Running head: RESTRAINT REDUCTION Patricia Rhinevault WGU C361- Task 2 1

RESTRAINT REDUCTION A. Nurses must constantly assess the need and use of restraints and seclusion for patients who are a danger to themselves or others, such as staff or other patients. Restraints are anything that is used to reduce the patient’s ability to move their legs or arms and also includes medications used to control their behavior. Seclusion is confining a patient to a room and not allowing the patient to leave. Each of these measures is used on a case by case basis and needs a doctor’s order. A1. Both restraints and seclusion can cause psychological and physical harm to a patient. Patients have even died will in restraints. Staff taking care of patients in restraints and in seclusion have also reported psychological problems as well as injuries resulting from putting a patient in restraints. While there is sometimes a need to restrain or seclude a patient, conscious thought and care should be taken before this intervention. A2a. The manager of the emergency department is currently responsible for the restraint and seclusion policy. The policy was effective in 1999 and has been updated twenty-four times since then. A2b. The emergency department manager last updated the policy in April of 2015 and uses the Washington Administrative Codes as a reference. The policy must comply with current state laws and regulations. The policy is also based on patient rights from the DNV and references the state operations manual in regards to patient rights. A2c. The current restraint policy was decided upon using nursing research, current laws in Washington state and patient rights. A3a. Changing the culture of departments to reduce, or even eliminate restraints, starts with management. I recommend a practice change of including a debriefing after the use of restraints and seclusion. “The participants emphasized that, after a few days, it is important to discuss the seclusion or restraint situation in multidisciplinary teams and with managers. (Kontio,Valimaki, Putkonen, Kuosmanen, Scott & Joffe, 2010).” I suggest doing a debriefing at least once a month with different staff members and/or during staff meetings. “Where staff have the opportunity to discuss issues related to the 2

RESTRAINT REDUCTION use of containment measures this, could be an important variable in reducing the frequency of seclusion use. (Happell & Harrow, 2010).” Reducing the amount of time patients spend in restraints and seclusion is beneficial for staff members, the patients and family.