Specific Behaviors that Justify Seclusion/Restraint

[kurlos]

Hi, I'm new to inpatient psychiatry, and the recommendations for using seclusion or restraint are vague. Usually, its to prevent "imminent" harm to self or others. I'd like someone to describe specific behaviors which indicate that you, the RN, are observing imminent harm.

Some possibilities:

Holding up a chair

Threatening to throw feces

Any verbal threat--"I'm going to hit you."

And what about after the fact? If someone has punched a person or wall, but then appear relatively calm, does that warrant S/R?

I am unable to find specific descriptions of behaviors. Thanks in advance.

[Davey Do]

Good question, kurlos.

I believe "imminent" is the key word here. "Likely to occur at any moment" is a suitable definition. However, the likeliness of an occurrence can be interpretted differently by different individuals.

You gave some good examples. These actions are a likelihood of a threat of harm. However, each of these situations could be dealt with through other means than the application of restraints. All these patients could: be talked down, cease their activity, and commit to safety.

Restraints are a last resort and are applied when no other method utilized will stop the agitated individual from their course of action.

In your final example, the individual "appears calm", in that, they are no longer a threat of harm. To apply restraints, or enforce seclusion, could be interpretted as a punitive action. This action would be outside of the accepted guidelines and be subject to scrutiny.

Dave

[7student7]

You should never restrain after the fact or as a punishment. Seclusion is less restrictive but inappropriate for any patient with self-harm precautions. Specific reasons I've seen for seclusion/restraint:

Court ordered forced medication that the patient refuses - only requires holding someone down for a minute for the injection.

Self-harm: ripping open old wounds or repeatedly banging their head against something.

Violence: If two patients got in a small fight they might be restricted from smoking or activities.

If they continue to escalate we might send someone to the seclusion room (sometimes locked, sometimes not).

Unstoppable violence: S/R might occur if the patient is psychotic and truly believes they must attack someone. For example, a patient once threatened and chased a staff member out of the room. He was mixing her up with an abusive family member. He went in restraints only because he would not stop chasing her and also needed an injection - not as a punishment. Make sure threats are real - don't restrain for bluffing and showing off.

Remember, restraints are always the last resort! Logically, it just isn't all that useful for changing behavior, but more than that it's just plain unethical to do something so undignified to a person without good reason. There's almost always an alternative.