Posted by yxibow on September 27, 2006, at 1:57:02
In reply to Re: Suicide Attempts » yxibow, posted by SLS on September 27, 2006, at 1:19:10
> Hi.
>
> I was kept in restraints on several occasions during psychotic manic rages. No PCP. Involuntary. Not pretty.
>
>
> - ScottI was using PCP as a violent example, but hospitals are in their realm to use restraints if they feel they and the patient are endangered in a rage situation.
Nonetheless I feel sympathetic towards you. Its not pleasant for the patient and if the psychiatric nurses have any empathy in them, its not a job they really would prefer to do. I understand its a time you don't want to remember and I will recount a time I don't want to remember (no restraints, just practices.)
I was in an unnamed tier 1 psychiatric facility with a fairly good reputation voluntarily for extreme OCD. Besides the sheer boredom of being in a place for 2 1/2 months (although they take people out on guided walks in the area), I was to reduce my shower time. There was an episode where large people of a certain race were used to pull me out of the shower when I was almost done. I felt both violated as I was forcibly removed from an area normally expected of some privacy naked, and "unclean" all over again as I was touched and the whole showering compulsion was "ruined." I was in the adult facility as a near adult minor because my intelligence and demeanor was felt to be coexistant with the adult population. I ran away (the door is open, but I was a minor) and when I came home my parents took me back and I was on a 72 hour hold on "the other side". Even more boring and mildly scary but uneventful. I was returned back to the unlocked ward. In retrospect, I needed definite treatment, but the "big men" could have been instructed to be more compassionate when I passed my shower reduction time.These days though restraints are used less than they used to unless of course as I was saying a out of some movie PCP rage scene. More humane approaches have been used in recent years, in the following articles, followed by JCAHOs position.
Psychiatric Quarterly, Springer NL, 76(1);51-65
"This paper describes the violence safety program instituted at Elmhurst Hospital Center in Queens, New York City in 2001, which significantly reduced the use of restraints and seclusion department wide, while providing a safe and therapeutic environment for patient recovery. The hospital service and program instituted is described, followed by restraint and seclusion data since 1998, and the programrsquos results through 2003. Concurrent data in areas that could be affected by a reduction in restraint and seclusion such as self-injurious behaviors and altercations; use of emergency medication; use of special observation and length of stay data are also presented. In addition, types and frequency of alternative methods utilized to avoid restraints and seclusion are described."
Psychiatr Serv 56:1105-1108, September 2005"Reliance on seclusion, restraint, and psychotropic PRN (as needed) medication for behavior management has been tied to a variety of untoward outcomes that detract from the quality of care in public psychiatric hospitals. A large body of evidence has accumulated to demonstrate that behavioral approaches to care can provide useful alternatives to reliance on seclusion, restraint, and psychotropic PRN medications. This article draws from the research to outline how behavioral approaches to psychiatric care can assist in realizing alternatives to these restrictive interventions. Strategies to assess the behavioral competence of direct care staff, improve it, and establish ward programmatic structures that facilitate competent behavioral applications are discussed as well as methods to enable expert consultation and demonstrate clinical and administrative support. These steps have had a positive impact in reducing reliance on seclusion, restraint and psychotropic PRN medication in the inpatient psychiatric setting. Given the wealth of supportive data to confirm the value of behavioral applications, there is no excuse for failing to aggressively pursue these options."
I can't actually post the whole articles as they require special access but the summary is fairly indicative of the articles in general.
This one has a whole articleAlternatives for Physical Restraint:
Myths and Truths about Physical Restraints; Including a Nursing Survey on Restraint PracticesThe University of Texas MD Anderson Cancer Center Restraints Improvement Group
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijanp/vol3n1/myths.xml
This is JCAHOs position
poster:yxibow
thread:689496
URL: http://www.dr-bob.org/babble/20060919/msgs/689528.html