Laypersons and nursing professionals indicate that the restraint process utilized for mental health patients may portray a violent image that does not contribute to the quality of care delivered. In order to assess the requirements for enhancing care in the mental healthcare setting themes that are associated with restraint are presented. In addition, an alternative to restraint is described, which does not consider the use of therapeutic drug restraint.
Nurses facilitating the care of mental health patients are typically placed in scenarios where there is a thin line between ethical practices and maintaining safety for the patient and themselves. As a means of ensuring client safety polices across U.S. facilities normally incorporate the use of restrain that will keep the patient in the position that is desired. Restraints within the scope of this report are identified as physical barriers utilized to reduce motor function of the patient. Data collected by researchers within the past decade allude to an unfavorable theme, with respect to the violence associated with restraint of this nature.
These themes have been collected from nurses across various mental facilities in the U.S., and are indicative of troubling considerations in the current practice of dealing with these patients. This report will address these eight (8) themes while providing a plan to develop a level of quality care that reduces violence and negative connotations that are associated with mental health patient restraint. These themes identify areas in which the current use of physical restraint may be optimized and include; (1) Implement in a positive manner, (2) Resort to less therapeutic restraint, (3) Resort to less restrictive measures, (4) Enhance the safety, (5) Prevent harmful behavior, (6) Ensure control of behavior (7) Implement less restrictive interventions, and finally (8) Avoid use (McCain et.al, 2005).
Nursing professionals may find comprehensive broad guidance on how to properly conduct restraint of mental health patients within the American Psychiatric Association’s “Resource Document on the Use of Restraint and Seclusion in Correctional Mental Health Care” (Metzner et.al, 2007). Due to the violent nature of mental health patients professionals understand the importance of restricting a patients mobile capability, however, a layperson may consider the use of restraint to be non-necessary, invasive and unethical (McCain et.al, 2005). Plans that require the use should consider each procedure based on the individual attributes of the patient. This means that Standard Operating Procedures may be drafted and approved by the management team of a mental health facility, but that discretion in the implementation should be exercised. When possible, a minimum amount of restriction should occur and in this case individuals should be present (on staff) for an intervention that requires that the Nurse deliver care to the patient. It is not feasible nor practical for the Nurse to approach a potentially violent patient and place him/herself at risk. What may occur is that security personnel are present within “arms reach” should the patient exercise a function that is not desirable. These security personnel may be trained in a high-level manner in which they are aware of their surroundings, the invasiveness of the procedure that requires administration and that they interpret social cues from the patient. These personnel should have the ability to predict the moves of the patient prior to the patient actually taking them. In order for this to occur security personnel must be educated in order to possess a basic minimum level of understanding, with regard to the various mental health disorders that they will come into contact to. The use of security personnel will allow for Nurses to exercise minimum restraints in the healthcare delivery setting.
The process of implementing lasting change in the healthcare system is not typically an easy process. With respect to the addition of further staff indented for the sole purpose of security, and reduction of patient restraint, healthcare administrators will incur serious barriers. The cost of adding personnel will increase the expenditure at the facility. It is likely that the facility may reduce costs by seeking government aid to subsidize funding, by stating that this is a “medical necessity” that should be supplemented through tax payer dollars. Healthcare administrators may also assess this issue by balancing their budget by offsetting the costs incurred at this point, by reducing the costs through a parallel area of their business model. Unique strategies must be considered that will be novel to the applicable facility and its current operating business model.
Adminsitrators that are tasked with overseeing the implementation of this practice may reduce costs by seeking more effective delivery of therapy. The goal will be to maintain equal costs by seeking out drug products that are cheaper yet still effective. In the event that a facility has a contract in place to obtain drugs from one wholesaler, the facility may re-enter into negotiations to lower the price of acquisition and/or simply seek medication from generic competitors. Lean processes may also be applied throughout the overall facility to cut costs, yet deliver the same level of quality care that is current. Savings that may overcome barriers are likely to require supplementation from government programs and it is also likely that administrators may apply or bid for government contracts to care for the mentally ill, whom may otherwise pose a threat to individuals in society.
The eight themes that have been identified by nurses do not represent a comprehensive list of requirements. In contrast, they provide very broad observations that should be considered when moving forward with the development of a care plan. Utilizing the use of security personnel will positively impact all eight themes. In a best-case scenario there will be no restraint required due to the level of highly trained personnel that will be present. If the patient is determined to be particularly violent, due to their mental health issues, then a combination may occur. It is also important to note that utilizing security personnel will also benefit the safety of the patient and the nurse. In a worst-case scenario where there are minimum levels of restraint and no security personnel and the patient expresses violent tendencies, it is highly likely that the patient and the nurse will be placed in a dangerous event (Metzner et.al, 2007).
Prior to the implementation of the safety plan, the plan itself should be assessed by all nursing staff and management. These professions must vet the plan to ensure that all eight themes are applied, when applicable. Additionally, It is not an option to eliminate the use of all restraint in all scenarios. The particular diagnosis and the behavior of the patient will determine the level of restraint that will be required. Laypersons often believe that restraint should be removed from a primary care setting due to the images that have been prevalent in media, at the onset of mental health treatment. However, these persons are likely to agree (given a minimum amount of education to the process) that the restraint is meant to be applied in a manner that is non-violent and is a safer alternative to restraint via therapeutic mechanisms (Metzner et.al, 2007). Finally, seclusion may provide to be a more effective alternative to restraint. In the event that a patient does not require an active intervention (presence of the nurse), the patient may be escorted via security personnel to the area in which they may be held away from any other individual. This too should be a last resort as it is not always effective to the mental psyche of a patient to implement treatment interventions that devoid the patient of essential human contact.