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.