The Kinder Gentler Psych Unit

TitaniaSidhe · Mar 2, 2006

Nice in theory however there will inevitably arise a crisis situation & unfortunately no restraints ever is a somewhat unrealistic goal( unless you have some other unit that will utilize restraints that you can transfer the patient to in your facility). Now minimal restraint usage is admirable however one must have alternatives & choices avaliable & in place. Our unit has swung in this direction & we have greatly reduced our use of leather restraints, we do however still make use of chemical restraint as one of the end line alternatives prior to mechanical restraint.

GooeyRN, ADN, BSN, CNA, LPN, RN · Mar 2, 2006

I like the idea of less use of restraints, but not restraint free. I saw a lot of self biting, but never someone who gauged their own eyes out!! I hope you didn't have to witness that! Im just curious, did they have remorse afterwards?

Nanaie4ever · Mar 3, 2006

This does sound great in theory however I have the same concerns of the above posters. One hospital I worked with decided after hiring a lot of new nurses and giving us a lot of really exceptional training, was able to see a 70% reduction in restraints in 1 year. It was exceptional as I said. Was also one of the best jobs I ever had.

I'm curious as to what area of the usa you are in? Would you be willing to say where you are from?

Wishing you and your unit the very best with this process.

Teh

student4ever · Mar 3, 2006

This does sound great in theory however I have the same concerns of the above posters. One hospital I worked with decided after hiring a lot of new nurses and giving us a lot of really exceptional training, was able to see a 70% reduction in restraints in 1 year. It was exceptional as I said. Was also one of the best jobs I ever had.
I'm curious as to what area of the usa you are in? Would you be willing to say where you are from?
Wishing you and your unit the very best with this process.
Teh

I think that bringing the level of restrain usage down is a great idea, as it makes you think very closely about whether the restraints you do use is truly appropriate, or just what's easiest. However, I do not think that total banishment of restraints (Chemical as well as physical) is appropriate in any facility, particularly hospital wide. I work ED, and there are many times when patients are so confused be it from a traumatic head injury or a severe case of dementia that they are potentially (and sometimes actually) harmful to staff and/or themselves and their treatment. I have yet to see the leather 4 points used on a patient in my facility. We have them, but usually use a posey vest or the soft cuff for hands first, and if they still present a threat, feet as well. imagine a trauma pt. getting a rapid infusion of blood pulling out the IV, exposing staff to blood/body fluids as the blood spurts everywhere, and causing themself to bleed out the blood they so desperately need as the 16guage IV leaves quite a big hole in the skin when pulled out! Also imagine the psych patient who has violence issues trying to choke staff to death, or another patient. I cannot imagine that a facility could ever feasibly go completely restraint free. I think it would potentially be VERY harmful to others, as well as the patient, and that would cause liability problems as they are under the facility's care.

Orca, ADN, ASN, RN · Mar 6, 2006

I worked on a restraint-free unit. It's a great theory, but there are situations in which restraints are the best recourse. Case in point: On a geropsych unit, I went to report. About midway through the report, I heard a page overhead for the code for a psychiatric emergency - on my own unit. I opened the door just in time to be shot in the face with a chemical fire extinguisher, which an out-of-control patient had ripped off the wall and was now spraying all over the unit. The house supervisor ordered the use of restraints.

In another facility, I had a patient who deliberately assaulted staff on a regular basis. His first action before going off was to reach over the desk and pull the telephone cord out of the wall so no one could call for help from another unit (we had no panic button). We had this patient in five-point leathers every day for almost six weeks - when he was finally removed from the facility.

Nanaie4ever · Mar 7, 2006

Hi Janelle: I did not mean to give the impression that I completely agree with restraint free units. I do think it is a great "idea". However, after 23 years in the psych/substance abuse field, I honestly do not think it will ever be possible. At the very least there has to be a level of protection for both the staff and the patients. Sometimes the only way to have that protection is thru mechanical restraints, be they leather or cloth, however I feel the cloth is less humiliating. The other means for protection is thru medication restraints. This is very important especially in areas which are not an actual psych unit. I have made many a "code" call to our ER when a psych pt is out of control and even the security has a hard time with psych patients. I wish most ER's employed at least 1 psych RN who could be there as the one to go to when a psych pt is admitted. I agree with you in most all of what you say! There really is no happy answer, because most of the people who end up needing the restraints of either kind are either the true psychotic, the true alcoholic in withdrawal, the true drug addict in w/d, and then there are the (Hate to use this word even) borderlines, the narcisists, the manipulative who just need to get as much attention as they can and will do anything to ensure they are the center of attendtion ( and being in restraints really puts them in the center of attention!! Good luck to you, enjoyed "chatting" with you. Enjoyed your input. Teh

Meerkat · Mar 12, 2006

I like the idea of less use of restraints, but not restraint free. I saw a lot of self biting, but never someone who gauged their own eyes out!! I hope you didn't have to witness that! Im just curious, did they have remorse afterwards?

Sorry for the delay in response. Nope, no remorse. He continues to self mutilate and get readmitted.

CharlieRN · Mar 19, 2006

Just a thought re restaint. There is a documented incidence of serious injury during restraint proceedures. This is no surprise. We all know what we are being forced to do has some risk to the client. What was recently pointed out to me is that there is also a documented incidence of staff injury. The rate of serious injury and death during or as a consequense of a restraint is twice as high for staff as it is for clients.