Physican restraints still being used???

[Lawnurse]

Previously I posted here when I was looking for a paper topic - and that discussion got bumped because it boardered on research, so I'm not looking for examples here.

My professor wants me to focus on the use of physical restraints in psych hospitals....WHAT?! I did a whole psych rotation and never saw a single patient in restraints (my previous paper topic focused on patients outside of psych hospitals as well).

My professor said this institution was "incredibly enlightened." I guess it should be, it was the Cleveland Clinic.

my question is, what are these restraints like? handcuffs?? straightjackets?? I didn't realize there were still in use. Please, enlighten me!

[lil'nurse]

A baskethold is used to physically restrain an aggressive individual, involves grabbing an aggressive individual from behind, pinning their arms so they can't strike out. Difficult to explain I guess.

[CharlieRN]

I have used a basket hold but as I was taught it, it is a one person technique and is only useful if applied to someone smaller than you are. Holds for full size adults need to be more than one person holds. The restraint bag we use is something like this:http://www.pxdirect.com/fullbodyrestraint.htm

[Marie50]

Okay, I hope this isn't a stupid question....

how do you know what you are legally allowed to do in terms of restraining a patient? Do you just adhere to whatever the facility policy is?

I'm just imagining a bunch of nurses holding down a screaming, kicking patient while trying to have an intelligible discussion about the consitutional right to liberty and the patient's due process rights under state law... :uhoh21:

each state has mandated statutes that govern restraint use and process...it is more and more rare these days but still at times a very last resort

[PRNMEDS]

I work in a hospital that has only Adolscents, and unfortunatly we are forced to use restraints (4 -pt - leather restraint to bed, or locked seclusion) several times a week. Our hospital policy is very clear that restraint is a "last option" to be utilized only when all else has failed, and a patient is an immediate danger to self or others. Hospital policy is pretty clear on how and when restraint can be used, and is written to meet State/Federal regulations. Also there is a ton of paperwork to be done to ensure policy is followed correctly and patient safety is maintained.

If you are wondering HOW it usualy works - at my hospital it usualy goes somewhat like this.

Patient agitated - throwing things, attacking peers or staff, or injuring self. We attempt to de-esculate by talking, offering meds, etc. If patient continues to threaten safety of self and others - Registered Nurse will call for restraint and patient will be placed in restraint. Doctor is then immediatly called and told of situation - he/she then has 30 minutes to come to unit and do face/face eval and sign order for restraint. Patient can only be in Restraint for maximum of 1 hour (if still out of control - Dr. can order another restraint - but new set of paperwork is required), but often is out in 20 - 40 minutes if they de-escalate (nurse or doctor makes that eval).

Usualy the RN on duty will make the call. Generaly other nurses are in agreement and depending on situation may have a quick discussion to decide. More often then not there is not time to have long debate as someone can get injured. On occasion Nursing Supervisor may intercede and stop restraint - but this does not happen often. If any disagreement can usualy be discussed after.

Hope that helps you understand the process a little better. If have any questions feel free to contact me or post on here.