Just posting this because there seems to be confusion about my views on restraints and seclusion. I am opposed to restraints and seclusion when it is not needed. However, when there is a clear and imminent danger to the service recipient or others, I highly support restraints and seclusion as a lifesaving measure, just like CPR for cardiac arrest. The commonality between CPR and restraints is that they are only used when necessary and all else fails, and are avoided when safe to do so
While restraint and seclusion are not ideal, they cannot be eliminated. However, they can be reduced by changing the culture in our facilities. When done appropriately, safely, and correctly, they can be lifesaving interventions.
For instance, if someone is banging their head and staff cannot stop them from doing so, they could go blind from detaching their retinas or suffer seizures or death from the neurological consequences of the behavior.
We need more trauma-informed care and safe and therapeutic crisis intervention.
Some service recipients find restraints and seclusion soothing. We need to teach these individuals other coping mechanisms that are more adaptive in the community that meet the same needs that restraints and seclusion are meeting.
We need to track and trend antecedents to these adverse events on a weekly, monthly, quarterly, and annual basis.
In my experience, nurses will restrain or seclude individuals they dislike more than those they like. Also, service recipients who “cause trouble” will be restrained or secluded for excessive periods. Nurses and staff sometimes purposefully escalate a crisis, so they have an excuse to use restraints and/or seclusion. This is unacceptable, inappropriate, and should be considered abuse.
Nurses should not be allowed to combine seclusion and restraints by locking the door to a room where someone is restrained and having staff watch them via a surveillance camera. This is unsafe, inappropriate, and potentially frightening for the restrained individual.
Until we wholeheartedly adopt the philosophies of psychiatric rehab, trauma-informed care, and person-centered treatment, we will continue to rely on restraints and seclusions. We need to try a different approach to crisis intervention, one that we are not used to. This is the only path to reducing and eliminating restraints and seclusion.
Restraints do not teach anyone new skills, and they are little more than a punishment for bad behavior.
Restraints and seclusion are traumatizing, both emotionally and physically. Service recipients can sustain serious physical injuries when restraints are used improperly, sometimes worse than the behavior that prompted restraints.
Nurses need to take the time to listen to service recipients about their thoughts and feelings regarding the incident. Restraints are especially harmful when the service recipients do not know why restraints or seclusion were used, and what to do next time to avoid a similar situation.
Centers for Medicare and Medicaid Services (CMS), The Joint Commission, CARF, and other accrediting bodies need to weigh in on the abuse and misuse of restraints and seclusion.
We need crisis teams comprised of peer specialists, nurses, psychologists, psychiatrists, therapists, and therapeutic security officers to help de-escalate crises, hopefully without restraints or seclusion. More peer support specialists are needed at a higher or equivalent ratio to the direct care staff.
In conclusion, restraints and seclusion should be a last resort intervention in a dangerous crisis. They should be thought of as a “treatment failure” rather than a “treatment intervention”; however, when needed, they should be available. It’s a tricky balance.
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