Question

[CliveUK]

Am I right in thinking that, over there in North America, you sometimes use physical restraints (leather straps and the like) to control violent behaviour? If I am right, I'd like to know what your thoughts are about them, as I was debating this with some people the other day. Over here, it's four man restraint teams and medication. I was arguing that maybe there's some value in physical methods of restraint as opposed to chemical restraint, in that the physical restraint is over when it's over, whereas meds can hang around in the system for days, causing side-effects and what have you.

I'd appreciate an American perspective on this.

Thanks,

Clive

[sjoe]

Frank--interesting THEORIES you have. So what happens when you are working a forensics psych ward with 25 male patients, several of whom are relatively easily triggered, one assaults another and they begin fist-fighting, throwing chairs, etc. And the staff consists of you (an RN) and ONE aide to help out. Several of the patients are now "getting high" on adrenaline, shouting, beginnning to get into each others' spaces, etc.

Duh!

If you can, you grab the major troublemaker and put him in restraints, then the next one, etc. until things calm down. If you need more help temporarily to do this, be aware that this "help" might take 15 or more minutes to arrive.

Whether restraining or decking "bothers you" is beside the point. It might bother you a lot more to have your two front teeth punched out (as happened to one of my co-workers) in a similar situation. Fortunately, this was just before shift change, so while I was wrestling with the chief assailant (I had to physically pull him off her as he was trying to twist her head off, literally), one of the new staff happened to come in and notice us. Together we wrestled him into restraints in a seclusion room.

So while your theories may sound "nice" and "humane," we are talking about the real world here, not a nursing school exercise. Liberal sentimentalism (as one of your own--Terry Eagleton terms it in his excellent and amusing "The Gatekeeper") is hardly a useful model when the rubber meets the road.

(Or perhaps the psych patients in the UK are better-mannered than some of ours.)

By the way, that facility's theory was (and perhaps still is, I don't know since I quit after that shift when they inappropriately blamed the injured nurse for this attack) that it "bothered them" to have these patients on high doses of psychotropics, so they were using minimal doses, or none at all. (Of course, these decison-makers were not around to put out the fires their policy caused. Surprise!)

[sbic56, BSN, RN]

Interesting thread. I wonder how much our unique cultures have to do with the way we treat our psych patients? I bet there is a significant influence.

[CliveUK]

I am a fluffy bunny nurse - make no mistake about that, but personally, I have no problem with sensitively-used restraint techniques. I have found that in some cases, being held by nurses has actually been therapeutic for people.

However, there are the odd few macho nurses (male AND female) who love a "bit of action", and that disturbs me.

Walking off the energy would be infinitely better, but sadly, when resources are few, this isn't an option. Also, it doesn't help when you have to give someone medication against their will, and they are determined to fight you all the way.

[sjoe]

Clive--Many of our basic values are much the same. However, since the economic models and social/political foundations of our healthcare systems are much different, we can only expect substantial differences in actual practice.

Since US psych patients don't tend to vote in large numbers and don't tend to have high incomes or substantial political influence (perhaps that last item is simply redundant), their healthcare resources tend to be something less than substantial (or even adequate).

As your system now is encountering increasing financial problems, we may well find increasing similarities in treatment between our two systems. (Forgive me if I, for convenience here, refer to the US healthcare industry as a "system," as it is anything but that.)

In either case, my advice is: DON'T be a patient if you can help it.

Best wishes.

[Nurse Ratched, RN]

Sometimes there is no other alternative, altho the trauma to pt and staff, not to mention the extreme paperwork involved, certainly makes it the last option.

I have written up a doc who refused to come in as required by policy in an hour to visually assess the newly restrained pt. He told us to control the pt in some other way that didn't require him getting out of bed at 2am. Sorry - violent, assaultive pts with a skeleton crew on night shift get restrained and if that interrupts the doc'd sleep, he needs to find another line of work.

[maureeno]

what I wish would be to have available a safe seclusion room; no hard corners, no closets, padded surfaces. the design of our unit works against us.

[sanakruz, ADN]

Hey iknow this thread is old but...

There was a psych hosp. in CT. that was well renowned (forget the name) where they used body bags. The individual was kept in the line of sight of all, other pts included. Resistance was futile,basicly. I have never seen these used elsewhere. I'm guessing there was an inherent problem with them. Anybody see this as an option/not

[mumseyllama]

I worked in a hospital in CT that used body bags. We did a good job with them although the patient really needs 1:1 observation due to potential for asphyxiation. They can get out too if they're small enough (really).

My last 2 hospitals haven't used them. We don't really need them with 4 points and chemical restraints. And we send violent, acting out types to the state hospital within 24 hours. They're incredibly dangerous but with some of the situations y'all seem to be facing out there one has to keep unit safety in consideration.

[the new girl]

I'm the poor stiff who gets them when you send them to the state hospital! LOL. We use Full belt canvas and/or leather restraints. The reason I mention both is because depending on the situation, and where it occurs, we may need to walk the patient to a bed, or we may be able to bring the bed to them. When they are safely placed in full belt restraints in the bed, a chest posey is usually applied if they are out of control, to keep their upper torso stabalized. This is removed as soon as we feel they are not a threat to themselves (thrashing about) We also use chemical restraints with mechanical restraints, although, most of the time, I have already intervened and given the patient a p.o. prn of some kind to assist them in settling prior to them escalating to restraints. If we still feel the need for an IM injection, Ativan & Haldol (the "cocktail") and Thorazine are common drugs of choice.

Another Note: NEVER NEVER NEVER DO WE LAY ANYONE FACE DOWN IN RESTRAINTS!