Physical Restraint of a Mentally Ill Person

Isn’t a medical scene more dramatic when you get to restrain someone? However, to ensure your scene is medically accurate, an understanding of the law and the limitations on using restraints is important. Of course, evil characters can do away with the law. That’s your latitude as a writer. Just remember the reader needs to know that you know this medical person is doing something improper.

I’m pleased to host Patti Shene as she shares her expertise from working as a psychiatric nurse. You can learn more about Patti by visiting her website.

Welcome, Patti!

For a long time, restraint was used as a means to control the unpredictable and sometimes violent behavior of mentally ill patients. However, over time, the courts have recognized that these persons have an inherent right to freedom from inappropriate use of physical or chemical restraint.

The Supreme Court acknowledged, in the 1982 case of Youngberg vs Romeo, that the use of restraint severely inhibits personal liberty. They concluded the use of restraint should reflect “the exercise of professional judgment.” However, this statement encompassed a broad range of views that resulted in a nebulous interpretation.

Over the past decade, it has become clear that restraint and seclusion can legally be used only as a method of last resort when the patient is an imminent danger to himself or others.

Suppose you have a character who meets this criteria for “imminent danger to himself or others”. First, this information pertains to leather restraints.

Physical restraint consists of four leather cuffs placed around the wrists and ankles of the patient. The cuff has adjustable sizes and is fastened with a leather belt that passes through a metal loop on the cuff. The belt is then secured to the frame of the bed and locked in place. The belt can only be released, or opened, with a key.

The use of restraint should be considered a psychiatric emergency, and not used for convenience of staff or as a form of “punishment” for inappropriate or unacceptable behavior. There are many safety issues to consider when a patient is placed into physical restraints.

A nurse must always be present to assess the need for restraints. A patient can be physically contained by staff members prior to the arrival of the nurse, but only if there is an imminent danger to the patient or others.

Physical restraint without the use of an external device should adhere to strict guidelines. Cornell is one such method, a procedure that incorporates three staff members and greatly reduces the risk of injury.

The patient should always be physically contained face up to prevent asphyxiation or choking.

No cloth, clothing, or other restrictive material should ever be placed over the face during a restraint procedure.

Once the patient is placed into physical restraint, is imperative that circulation be maintained. If the caregiver’s finger does not fit comfortably between the cuff and the patient’s skin, the cuff is too tight.

A caregiver must check the patient at a maximum of fifteen (15) minute intervals.

The emotional needs of the patient must be met at all times.

Hydration and toileting needs must be met every two (2) hours.

A patient should never be left alone in a room with a door open after restraints have been applied. This would expose the patient to possible assault or injury by another patient.

The nurse must notify the physician and obtain a telephone order for restraint not later than one hour after the restraint has been initiated.

The dignity and privacy of the patient must be maintained at all times during the restraint procedure. Never is the patient to be teased, taunted, screamed at, intimidated, or in any way physically or verbally abused during the application or confinement of restraints.

If a personal issue exists between the patient and a particular staff member that could result in the violation of these basic rights, that staff member should immediately be removed from the situation.

In the case of child restraint in a residential child care facility, the parent/guardian must be notified as soon as possible that the intervention has taken place and the behaviors that led up to it.

Reevaluation of the patient in restraints, according to the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is 4 hours for adults ages 18 and older, 2 hours for children ages 9-17, and 1 hour for children under age 9.

The patient must be released from restraint as soon as he/she is calm, cooperative, and able to maintain control. He/she must be able to commit to display safe behavior toward himself and others.

Several incidents across the country in recent years resulting in serous physical or psychological injury or even death have brought national attention to the issue of physical restraint. Do your mentally ill character justice by knowing the legality of how they should be treated when restraint is warranted.

Source material found at here and here.

***This is a repost from 12/3/2010***

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Patti is a 1969 graduate of a state nursing school in Long Island, New York. Her exposure to state hospital surroundings led her to choose a career in psychiatric nursing. She is a Veterans Administration Hospital retiree and also worked at Colorado Boys Ranch, a psychiatric residential treatment center for several years. Retirement allows her to pursue her interest in writing. She currently fills the position of Executive Editor for Starsongs Magazine, a publication of Written World Communications for kids by kids.