Restraints are currently used as a last resort measure when psychiatric patients are at severe risk of harm to themselves or others. Many procedures must be followed once a patient is restrained. Legal paperwork such as restriction of rights’ documents must be filed that explain what methods were used to restrain the patient (mechanical restraints, medication, or seclusion), and the criteria for restraining the patient. Within fifteen minutes of a patient being restrained, an order must be obtained from the physician. A new treatment plan must be initiated that declares the patient as an imminent risk of harm to self or others. While a patient is restrained, 15-minute documentation is required. During 15 minute checks, patients must be assessed for comfort, circulation, neurological state, skin integrity, and behaviors. Patients must be offered/provided toileting, comfort measures, education, food, and readiness for discontinuation. Within an hour of a patient being restrained, a physician must perform a “face-to-face” assessment of the patient to ensure the patient is in good shape.
Restraints should be discontinued as soon as patients resolve behaviors and no longer presents as harm to themselves or others. Within twenty-four hours of a patients’ restraints being discontinued, mental health staff provides patients with a survey about their restraint experience to assess what measures could have been taken to improve their restraint experience. All staff that participated in restraining the patients attend a debriefing session. During that meeting, they discuss preventative measures to avoid restraining patients in the future. Many patients view being restrained as a traumatic experience. Using de-escalation techniques when patients present with aggressive behaviors will help avoid restraining patients.
De-Escalation is defined as “talking with an angry or agitated service user in such a way that violence is averted and the person regains a sense of calm and self‐control” (Spencer & Johnson, 2016; p.2). In the mental healthcare sector, various talk-down and de-escalation techniques are employed in diffusing the aggressive behavior by the patient. Some recognized de-escalation techniques include verbal and non-verbal strategies and stature. The verbal techniques include the use of a calming tone, which may guide the patient to a calmer personal space. The non-verbal techniques include personal safety, self-awareness, eye contact, and an appropriate body stance. In practice, however, there is quite scanty scientific backing supporting the use of these de-escalation techniques in the mental health sector (Price & Baker, 2012; Spencer & Johnson, 2016).
In hospitalized psychiatric patients (Population of patients), how does the use of restraints (Intervention) compared to de-escalation techniques (Comparison) decrease aggression (Outcome) during hospitalization (Time)? (Appendix 1, check for Intervention-based question).
