PSYCHIATRIC NURSING INTERVENTIONS

RESTRAINTS

PHYSICAL RESTRAINTS
Direct application of physical force to a person without his or her consent to restrict freedom or movement or access to ones body, material or equipment. Methods or devices attached to or adjacent to the clients body that cannot be easily removed

PHYSICAL RESTRAINTS
Physical force: human, mechanical or both
Human restraint: staff members physically control the client and moved him or her to seclusion room Mechanical restraint: devices, usually ankle and wrist restraints, fastened to the bed frame to curtail the clients physical aggression such as hitting, kicking and hair pulling

CHEMICAL RESTRAINTS
Medications used to restrict the clients freedom or movement or for emergency control of behavior, but not a standard treatment for the patients medical or psychiatric condition

SECLUSION
Involuntary confinement of a person in a specially constructed room equipped with a security window or camera for direct visual monitoring Goal: Give the client the opportunity to regain physical and emotional control

SECLUSION
Degrees of seclusion Confinement in a room with closed but unlocked door Confinement in a locked room with a mattress but no linens with limited opportunity for communication. Safety precautions Bed bolted to the floor and mattress Any sharp objects (pens, glass, belts, matches) removed from the room

SECLUSION
Advantages Containment: safe from harming self and others Isolation: distance from pathologically intense relationships that are brought about by the illness Decrease stimulation or sensory input: indicated for patient with heightened sensitivity to external stimulation. Prevents property destruction Provides privacy for the client

NURSING CONCERNS ON THE USE OF RESTRAINTS AND SECLUSION

Used only when the client is imminently aggressive and dangerous to self and others. Use of restraints and seclusion requires a physicians order, assessment by the nurse every 2 4 hours and close supervision of the client.
Physicians order maximum of 4 hours for adults, 2 hours for adolescents 9 17 y.o. and 1 hour for children under 9 y.o. Orders may be renewed for 24 hours before another face to face evaluation if necessary by a physician or licensed independent practitioner.

NURSING CONCERNS ON THE USE OF RESTRAINTS AND SECLUSION

The physician or other licensed independent practitioner evaluates the patients need for seclusion and/or restraint within 1 hour after the initiation of the intervention. Nurse assess the client for any injury and provides treatment as needed Checks the client in person at least every 10 15 minutes and may continuously monitor via video camera.

NURSING CONCERNS ON THE USE OF RESTRAINTS AND SECLUSION

Nurse monitors and documents the clients skin condition, blood circulation in hands and feet, and emotional wellbeing as well as the clients response to the procedure. Observe the client for side effects of medications, which may be given in large doses in emergency. Nurse implements and documents offers of food, fluids, and opportunities to use the bathroom per facility policies and procedures.

NURSING CONCERNS ON THE USE OF RESTRAINTS AND SECLUSION

As soon as possible, staff members must inform the client of the behavioral criteria that will be used to determine whether to decrease or end the use of restraints or seclusion.
Ability to verbalize feelings and concerns rationally Make no verbal threats Have decreased muscle tension States ability to be in control

NURSING CONCERNS ON THE USE OF RESTRAINTS AND SECLUSION

If a client is in restraint for 1 to 2 hours, two staff members can free a limb at a time for movement and exercise. Nurse offer support to the family, who may be angry or embarrasses when the client is restraint or secluded. Careful and thorough explanation about the clients behavior and subsequent use of restraint or seclusion is important. For adult clients: a release of information must be secured before the discussion. For children, no consent is needed to inform the parents.