Eliminating Seclusion/Restraint? Um, NO.

Specialties Psychiatric

Published

  1. Do you believe the elimination of seclusion/restraint is practical?

    • 4
      Yes
    • 87
      No

26 members have participated

Specializes in Mental Health Nursing.

I read numerous research articles and reports about how a major goal for the mental health profession is to eventually eliminate seclusion and restraint. Yeah..... don't see that happening anytime soon. Reduction, yes; but complete elimination, no. It's just not a realistic goal. But that's just my opinion as a forensic psych nurse who deals with behavioral crises several times daily. What do you think?

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Specializes in Psych (25 years), Medical (15 years).
Reduction, yes; but complete elimination, no.

Agreed.

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Specializes in Psych ICU, addictions.

In an ideal world, we would be able to manage even the worst psychiatric crises without resorting to S&R.

In the real world, not going to happen.

In fact, I experienced an instance where in my opinion S&R should have been used, but they tried to manage the problem without it. It made things far worse--and far more dangerous for other patients and staff--than they should have been. But this was a rare exception--I believe that S&R should only be the last resort when all else fails.

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Specializes in LTC, SNF, Rehab, Hospice.

I don't work in mental health, but do work in LTC/SNF. Patients with dementia, psychosis, schizophrenia, etc. are the norm. I can't imagine not being able to use alarms, low beds, self-release belts, etc. Even with several of these measures, we have to do 1:1 all shifts for several patients. I wish we could use more restraints.

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Specializes in Psych.

I agree. I don't think it will be possible to ever totally eliminate it. Sometimes people are so sick that no amount of verbal Dr-escalation or PO PRNs (if the of even agrees to take) will keep them safe. I have worked places where it seems like there was a rush to restrain someone but where I work now I have yet to see one and it's been 6 months. Now granted I work on a voluntary unit. Involuntary and forensic, those are some really sick pts. And I feel like they are getting sicker.

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Specializes in Mental Health.

We don't use seclusion on the unit I work in - restraint is used as needed, it is not needed all that much but can be up to 3 times on a single person per day. I can understand the need for both but I have also seen the use of both when really unwarranted

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Specializes in Outpatient Psychiatry.

Frankly, I don't think S&R are employed enough. There are too many patients in a milieu and too many staff to let the needless games of manic and delusional patients cause such distractions. I want to add, S&R are not an extension of the therapeutic process. I was taught that in some class - CPI or HWC (don't recall which).

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Specializes in Forensic Psych.

How would that even be possible?

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Specializes in Psych, Addictions, SOL (Student of Life).
I don't work in mental health, but do work in LTC/SNF. Patients with dementia, psychosis, schizophrenia, etc. are the norm. I can't imagine not being able to use alarms, low beds, self-release belts, etc. Even with several of these measures, we have to do 1:1 all shifts for several patients. I wish we could use more restraints.

The LTC I work in is a no restraint facility - we even have to justify use of and do periodic reduction trials of psychotropic medications.

I worked acute psych for 6 years and while I agree total elimination is not practicle - I also believe S&R is over used and more therapeutic methods at intervention should be used whenever possible. Medicating and strapping someone down doesn't teach them any coping skills.

Hppy

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Specializes in Behavioral Health.
I read numerous research articles and reports about how a major goal for the mental health profession is to eventually eliminate seclusion and restraint. Yeah..... don't see that happening anytime soon. Reduction, yes; but complete elimination, no. It's just not a realistic goal. But that's just my opinion as a forensic psych nurse who deals with behavioral crises several times daily. What do you think?

There's lot's of goals in life or perfect ideals that are unattainable but that doesn't mean we stop trying to find ways to reduce seclusions and restraints.

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Specializes in Aged mental health.

I'm curious what other strategies your organisation has implemented to substitute S&R?

There is a huge shift here in Victoria, Australia to reduce and potentially eliminate S&R by the Reducing Restrictive Interventions initiative (feel free to read more about it 'Providing a safe environment for all: Framework for reducing restrictive interventions' retrieved from the health.vic.gov.au document library)

There's a lot of focus on Sensory Modulation, gender senstive care and trauma informed care that underpin the rationale behind this initiative. So far there has been some great progress amongst acute inpatient units who had some of the highest S&R rates in the state.

I suppose my point is, is if there is no support or a recommendation for an alternative strategy to assist in reducing and/or eliminating S&R, then how is this idea supposed to be well received amongst us nurses?

I'll be curious to hear what other organisations have to offer.

Midazoslam.

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I work on an Acute Child and Adolescent Psych Unit and I strongly disagree that seclusion and restraint should be removed entirely. What do they propose as a sufficient alternative?!?!

Uhmmm..I have 20 HIGH acuity patients on my unit all struggling with some very serious anger management issues, manic episodes, mood lability, mood D/O, autism, psychoses, lack of impulse control, sexually acting out, Hx of neglect and traumatic abuse, CPS patients, suicidal, and self mutilators. On a daily basis, I have to intervene physical and verbal altercations between peers on the unit, confiscate items from patients who DIY their own self-harming weapons (plasticware, stolen paperclips, peanut butter cartridges, med cups..etc etc), i have to dodge chairs and lunch trays and pediasures chunked at me, I have to jump in when a pt is trying to attack my staff, I have to physically hold a patient with trichotillomania to prevent her from ripping out the other half of her scalp, I have to forcefully remove foreign bodies from patients mouths who are trying to ingest anything they can get their hands on, I have to have 2 support staff help me restrain while i give Emergency IM meds to severely agitated/out of control patients, I have to protect all other 19 patients from imminent danger when a pt flips out in rage and starts flipping tables and throwing chairs and threatening harm against himself and others... and the list goes on&on..

My point is.. how do they suggest I intervene without restraint or seclusion in any of those examples?! Im not a big fan of seclusion, emergency medication, or restraint.. but, i definitely think it's a necessary LAST resort effective option when there is an imminent risk of danger to the health and safety of my patients and my staff! I mean, if i could have it my way, all the patients would be well behaved, cooperative, and not ever exhibiting any unsafe behaviors.. but, that's not real life. So, realistically speaking, taking away seclusion and restraint is a terribly dangerous gameplan!!

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