Medical Restraints

Use of Physical and Chemical Restraints

Use of Physical and Chemical Restraints

Introduction

The use of physical and chemical restraints in Intensive Care is a common practice, and they are used in order to get control over disturbed patients and to avoid self harm and unintentional extubations. Chemical restraint is primarily, a kind of medical restraint. Drugs may be used to sedate patients. It is used is in psychiatric, emergency and acute settings for the purpose of controlling those patients who are unruly or who might interfere with their care or who are dangerous to others or to themselves in their area.

Discussion

Client X, a Fifty three-year-old lady, was in-tubated postoperatively on a ventilator after surgery. The hands of the patient are controlled with the use of hand belts so that she is unable to pull out the endotracheal tube with her hands. Because she was a dementia patient, the ability to be agitated by practically everything and the risk that she will pull the tube out was very high. Before the surgery, the doctors explained her family the need of using physical restraints and permission was granted.

As a nurse, I have come across intense and combative patients regularly in the emergency department. The family members of these patients brought them in hospitals, referring to the emergency department by some other doctors, or emergency medical services or the police personnel's even brought them in hospitals because of creating a public disturbance. These patients create significant management and diagnostic challenges to doctors, technicians, staff members and nurses who are caring for them. There are various causes of combative patient's performance that includes but not limited to psychiatric illness, withdrawal and substance abuse, metabolic disturbances and traumatic injury. Those doctors who are in the emergency department usually manage the behaviours of those agitated patients carefully, determined whether a traumatic or medical plan is the reason for the agitation, and assemble for proper disposition. To distinguish among functional and organic cause for the violent or agitated behaviour, it is very much essential to have a history and then carry out the entire physical tests of these patients, and, in most of the scenarios, order laboratory work and radiologic imaging. Unluckily, both violent behaviour and agitated behaviour are a problem to the medical work-up and the patient himself and each caregiver are in trouble. In that case, when the de-escalation approaches are useless in making a sadistic patient to co-operate, chemical and physical use of restraints is required. Once, it has been decided to use the restraints, it is crucial for every nurse to pursue hospital policy on the patient observing and documentation. The policies of hospitals on restraints must be resulting from the Joint Commission's Restraint and Seclusion Standards because Joint Commission tracks the restraint use.

In 2002, it was suggested by Jacobi that eighty percent of the patients in critical concern have delirium and agitation which they describe as a highly fluctuating and changing mental state, disorganized thinking, inattention and changed consciousness level that might or ...