offering them information about how to avoid ending up in restraints and a way out of the situation, and it's treating them with respect and connecting with them as another human being. (Of course, that approach isn't always successful :), but it is successful a good deal of the time.)

[Mandychelle79, ASN, RN]

My objective of the patient is toeing the line is to eliminate the audience so I offer going back to their room or going into the seclusion room with the door open for a calm down period. When they make their choice we offer prns if ordered.