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...am i missing something...


Specializes in Mental health. Has 12 years experience.

Couple of years back a team of people from our hospital visited in Pennsylvania to receive knowledge about reducing seclusion and restraint uses. They started a project in our facility to reduce the number of seclusion and restraint use.

We have managed to reduce the number of seclusions and restraints, but we also have managed to raise the number of severe attacks on staff. I´ve read some papers about Pennsylvania reducing their secl./rest. numbers dramatically over the years. I havent´t noticed much difference in the methods of treatment comparing to ours and yet still they have managed to do this without considerable raise in violence towards staff. So I´m wondering that am I missing something or is the deal as transparent as they say? I kindly ask comments on the matter because this is causing much mixed feelings amongst the staff.

I work in a goverment facility in Finland that takes care of the forensic patients and those who are too difficult to treat in other facilities (violent and dangerous).

Davey Do

Has 41 years experience.


You have an interesting observation there: Decreased restraints in Penn. with no rise in attacks vs decreased retraints with rise in attacks in Finland. I see nothing obvious, based on the information you provided, that you have missed.

I wonder: Was the Penn. Faclity also forensic? I'm assuming that the knowledge was gained in a like facilty, in that, it was.

I can give you no pat answers based on statistics and empirical data. I can only give some basically subjective considerations. I'm sure you have certain programs and techniques you utilize in your facility in dealing with crisis situations. I 'll give a few of ours and make a few points in a free-verse sort of way. Perhaps something will spark a small revelation:

For example, the initial approach in a potentially dangerous situation often sets the tone for its result. Safety is always the priority. The Clients need to know that they are in a safe environment. They also need to know that no harm will come to anyone.

Many times, personality conflicts are the precipatating cause for rifes between Clients and Clients and Staff and Clients. Principles are always put before personalities. For example, there are no insults given by Staff and no insults made by Clients are ever taken personally.

Behaviors are always addressed in a logical, systematic manner. No emotions, except empathy, should be displayed by staff.

Power struggles are often a factor in crisis situations. Power struggles never need to occur. It is always understood that Staff are in power. The Clients always have obtions, within appropriate boundaries, of course. The outcome is based upon their decisions.

Restraining or secluding the Client is always a therapeutic procedure. It is never done as a form of punishment.

Approaching and therapeutically holding the Client is often a time when physical injuries occur. Systematic techniques need to be utilized. All Staff need to be knowledgeable of and well-trained in this technique.

We have a program in this area called Crisis Prevention Institute (CPI) that, in part, teaches de-esculation techniques. Its been around for as long as I've been in nursing and its basic premise is sound.

Well, toddlerdino, I hope something clicked. If not, it was a good overall review for me.

Good luck in your problem-solving search.