imminent risk

[lottieloo]

Hi all!

So at a training, the trainer mentioned that if a patient got angry and started destroying property (the unit) that the pt could NOT be restrained or placed in seclusion or given a forced IM unless they then started directing the aggression AT someone. Is this true? The trainer said they have been in a scenario where the pt tore the unit apart and hit chairs off walls and the other patients were all removed from the area but he was just allowed to do his thing bc he wasnt harming himself or anyone.

[elkpark]

Welcome to allnurses!

Whether or not property damage "counts" as acute danger for which someone can be involuntarily medicated, restrained, or secluded is a controversial issue within the psychiatric community. Different professionals have different views about this. The classic standard for restrictive interventions is "acute danger to self or others." Nothing in there about property. The justification I've heard over the years (for initiating restrictive interventions in cases of damage to property) is that the person is putting her/himself in danger by throwing chairs or whatever else s/he is doing in the way of property damage. I've usually found that a pretty flimsy rationale. (although there certainly can be specific situations in which the individual's actions truly are putting her/himself in acute danger (e.g., breaking a window or plates, producing broken glass or china). But, in my experience, people who are damaging property usually have no intention (and little actual risk) of harming themselves or others.

[lottieloo]

thanks so much for your answer elkpark! That makes perfect sense. My only other question is-what if a patient is forceably kicking the door saying they want out of the hospital? Technically it's a danger because they need to be in the hospital and also they could injure themselves by forceable kicking. Also what about behavior such as punching a wall (could break their hand). Could PRN IM meds (if they refuse PO) /seclusion/restraint be justified?

[Novo]

I think it's appropriate to take reasonable action against a client who is destroying property, rationale being that they are causing other clients distress.

[elkpark]

I think it's appropriate to take reasonable action against a client who is destroying property, rationale being that they are causing other clients distress.

Define what you mean by "take reasonable action." "Causing other clients distress" is not a legitimate reason for forcing medication or restraint on someone anywhere I've worked over the years, which is what the OP is asking about.

OP, situations in which the person is truly in danger of injuring her/himself, like punching walls or repeatedly kicking something solid and being unwilling or unable to stop, could be considered situations in which it is appropriate to initiate restrictive interventions (like forced medication, seclusion, or restraints).

[KaffeineFiend]

A PT who has escalated to a point where they are destroying property out of anger NEEDS interventions.

Obviously relocation is a big priority. Other patients are at risk of being hurt even if the aggressive action was not meant for them.

you can relocate all the patients temporarily until the situation de-escalates, but the pt could still injure staff in their aggressive behavior aimed at property.

The appropriate course of action is to intervene before a pt escalates to the point that they've injured themselves or others. Waiting for a pt to direct his aggression at someone else and then act is dangerous, and a disservice to the pt.

When staff is attempting to redirect the pt, and all other less restrictive measures have failed, more restrictive measures are appropriate.

Why wouldn't you put them in seclusion? They are now safe, as well as others, since they can't cause injury with objects. It's a chance for them to regain control, stimuli is reduced, location is changed etc. They have also been prevented from continuing a course of action that could cause them severe guilt or shame (as many of our PTs do) and potentially set them back.

If the pt is so angry that seclusion is just going to cause him to redirect their aggression towards themselves, chemical and/or restraints are appropriate.

I just can't see a situation that would allow for a pt to just be allowed to persist with aggressive destruction of property.

If a pt isn't a risk to any one nor themselves, then it's not really destructive.

[Novo]

Define what you mean by "take reasonable action." "Causing other clients distress" is not a legitimate reason for forcing medication or restraint on someone anywhere I've worked over the years, which is what the OP is asking about.

OP, situations in which the person is truly in danger of injuring her/himself, like punching walls or repeatedly kicking something solid and being unwilling or unable to stop, could be considered situations in which it is appropriate to initiate restrictive interventions (like forced medication, seclusion, or restraints).

Disclaimer: I'm not an RN I'm just working as an undergraduate nurse employee for the summer but by reasonable action I mean moving the client to semi-seclusion or offering medication. I'm still learning but what would be the proper intervention?