Nurse Restraint and Seclusion Controversies

¶ … Nurse Restraint and Seclusion Controversies The use of physical restraints and/or seclusion as a method for dealing with aggression and violence in-patient settings is controversial for a number of reasons. First, these "solutions" do not really address he issues at the heart of the violence, which might include severe psychological disturbance and/or dementia and a host if other environmental and individual factors; restraining or secluding patients keeps them from being a danger to others and possibly themselves, but does not actually address the aggression (Mohr 2008).

At times, restraints and seclusions can actually exacerbated psychological distress, and they are certainly general stressors for the body and the mind regardless of the underlying cause of the aggression (Mohr 2008).

At the same time, the physical safety of the aggressive patient and those around the patient must be the paramount consideration of any responsible medical facility and medical professional, and thus it is sometimes necessary to use restraints and/or seclusion when other options are not available or when they are not proving immediately effective and danger is imminent (Mohr 2008).

The problem with any use of these methods, however, as well as with pharmaceutical methods that effectively act as physical restraints themselves, is that it can become increasingly enticing to employ even when it is not absolutely necessary. All medical professionals must work to ensure that these options are only used when they are truly necessary for the safety of the patient and those around the patient (Mohr 2008).

Handling Aggression It is likely that all nurses, and especially those working in psychiatric care unites, will be confronted with aggressive and violent patients on a fairly regular basis, and for that reason it is necessary for nurses to be able to perceive when aggression is escalating and how to deal with aggressive clients. Signs that aggression might be escalating include an increased appearance of confusion or outright anger, and the emergence of conflicts with another client or complaints regarding another client's behavior or interpretation of the rules (Mohr 2008).

When this begins occurring, a compassionate and understanding communication with the client should be instigated in an attempt to ensure the client that they are understood and that they are allowed to present their own voice, opinions, and values in an atmosphere of safety and respect (Mohr 2008; Nursing Planet 2010). Early intervention when signs of escalating aggression are present can halt this escalation and keep the situation from becoming violent. When it becomes clear that violence is escalating past an acceptable point, there are several interventions that can be utilized.

Verbal intervention is the first thing to try, and can often be effective for many standard situations if it is approached with patience and true compassion and understanding (Mohr 2008). At the same time, keeping space between the person intervening and the aggressive client/patient is important in order to ensure everyone's safety as the situation progresses (Nursing Planet 2010). Verbal intervention is not always effective, however, and drug and physical interventions might be necessary for everyone's safety (Mohr 2008; Nursing Planet 2010).

Attitudes Towards Abusers and Victims It is very tempting to have feelings of nothing but anger, resentment, and disgust towards people who abuse others regardless of the situation, and in fact it can be very difficult to develop any other feelings towards such persons.

I have attempted to cultivate some measure of compassion for these people, as it is almost certain that their lives and specific experiences have been largely negative and to such an extreme degree that an abusive personality is formed, but at some point I feel that people need to confront and deal with their issues rather than using them as an excuse to continue behavior that is harmful to others.

In some ways, this attitude extends to victims of a certain age; while they are of course deserving of compassion and of care and protection to allow the emotional healing.