Nurses providing ambulation assistance
for an afternoon nap.
Memos from on high regarding patient restraints were filled with officialese and gobbledygook in an attempt to camouflage what was really going on. I found a VA restraint and seclusion Professional Services Memorandum that illustrates this point: VA Form 10-2683, Report of restraint and seclusion. "The doctor's orders (SF508) will be initialed by the GS9-11 ward nurse. The nurse will copy the prescription (form 10-2913) on the nursing notes (SF510) indicating the type of restraint and 24 hour report of patient's condition (VA form 2915). The nurse in charge of the ward during each tour of duty will maintain a record of each application of restraint on VA form 10-2683. After the last day of the month, the nurse will sign this form and forward it to the Registrar Division - 114A." Some head nurses referred to the monthly reports as the "Funny Papers" because restraints were not always used according to Hoyle with the frequency of use almost always understated.
Downey VA Hospital, the long term psychiatric hospital I worked at in the early 1970s made extensive use of full restraints that consisted of heavy leather cuffs secured by robust belts. My ways of caring for these patients were unique and foolish, but averted some of the unpleasantness associated with 4 point restraints. I began a patient enlightenment program that involved patients recognizing when they were beginning to escalate and request restraints before anyone was injured. A veteran of the Viet Nam war summed things up quite nicely, "Restraints are just like an Asian civil war-much easier to get in than get out." I couldn't have said it better myself.
Distraction is another useful tool in the nurse's position inhibition armamentarium (please note, I did not use that dreaded "R" word.) This
Children are especially vulnerable and the isolated snippets in my mind of pediatric restraint have long sense departed. Whew! Am I ever happy for that. There is a harrowing pediatric restraint device known as the Pigg-O-Stat. Google it if you dare. This thing looks like a blender with the lid off and the youngster is dropped into it for X-ray procedures. It's no wonder so many people have claustrophobia later in life. They were probably popped into a Pigg-O-stat as a mere youngster.
One of the more humane child restraint devices is a take-off on the old Trojan Horse idea. The restraint device is a toy rocking horse that lures it's young patients by whimsical looks, not brute force. While the child plays horsey, an X-ray plate is slid into position and the exposure made before anyone is the wiser. An elegant restraint solution! I wish they all could be so easy.
Welcome back, OFRN! You have been missed!ReplyDelete
Restraining patients always horrified me. I had regrettably suffered an assault as a child, and the memory of what it was like to be overpowered never left me. A very good idea is to ensure the patient being restrained doesn't have a past history of some kind of trauma like that. Sue.
Thanks. Not do be done lightly, always to be avoided if possible, but sometimes. . . necessary.ReplyDelete
How very true!Delete
Thanks Sue, I will attempt to be more diligent about posting. It's nice to be missed.ReplyDelete
Holding hands the most fun when patient had really long nails!ReplyDelete
My only time spent with pediatric patients was in Nursing school- They sent us to the burn ward for a day during the pediatric clinical. I assisted the nurse by restraining a toddler undergoing a debridement. I was a fresh father at the time and the look on that child's face is one that will stay with me forever. It guides my choice to never work in pediatrics- Those who do have my utmost respect. In the setting I worked, group homes for the Intellectually disabled, restraints of any kind were a huge no-no, even an as needed medication (chemical restraint) prescribed by a doctor could never pass the human rights review (a process to approve any new psych med) at our agency.ReplyDelete
Thank heavens for contemporary oversight committees such as the human rights review you mentioned. The good old days of nursing practice when I worked were not always that great.Delete
Hospitals were indeed terrifying places for vulnerable children. They used to bring young patients up to the OR in cribs that looked like miniature prison cells on wheels.
We were engrossed in a weekly nurse's meeting with Alice, my beloved OR supervisor. Just as she was initiating one of her rants about our failure to keep ratcheted instruments fully open at the end of cases, I heard an inconsolable child crying in the hall outside the ENT room. Without further ado, I bolted from the meeting room and scooped the young girl from her crib and hugged her to my chest until the crying ceased. I figured that I would be in big trouble from Alice, but nothing further was said of my sudden exit.
Here's an article to give you the horrors...ReplyDelete
"Horrifying Psychiatric Treatments in the Age of Reason" if the link doesn't work...
Thank Heaven's we've moved away from this kind of treatment!!! Sue
Thanks Sue. Psychiatric patients always received the short end of the stick when it came to effective treatments. Freud never received a Nobel Prize-they gave it to the guy who pioneered the lobotomy. Talk about rewarding very bad behavior!ReplyDelete
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My husband had to be hospitalized for exhaustion a few years ago. It was the most traumatic thing I witnessed. He was completely out of it, he got combative and had to be restrained, they used a strip of what looked like some sort of gauze/fabric, looped it around his wrists and then to the hooks on the bed. He fought against them, manage to get a hand free while a nurse was trying to administer meds. I ended up having to talk him down enough and give him the medicine as he thought the nurse was trying to kill him. He would pay attention to me and listen to me, anyways. He got a hand free grabbed my left breast so hard I thought he was going to physical pop my breast implants. My reaction off the cuff was to grab his balls and squeeze in a loud firm commanding voice I had some how managed to get him to give up his grip on me and got him to grab the bed so the nurse could try to restrain him again. He flipped out ripped his catheter (a folley correct?) got up ripping his IV out and make it to the hallway where 4 nurses and I had catch him as he just went DOWN! It took them and me to wrestle him into a wheelchair. They then had me and only me take him back into the room, get him back into the bed use the previously mention loud firm commanding voice I did before. We got him retrained again and we all took extra care to make sure he was in nice and firmly where he couldn’t get out. We were trying to get him to sleep and it took hours. They ended up pulling me out into the hallway and telling me that they needed me to stay over night with him as he would flip out on them. It changed my opinion of restraints and really opened my eyes to some of the difficulties nursing staff has to deal with each shift. I really appreciated all of their hard work.ReplyDelete
It ended well. He got some sleep finally and over two days he became the married again.
I'm so happy everything turned out well for your husband. Men seem to have an instinct to grab their penis and fool with Foley catheters when in an altered state of consciousness. Recovery Room nurses know all about this and try to prevent unauthorized excursions by keeping their hands outside the sheets.ReplyDelete
It's usually a good prognostic sign when seriously ill men take an interest in their nether regions and pull on catheters.Delete
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