I know how you feel...I can't stand seeing patients in restraints, either. But what I try to remind myself is that it is for both the patient's and others' safety. If I have a patient on restraints, I just try to check up on him as much as possible to make sure he is safe, etc. I also use this time to reassure the patient why he/she is being restrained ("this is for your safety")
=( yeah. at the VA, it is required to have 1:1 sitter per restrained patient. i did try and reassure, but i was told not to continously hold conversation as it would be 'negative reinforcement'
2007-07-12 02:41 pm (UTC)
Mmmm I have to appologize, I didn't really see your question about 1:1-- I'm pretty blind when I hear the word restraints. I'm sorry. From what I have observed, there is no communication whatsoever except during tightness checks and to assess whether the person is calming down enough to remove them. I think the calming down period with little stimulation would probably be helpful for people-- I just wish they didn't have to be restrained to do it.
i was told that the constant reassurance was negative reinforcement.. possibly reinforcing bad behavior with extra attention.. i definitely did give reassurance, but was told not to just stand there and hold continuous conversation. and they were in seclusion to prevent violence. the guy threw a table and threatened to hurt a nurse.. and the woman refused to stop slamming her head into a wall.
Why were you meant to not talk to them?
i was told that the constant reassurance was negative reinforcement.. possibly reinforcing bad behavior with extra attention.. i definitely did give reassurance, but was told not to just stand there and hold continuous conversation.
I have posted my thoughts on restraints in my personal journal. Basically I don't think they're necessary if the unit has the proper facilities in place. Most don't, restraints are cheap.
in this situation, the guy threw a table and threatened to hurt a nurse.. and the woman refused to stop slamming her head into a wall. and they couldnt be talked down. i was told that restraints are rarely used in the facility, but this was an anomaly. =( but i did hate it.
There are facilities that have zero restraint policies. I've read a fair bit of research on restraints and seclusion and I believe it is NEVER necessary to use 4 point restraints if the facility is prepared and if nurses are trained in deescalation. The woman could have been helped by having a padded quiet room (no bodily injury could be done). The man who threatened to hurt a nurse and threw a table could have been handled in a lot of different ways as well (constant obs, quiet room, earlier intervention-- what happened before he threw the table and threatened the nurse?). They don't use 4-points in jails so why do we use them in health care?
i cant answer those questions.. a padded room would be a good idea, but we dont have one. and i wasnt there when the man escalated. I just know that i wouldnt want to take the risk of getting hit by a table. whether we could have been better prepared is a question i cant answer, but at that moment, with our current resources, i believe it was necessary.. but i do agree that if possible, it is much better not to use them.
as a student nurse extern, im required to do a research project on possible ways to improve the ward. I am curious about your belief that restraints are never necessary. I have never seen a true padded room; have you worked with them? Do you have any research supporting the efficacy of padded rooms versus restraints? maybe the administrators would listen? everyone there hates using the restraints.. i could see it in everyone's eyes.
There is a lot of research out there on restraints and seclusion. You should check the journals your school offers.
Here are a few to get you started • Dix, R. & Betterridge, C. (2001). Seclusion. In D. Beer, S.M. Pereira, C. Paton (Eds.) Psychiatric Intensive Care (pp. 133-155). Greenwich: London
• Johnson, M.E., & Hauser, P. (2001). The Practices of Expert Psychiatric Nurses: Accompanying the Patient to a Calmer Personal Space. Issues in Mental Health Nursing, 22, 651-668.
• Polczyk-Przybyla, M., & Morahan, T. (2001). The use of restraint. In D. Beer, S.M. Pereira, C. Paton (Eds.) Psychiatric Intensive Care (pp. 158-168). Greenwich: London.
I have post traumatic stress disorder. I was placed in 4 point restraints, chemically restrained and placed in a lock down room all because I pulled a fire alarm cover during a dissociative state. The restraints were taken off me 4 hours later and I was left in a lock down room for 7 days. No food, water or access to bathroom facilities were provided. I do not feel that this was reasonable because I have never been harmful to myself or others unless it's been in self defense. Also I have post traumatic stress disorder because I was held hostage, raped and almost murdered. Psychologically can you understand how harmful it was to be restrained to that degree by the caregivers that were suppose to help me. It's a year later and those 7 days still effect me each and everyday.
In some situations it is reasonable by all means. If a person had attempted suicide, threatens with a weapon, was outwardly physical aggressive without provocation it would be reasonable for a short time....exceeding 48hrs is excessive.
2007-08-12 09:44 pm (UTC)
im really sorry all of that happened to you =(. If i work in the field, i would NEVER stand and do nothing if someone was treated like that.