Seclusion and Restraint PDF

Restrain and Seclusion Prepared by Dr.Araz Mohammed Abdulkarim MSc , PhD Mental Health 1  Restraints Restraint: This involves restricting a person's freedom of movement or...

Restrain and Seclusion Prepared by Dr.Araz Mohammed Abdulkarim MSc , PhD Mental Health 1  Restraints Restraint: This involves restricting a person's freedom of movement or physical activity. Restraints can be physical (e.g., wrist or ankle restraints) or chemical (e.g., sedative medications). Physical restraints may involve the use of devices or equipment to limit a person's ability to move freely. 2  Seclusion Seclusion: This refers to the involuntary confinement of a person alone in a room or an area from which they are physically prevented from leaving. Seclusion is typically used in situations where the person's behavior poses an imminent risk to themselves or others. 3  Importance of the Topic in Psychiatric Nursing □ Patient Safety: The primary goal of using restraint and seclusion is to ensure the safety of patients and others in the healthcare environment. Psychiatric nurses need to be well-versed in when and how to appropriately implement these interventions to prevent harm. □ Legal and Ethical Considerations: There are legal and ethical implications associated with the use of restraint and seclusion. Psychiatric nurses must be aware of and adhere to relevant laws, regulations, and ethical guidelines to protect the rights and dignity of the individuals under their care. 4 □ Effective Communication and De-escalation: Psychiatric nurses play a crucial role in de-escalating challenging situations. Understanding alternative strategies to restraint and seclusion, such as effective communication and de-escalation techniques, empowers nurses to manage crises in a therapeutic and compassionate manner. □ Minimizing Trauma: Improper use of restraint and seclusion can lead to physical and emotional trauma for patients. Psychiatric nurses should be trained to minimize the potential negative impact of these interventions and prioritize less restrictive alternatives whenever possible. 5  Types of Restrain 1. Physical Restraints: Physical restraints involve the use of devices or equipment to limit an individual's freedom of movement or physical activity. Examples: Wrist restraints, Ankle restraints, Mittens, Belt or body restraints Purpose:To prevent harm to the individual or others by restricting movement in situations where less restrictive interventions are not feasible. Guidelines for Use:Should only be used when absolutely necessary. Regular monitoring and assessment to prevent complications 6 2. Chemical Restraints: Chemical restraints involve the use of medications to control behavior, typically through sedation. Examples: Antipsychotic medications, Benzodiazepines, Sedative-hypnotics Purpose: To manage acute agitation or aggression when non-pharmacological interventions are insufficient or not possible. Guidelines for Use: 1. Informed consent whenever possible 2. Regular assessment for side effects and effectiveness 3. Close monitoring for adverse reactions 7  3. Mechanical Restraints: Mechanical restraints involve the use of devices or equipment to restrict movement, similar to physical restraints, but with a focus on non-body attachments. Examples: Posey vests, Limb holders, Bedrails, Chairs with restraints Purpose: To prevent the individual from harming themselves or others or to assist with medical procedures. Guidelines for Use: 1. Should only be used as a last resort 2. Continuous monitoring to ensure safety and prevent complications 8 9 Physical Restrain 10 RESTRAINT CHAIR Type of Mechanical Restraint Indications for Restraint and Seclusion 1. Specific Situations: Aggressive or Violent Behavior: Instances where an individual poses a threat of harm to themselves, other patients, or healthcare staff through physical aggression. Risk of Self-Harm:When there is an immediate risk of self-injury, and less restrictive interventions have proven ineffective or are not feasible. Impaired Decision-Making: Situations where an individual is unable to make rational decisions about their safety or the safety of others due to a mental health crisis. Medical Emergencies: In certain medical emergencies where the individual's behavior may hinder necessary medical interventions, such as during a seizure. 12  Patient Rights Overview of Patient Rights Related to Restraint and Seclusion 1.Dignity and Respect: Emphasize the fundamental right of patients to be treated with dignity and respect, even in situations involving restraint or seclusion. 2.Informed Consent:Explanation that individuals have the right to be informed about the reasons for and potential risks of restraint or seclusion whenever possible. 3.The Least Restrictive Alternative:Highlight the principle that patients have the right to receive care that is the least restrictive alternative to meet their needs. 4.Participation in Care Planning: Emphasize the importance of involving patients in the development of their care plans, including discussions about the use of restraint or seclusion. 13 5. Communication Access: Acknowledge the right of patients to have access to effective communication, which may include language interpretation or communication aids. 6. Privacy and Confidentiality: Reinforce the patient's right to privacy and confidentiality, even in situations where restraint or seclusion is necessary. 14 15  There are many potential risks and side effects of restrain use: Psychological/Emotional : 1. Increased agitation ,honesty, aggression and combativeness. 2. Feelings of humiliation, loss of dignity. 3. Increased confusion. 4. Fear. 16  Physical: 1.Pressure ulcer, skin trauma (lears, cuts, bruises). 2.Bone loss (deminerazation) from decreased weight bearing activity. 3.Decreased muscle mass, lone, strength, endurance. 4.Deconditioning leads to stiffness, contracture, loss of balance increased risk of falls. 5.Physical discomfort increase pain. 6.Increased constipation, increased risk of fecal impaction. 7.Obstructed and increased circulation. 8.Reduced appetite. 9.Dehydration. 10.Death. 17  During Restrain should : Offer bedpan or bath room every two hours. Offer fluids and nourishment, frequently , keep water within reach. Provide diversional activity. decreased stimuli and noise. Provide change of position, and ambulation. Activate bed alarm. Increased observation. - Ask family to set with patient. - Alert other staff to be observant. - Move the patient to room near the nurse station. 18 19 20