Restraint Types
Three types of restraints that are used in the inpatient psychiatric setting to help manage or prevent harmful behavior
Physical, chemical, environmental
Patients should be encouraged to use these when they are having difficulty regaining control
coping skills
Risk associated with the use of seclusion and restraints
PTSD, decreased trust, injury, death
Two clinical justifications for seclusion and restraint use
Patient is a danger to themselves, patient is a danger to others
The maximum length of time that a 12-year-old patient can remain in seclusion or restraints
2 hours
You give the patient sedating medication to prevent the patient from harming others
Chemical restraint
Practicing this coping skill can help patients regain control during acute distress episodes and prevent the need for restrictive interventions
Deep breathing exercise
The first intervention to prevent harm when patients become increasingly agitated
Least restrictive intervention
Clinical justification for the use of restraints on a patient attempting to cut themselves
Danger to self
The maximum length of time that an 8 year old can be in restraints
1 hour
You close the quiet room door to prevent the patient from harming others
Environmental Restraint
Two nursing responsibility during a four point restraint event
Staying with the patient. Assessing patient vitals
Repositioning the patient as needed
Checking circulation. Assessing patient needs such as need for food, fluids, and toileting
A patient became very upset when she found out she would not be discharged today and attempted to kick and bite staff, requiring staff to hold her down and give her emergency sedating medications.
Physical restraint and chemical restraint
Clinical justification for the use of restraints on a patient attempting to hit peers
Danger to others
The maximum length of time a 50-year-old patient can be secluded
4 hours
A patient is attempting to hit staff by throwing objects. Staff has attempted to de-escalate the patient, but the patient is only getting increasingly agitated. As a team you decide that the best approach for the patient is time in the seclusion room to help the patient regain control and prevent harm to others.
Environmental restraint
Two ways to reduce the use of seclusion and restraints
Providing a space with decreased stimuli, advocating for patient concerns, assessing patient's stressors and guiding patients to develop coping skills
TRUE OR FALSE: You are caring for a patient who is attempting to self-harm with a paint brush during an occupational therapy session. The nurse talks to the patient and assists them in regaining control by practicing deep breathing exercises. The patient returns the paint brush to the nurse and walks back to their room. The nurse can initiate seclusion for this patient to prevent the situation from occurring again?
False
The name of the code that should be called for an aggressive or combative patient
Code gray or code white (depends on the hospital)
You are a nurse caring for a patient who is currently in seclusion due to being an imminent danger to others. As the nurse you must document every _________ minutes to ensure adequate patient observation.
Every 15 minutes