Physican restraints still being used???

MissPiggy · Mar 28, 2005

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!

Where I work, we have the leather 4 point restraints, a fifth point if necessary (for spitters/ head bangers) and then we use physical holds for anything else. It has been about a year since I saw anyone in 4 or 5 point restraints, though.

Hope that helps.

hypnotic_nurse · Mar 29, 2005

The title of this thread makes it look like you are restraining physicians!

MissPiggy · Mar 29, 2005

The title of this thread makes it look like you are restraining physicians!

Sometimes that becomes necessary to!!! :lol2:

MissPiggy · Mar 29, 2005

The title of this thread makes it look like you are restraining physicians!

Sometimes that becomes necessary too!!! :lol2:

Nurse Ratched, RN · Mar 29, 2005

We have locked leathers - wrists, ankles, and belt around the middle if necessary. Hate to use 'em but sometimes they are necessary - the shorter the length of time, the better, but occasionally no amount of medication will calm someone fast enough to prevent staff from getting hurt without them.

Aside from the indignity and potential for risk to harm to the patient, they're also a TON of paperwork, but I prefer to have them as an option for those rare occasions.

Lawnurse · Mar 29, 2005

Sorry for the typo - thanks for the replies. :)

So...how do you know when a patient needs restraints? What if you feel that the patient is putting everyone else in danger but your charge nurse thinks it you're over-reacting? Or are people usually in agreement?

Nurse Ratched, RN · Mar 29, 2005

About the time 8 people are holding down the patient on the floor, everyone is generally in agreement that the pt needs to be in restraints .

Seriously - not trying to be flip here. There should be enough people around for a "show of force" when someone is that agitated, and either the person is going to calm down, or they're not, and if staff or other patients are in danger, then the pt is going to be restrained to protect himself or others. It's usually pretty obvious when it needs to happen.

Lawnurse · Mar 29, 2005

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:

elkpark · Mar 29, 2005

Information about the state and Federal requirements related to restraint and seclusion usage is a standard part of the job orientation for new employees, and is typically reviewed annually as part of the facility continuing education program. The state and Federal requirements are also incorporated into the facility's written policies/procedures re: restrictive interventions, but the moment that a patient is going off and throwing furniture isn't really when you want to have to go look something up in the P/P manual ... :chuckle

TitaniaSidhe · Mar 30, 2005

Alternatives & choices should ALWAYS be attempted first if possible. There are those rare occasions when you have someone go off without forewarning or get in a completely psychotic/violent admission & have no other recourse but to utilize mechanical restraints. Most times a patient gives clues to increasing agitation. Offer quiet areas to decrease stimuli, offer prn medication, reality orientation, diversion, 1:1 intervention, emotional reassurance, food/drink, etc. When all else fails & the patient is a danger to himself or others, violent, inflicting self harm with severe intent; in these situations mechanical restraint becomes necessary. Even then it is for the least amount of time as possible with very close & careful monitoring during the process. In our facillity the only people able to decide about utilizing mechanical restraints would be an MD or an RN. One, the other or both must be present during the application to ensure correctness, circulation, etc. I had to really smile about the comment of 8 people sitting o a bucking, violent patient trying to hold him down & wondering about if restraint is necessary...lol. Been there, done that, care to avoid it when possible but alas it still happens

God I am SOOOOOO glad to be out for the entire summer for maternity leave. These sorts of topics remind me why I will not miss my job for the summer, hehe but will enjoy playing stay at home mom for a short time *sigh* What is it about the psychotic men that they must threaten the pregnant lady??? I am glad to be away from that at least.

Lawnurse · Mar 30, 2005

Where does confinement to a "quiet room" come in?

That is one thing they DID have where I did my rotation. Do most psych floors have these?

When would you use restraints instead of a quiet room?