Seclusion brainstorm help

[Jules A, MSN]

Would you mind sharing your thoughts on seclusion and your opinion of your facility's policy regarding seclusion? I do child/adolescent psych and really try to avoid it, least restrictive environment, unless the kid is totally combative and continuing to try and injure staff. If they will take a PO or I give them a IM and they will remain in the safe room with the door open and staff observing I prefer that over locking the door because many of my kids are prone to self-injury and I don't feel it is safe.

There are a couple of techs that would like me to seclude more often and I would like to hear other opinions. Their thoughts are that doing a seclusion and IM upon the first meltdown will prevent a second one later in the shift. I know that with each incident comes the risk of harm to the PT, Peers or Staff and I definitely want to keep staff safe and don't want to make my Tech's job harder but also need to consider my patient's needs/rights. Thanks in advance for your insights.

[justpoorfect]

Wow, sounds like your problem is similar to my own! I work at an adult facility (98% forensic) and I have a tech on my shift who is chomping at the bit for me to seclude any antisocial that pushes her buttons. (She has one in mind in particular.) I know she just dreams of us getting a solitary confinement space where only she holds the key!

My own education emphasized seclusion and restraint as a last resort, and so far I have stuck to that mantra...but it irks her no end. So, as the new nurse, I must suffer the endless write-ups she gives to my superiors about how I do too much talking to the patient, and never enough discipline.

When she is not on duty, nights go very smoothly and with so much less tension it is like a vacation.

Good luck with your situation.

[little black cat]

Those techs work under YOUR supervision, your nursing judgment, and your license. I say this as someone who has worked both as a tech and presently as an R.N. Seclusion of a particular resident is not for staff convenience. As long as our residents(adolescents) are not presenting a major disruption to the unit, and are safe to themselves and others, though they may request a timeout in the quiet room, they are NOT placed in seclusion unless they cross the designated point and attempt to exit the quiet room. I agree that sometimes you need to go straight to the IM, but as a first resort and snowing them does not enable them to work their treatment. It goes without saying that it is not unusual for a resident "to throw a code" in order to receive the PRN in order to do so. But my education and my facility emphasize the least restrictive environment as well.

[aloevera]

We use seclusion/restraints as a last resort....on adolescent unit we may have to put them in the Quiet Room but we can never close the door...it must remain open....they must be in the nurses line of sight at all times....usually one night of this and they come around and are able to join the group...on my adult unit we generally medicate when escalating but if need be we have a quiet room there also...we can close the door but have camera watching them...

[aloevera]

Wow, sounds like your problem is similar to my own! I work at an adult facility (98% forensic) and I have a tech on my shift who is chomping at the bit for me to seclude any antisocial that pushes her buttons. (She has one in mind in particular.) I know she just dreams of us getting a solitary confinement space where only she holds the key!

My own education emphasized seclusion and restraint as a last resort, and so far I have stuck to that mantra...but it irks her no end. So, as the new nurse, I must suffer the endless write-ups she gives to my superiors about how I do too much talking to the patient, and never enough discipline.

When she is not on duty, nights go very smoothly and with so much less tension it is like a vacation.

Good luck with your situation.

I have a MHT similiar to yours....she seems to try to get a pt. going just to get them medicated/isolated....many of us have tried to talk to her re: this but nothing ever changes....it seems adm. is aware but does nothing...possibly because we are under staffed??? could very well be..