Seclusion/restraint reduction

[kiwipsychnurse]

Hi, I looked around to find an active nursing forum and this one seems to have it all. Just joined up and look forward to becoming an member.

Work as an R.N in a forensic hospital in New Zealand. I'm a C & R (Control and restraint) instuctor.

At present there appears to a national push to reduce the amount and seclusion and restraint we use. Most of the reseach that is quoted comes from the states.

I have a C & R meeting next week and would love to hear from some other nurses out there that are invloved with restraint training/seclusion policy.

What seems to annoy me is that policy makers seem to think we like restaining people and putting them in seclusion rooms. For everyone I teach I stress its the last option after averything else has been exhusted.

For those of you that now work in low seclusion/low restraint environments, whats your secret.

Part of our education package is de-escalation and communication, but lets get real, you come accross a psychotic male, whom has extensive history of violence, is threatening violence and your de-escalation is going nowhere. What do you do?

Cheers all

Look forward to the replies.

[wonderbee, BSN, RN]

Our use of restraints has decreased dramatically. However talking down a psychotic individual bent on violence is just so much pie in the sky. With these individuals, when we see the first twinges of escalation, we bring out the PRNs. I haven't seen the use of physical restraints since I started working psych a couple of months ago. There was one patient who really needed to be in restraints who wasn't in our quest for being restraint free. The consequences were nearly fatal. This subject needs to be approached with common sense.

[klm06231947]

Greetings, I have worked in a state psych forensic unit for the past 12 yrs. The hosp I work at is trying to go src/restraint (whether physical or chemical)free. Staff injuries have increased- most of the pts have nothing to lose as they are already serving time for murder or other serious crimes.It's to the point were the pts are running the asylum. We can't keep staff on the forensic unit as it is so dangerous and we have no guidelines to follow. The supt. of the hosp. is a rec therapist and believes if we keep the pt's engaged everything will be okay, but he does not work front line with these pts.I'm sorry I feel if a pt can not regain control I have to regain control for them- I do not like src/restraints, but most times that's my only recourse to maintain safety.By the way this hosp. is located in Augusta, Maine.

[kiwipsychnurse]

This is good guys, the information you are providing.

I'm shocked to here a Rec officer is running the hospital, that would not happen here. Nurses run hospitals. Sounds like you need to make this a union issue with regards to use of restraint/seclusion and keeping everyone safe.

Chemical free!!! I'm shocked even more, what are these managers thinking.

I forwarded your response to my unit manger to look over, he is a realistic old time psych nurse who supports restraint/seclusion. He rescently went to a mangers meeting and they said that it will get to the point(no hands on/no secluison) that all we can do is "Stare down the patient"