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Discussion

Question regarding psych nurses.. problem

So, right now I am furious with the psych nursing staff at a local hospital. My grandmother was admitted to a psych unit because she had a change in mental status r/t no sleep. The only way they could get her an appointment with a psychiatrist was to admit her there. Well anyway, in the middle of the night my grandmother gets up to go to the bathroom and accidentially hits the fire alarm. Well the nurse on duty at night came in there and told her she was sick and tired of dealing with her and that she was keeping everyone awake. So the nurse made the decision to restrain her with wrist restraints into a chair. Keep in mind my grandmother just had spinal surgery r/t 2 spinal fractures. Forced her into the bed with 3 people and now my grandmother is in so much pain. We took her AMA because the tx she was receiving was not appropriate. What do you guys think about this situation? Am I in the right to be furiated with the nursing staff?

Thanks a lot.

Kris, SN

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First off let me say I am sorry for your situation. Now as for your grandmother being in restraints there has to be documented cause as to why. For someone to be in restraints they have to be a harm to themself or to others, so I would get all the facts first. I'm not quite sure why she needed to see a psychiatrist for a change in ms r/t sleep. You normally don't get admitted to a psych hospital for sleeping issues, so I'm some what confused.

I would get a copy of the medical records and see exactly what happen. If your grandmother is having ms changes she may not have told you exactly what happen but what she thinks happened.

I'm always reluctant to comment given only one side of a situation - however, I loathe the use of restraints - moreso with elderly - so I will break my rule.

Even if there was a clinical issue behind her behaviour - such as wandering or confusion - international standards proscribe "least restrictive" interventions. Any decision to use restraints needs to be well documented and clinically defensible.

I suspect they have a single sheet for such use and the 'standard' phrases will apply eg " increased danger to self or others".

I was also under the belief that restraints needed to be medically approved - tho I am no local expert on this so please check that out.

If they were concerned they should have incremented contingencies - like starting out on a 5-15 minute observational check - or specialling on 1:1.

Spending some time trying to find the underlying reasons for her behaviour would have been worth doing also - so I'd check notes to see if any attempts were made to identify and ameliorate such problems.

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