Crisis Management: Physical Restraint

Crisis management: Physical restraint a. Case A 38 year old male patient was taken this afternoon by his family to the emergency room at the Mental Hospital because he was throwing a tantrum and throwing things around. While in the emergency room, the patient struggled, tried to hit the health worker and tried to run away. You as a nurse who is currently practicing in the emergency room with 2 fellow nurses will apply restraint to the patient. b. Material review Crisis managementis an emergency situation for patients suffering from mental disorders. On average, patients who fall into the critical management category are patients who experience an unstable condition, which occurs in new patients, patients who experience weakness, patients whose therapeutic regimens are ineffective, patients who run amok, patients who are noisy, anxious, patients who have broken down and several other causes. 1) Signs and symptoms - The patient paces back and forth - Cold and sharp eyes - The patient has difficulty sleeping - The patient disturbs other people - The patient is screaming - The patient hits objects or the bed - The patient creates a noisy atmosphere - Patient refuses instructions - Patients attack other patients, attack nurses or other health workers 2) The role of nurses in crisis situations - Medical collaboration in administering medication - Administer psychopharmaceuticals according to orders - Apply restraint - Critical management - Considerations for doing ECT - Environmental management - Give instructions to other patients regarding critical patient conditions - Monitoring the patient's condition Several considerations in carrying out critical management - Safety of other patients - Patient's own safety - Safety of health workers - Environmental safety - Family/community safety (if in the community) RestrainIn psychiatry, it generally refers to a form of action to restrain or limit the movements of individuals who behave uncontrollably with the aim of providing the individual's physical and psychological safety. Physical restraints include the use of mechanical restraints, such as cuffs for the wrists and ankles, binding hooks, as well as seclusion, namely confining the patient to one room so that he does not leave at will. Mechanical restraint is the last alternative intervention if alternative verbal and chemical restraints fail. In this mental nursing practicum, students will be taught how to perform physical restraints, especially mechanical restraints. Types of mechanical restraint include (1) camisole/restraint clothing, (2) restraint by fixing the wrists and ankles, and (3) cloth binding. Indication - Violent behavior that endangers patients or other people - Agitation behavior that cannot be controlled with medication - Threats to physical integrity related to the patient's refusal to rest or eat and drink - The patient's request for external behavioral control, which is done because it has been assessed and has therapeutic indications Things that are important to pay attention to in restraint - In emergency conditions, restraint/seclusion can be done without a doctor's order - As soon as possible <1 hour after carrying out training/incision, the nurse reports to the doctor to obtain the legality of the action both verbally and in writing - Renstrain intervention is limited to 4 hours for patients aged > 18 years, 2 hours for aged 9-17 years - Evaluation is carried out every 4 hours for patients > 17 years, every 2 hours for patients < 18 years - The minimum time for an evaluation to be carried out by a doctor is once every 8 hours for a patient > 17 years, once every 4 hours for patients < 18 years - Restraints are not allowed for more than 24 hours - During restraint, the patient is observed for 10-15 minutes at a time with focus; - Physical signs related to physical restraint injury - Patient environmental safety - Nutrition and hydration - Circulation and range of motion of extremities - Vital sign - Hygine and elimination - Physical and psychological status - Patient readiness to be released from restraints Physical restraint tools and materials - Camisole/restraint - Wrist cuff - Ankle cuff - Cloth/strap - Pads to protect protruding bones - Place for restraint (chair or bed) Purpose of restraint - Helping patients control emotions that can harm the patient or others - Reduces the possibility of disturbance to the physical environment - Prevent patient injury due to falls - Prevent the behavior of leaving the hospital without the permission of health workers (running away and running away)