||[Jul. 10th, 2007|05:05 pm]
There were two patients at the psych ward i work at in 4 point restraints today.. all the screaming..crying.. it was just too much for me and i broke down in tears. =(. i agreed that the restraints were necessary to prevent violence, but so much fricken suffering =(.
what do you guys think about restraints?.. i believe they are a necessary evil. and how do you emotionally deal with 1:1 these people while in restraints.. it was so hard not to talk to them and be nurturing.
it is times like this where i begin to question my future career in psych nursing =(.
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.