|Type of paper:||Research paper|
The use of restraints is whereby; a patient is physically subdued or controlled by either tying them down with fastening fabric or by dressing them in clothing than restrict movement. Although the practice has been effective in controlling the undesired self-harm, ethical issues have arisen questioning the method of restraining human beings in a not so humane way. Restraints were also discriminated against since they did not either fully protect the patient. For instance, in the event of a fall, a patient may not be able to support themselves and may end up acquiring injuries that are as much in any way fatal as those they are being protected from.
On the other hand, use of medication drugs that may either immobilize a patient or lull them to sleep is another way in which medics may be able to restrict a psychosis patient from causing self-harm.
Environmental restraining may be achieved by ensuring that the patient is kept in a safe surrounding where there are no objects that they may use to bring harm to themselves. For example, a garden or a closed bedroom door may be used.
To prevent a psychotic individuals from bringing themselves to harm, it is necessary to choose the most suitable method of bringing them under control, i.e., a technique that does not expose them to any risk and does not deprive them of their dignity at the same time. (Favazza, 1998). Using the PICOT model analysis, we will come up with different questions and answers that can be beneficial in choosing the best way how to approach this critical issue.
Why are we restraining the patient?
This is the first questions that nurses and other caregivers should ask before going ahead and putting the patient under control. Getting to understand the problem at hand helps us in going along the way into solving it. Is the patient a threat to other people surrounding them? Where this is the case, then physical restraining could be considered to ensure the safety of the sick person and those around them too rather than restraining, is there any other way that we can use to calm the individual down? If yes, then restraining is not necessary.
Have other means of intervention been considered and tried?
Health professionals and advisors have advised that immobilizing a person with psychosis should be the last result after all other options have failed. Immobilization not only increases the affected person's frustration but may also end up slowing or hampering their recovery process. Therefore, before restraining a patient, alternative means such as speaking calmly to the individuals could be used. However, if the general population is at risk of being put in harm's way, then restraining should be used.
Is the patient comfortable, or do they show distress and anxiety?
Upon establishing the need to control a patient physically, the patient's well-being must always be put first. The method of control chosen should not present any discomfort to the individual. Some physical restraints, for instance, may cause physical damage to the patient as they attempt to free themselves while on the other hand, a patient may be allergic to sedating drugs. In such circumstances, environmental control should be the correct form of curbing to use.
What are the risks or harms that may come along with the restraining method chosen?
Not all control methods are safe to use. Physical curbs have been known to cause injury where the patient may trip and end up acquiring injuries as they are not in a position to secure their landing. In other cases, they may end up breaking free and injuring those around them including children. Therefore, before settling on a restraining method, it is necessary to identify and alleviate the risk factors at hand before putting the chosen measure to work.
Are there any benefits, i.e., what is good for the patient and those around them in the approach taken?
Restraining a patient is done for the betterment of the patient's condition as well as those around them. This, therefore, implies that the curbing method used should be that which is aimed at the overall good of the patient. (Harvey., et al. 2008) For instance, instead of restraining a patient, listening to them and trying to reason together would work better. It has been proven to speed up the individual's recovery process as it puts their minds back into a real-world dimension.
Restraining should be the last result in attempting to immobilize an affected individual with the intent to cause self-harm. (Owens, Horrocks, & House, 2002) Where no other alternative is available, environmental controlling should be considered first as it has less potential risks as compared to physical and medicated restraining.
Keywords; restrain, sedation, self-harm, recovery process, delusion, psychosis, immobilize,
Haw, C., Hawton, K., Houston, K., & Townsend, E. (2001). Psychiatric and personality disorders in deliberate self-harm patients. The British Journal of Psychiatry, 178(1), 48-54.
Morgan, H. G., Burns-Cox, C. J., Pocock, H., & Pottle, S. (1975). Deliberate self-harm: clinical and socio-economic characteristics of 368 patients. The British Journal of Psychiatry, 127(6), 564-574.
Favazza, A. R. (1998). The coming of age of self-mutilation. The Journal of nervous and mental disease, 186(5), 259-268.
Harvey, S. B., Dean, K., Morgan, C., Walsh, E., Demjaha, A., Dazzan, P., ... & Murray, R. M. (2008). Self-harm in first-episode psychosis. The British Journal of Psychiatry, 192(3), 178-184.
Owens, D., Horrocks, J., & House, A. (2002). Fatal and non-fatal repetition of self-harm: a systematic review. The British Journal of Psychiatry, 181(3), 193-199.
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