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Eliminating Seclusion/Restraint? Um, NO.

Psychiatric   (4,496 Views | 19 Replies)

Angeljho is a MSN, NP and specializes in Mental Health Nursing.

8,535 Profile Views; 387 Posts

You are reading page 2 of Eliminating Seclusion/Restraint? Um, NO.. If you want to start from the beginning Go to First Page.

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

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

    • 4
      Yes
    • 85
      No

89 members have participated

3 Posts; 239 Profile Views

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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NurseSpeedy has 18 years experience as a ADN, LPN, RN.

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I agree. Restraints and seclusion should be a last resort but there are always going to be patients that will require these tactics, even for their own safety.

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931 Posts; 14,914 Profile Views

Oh my as a mental health worker went to a new hospital that has no seclusion or restraint room. I was in shock and awe we have restraint's, use the patient's bed's. I miss the room's. Granted rarely used the restraint room do feel seclusion is good as a way to chill pound it out scream it out does the trick all the time.

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wingding has 4 years experience.

76 Posts; 3,698 Profile Views

Junebug903 -- On my Acute Care Behavioral Health Unit, our restraints require 1:1 sitter with a 15min. check sheet - if the pt. becomes calm & not fighting nurse must get them out ASAP --- it is about 1-2 hrs worth of paperwork & charting after restraints are used --- We HATE using them, but there are times they are necessary. I don't know what kind of place you are at where you think using a restraint would be easier - it's not like you can tie them up & leave.....

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931 Posts; 14,914 Profile Views

Junebug903 -- On my Acute Care Behavioral Health Unit, our restraints require 1:1 sitter with a 15min. check sheet - if the pt. becomes calm & not fighting nurse must get them out ASAP --- it is about 1-2 hrs worth of paperwork & charting after restraints are used --- We HATE using them, but there are times they are necessary. I don't know what kind of place you are at where you think using a restraint would be easier - it's not like you can tie them up & leave.....
Old psych unit was in seclusion or restraints have to document every fifteen minutes their behaviro, a dress any health issue's, and document your interventions to their behavior. Was awesome thorough. Normally 30 minutes in seclusion with some chemical restraints they were set to go back to their room stayed for an hour. If not knocked out or snowed be allowed back in the milieu.

With restraints normally be straight to restraints had some that went seclusion to restraints though rare. In restraints same procedure as seclusion. Then every 15 minutes you talk to the nurse see if able to release one or two restraints. Rarely ever over 2 hour's. If over 2 hour's becomes a new order so doc has to come back up again as he did when they initially went into restraints or seclusion. Then doc monitor's them prior to release and reports back to primary doctor taking care of them. Most of the time happen when the on call doc was on so orders be passed on to be reviewed by primary psych doctor.

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mystory has 9 years experience as a BSN, RN and specializes in Med/Surg.

177 Posts; 9,282 Profile Views

Nonsense. That's what the folks in the ivory tower say..after all they are not the ones on the front line being threatened.

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TCASII has 8 years experience as a ADN.

198 Posts; 3,952 Profile Views

I worked in a crisis facility that did not believe in S&R, let alone forced IM. It was not only a last resort, but one that created a dangerous environment. The patients, especially those who were voluntary wanted to leave so fast. They didn't feel safe and were scared to death. The petition patients who were involuntary were often agitated and set off d/t their underlying psychosis/mania. It was ridiculous to see a person with a chair in hand threatening staff and having the medical director, an MD with years of experience, telling us to hold off and continue talking. Making matters worse, they would overfill the locked unit so when patients acted out, other patients had no where to be safe. Then when seclusion was employed, the management would second guess everything you did.

IMs were impossible to obtain an order for, regardless of the level of acting out. Usually a severely agitated patient would receive an order for Zydis 5 mg. Haha. Yeah, that'll work.

No way that S&R can be eliminated. The problem is, the regulations regarding S&R are several pages long. I think 12 compared to 7 for anesthesia. I was told that once. People have died with S&R, so everyone is paranoid about employing it.

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14 Posts; 723 Profile Views

I live in a country where the use of restraint is avoided at almost all costs.

I'm only a medical student, have never been with a restrained patient and have no experience from the psychiatric ward (I'm only here in this forum because I needed advice about how to deal with borderline patients in somatic departments), but I'm concerned that the "protecting patients right to freedom and not doing anything against their will" goes too far, and claims too much of already limited resources - and that other patients suffer for it.

What I hear from fellow medical students who have worked as nurse assistants on psychiatric wards, is that there are a lot of patients who come in with self-inflicted problems, and are acting out due to the use of illegal drugs. Because they aren't allowed to use restraint, they need several male nurse assistants there to help control the patient.

Meanwhile, in "my" department (somatic), old patients suffer, because there aren't enough nurses and assistants.

I am well aware that many psychiatric patients have had extremely difficult lives and are doing the best they can. However, I also think some of them "like" to self sabotage, and aren't accepting the help they are offered. And when the psych ward aren't "allowed" to use restraint, they occupy several nurses and assistants (and time!!!) - while a lot of old and sick people don't get the care they need. Why is protecting self-sabotaging people's "rights" more important than giving others the help they need? It is heartbreaking to see old, sick people (- who have worked hard all their lives and tried their best and never had the "luxury" of acting out and to experiment with drugs) suffer.

Sometimes I wonder if a more strict line would be better in some cases. "If you choose to do drugs instead of dealing with your problems, then expect restraint when you act out. The society can no longer afford to protect your rights when you try to sabotage the help you are offered".

Just my two cents. And just to point it out again, I am well aware that a lot of psychiatri patients truly do their best, and of course I hope they get all the help they need. I am just worried about what seems to be a "emo trend" and cultivation of destructive self sabotage.

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