Engaging James to De-escalate the Situation
Discuss about the Advanced Mental Health: Key Management Principles of Psychiatric Patients including Guiding Principles of Restraint.
Seclusion and restraint are terms that bear significant meaning to health professionals especially within the confines of mental facilities. Seclusion in itself defines the act of confining a patient in a room or location from which the patient or client is unable to leave (Wong, 2015). The act of seclusion of patients is viewed to arbitrary lead to negating psychological and physical effects to both the patient and the health care provider in question (Simpson, 2014). Restraint on the other hand illuminates any manual method that is employed to ensure that the patient is not able to move his or her limbs, or move from one position or location to another (Costemale-Lacoste, 2018).
Drugs, in most instances can be considered as a form of restraint when they are used to reduce the movement of the patient from one location to another (Simpson, 2014). Drugs can be used to immobilize the patient. Notwithstanding that seclusion and restraint have their own negating effects to the patient and the healthcare provider, it comes a time when they are necessary. In cases where the client may become a potential risk to both the healthcare providers and himself or herself, it becomes crucial to employ seclusion and restraint as appropriate management methods (Dahm, 2017).
James is a good example of a patient with schizophrenia (one of the many mental diseases) who presents with signs of aggression and hostility. His notable paranoid personality seen through his presentation and continued obsession that someone is after him raises the question whether it would be appropriate to seclude, restrict or confine him to a specific locale. However, seclusion and restriction of patients have not been viewed as the most effective and efficient methods to use in managing them due to the associated psychological and even economic implications –economic when the healthcare provider is required to pay for any associated damages (Knox, 2012).
In order to engage James properly, it would be appropriate to ensure that a private vicinity on which his concerns can be heard properly is appropriately provided for. Privacy is an important patient right whose importance cannot be underestimated. Patients with anger can be easily provoked if left in the vicinity of other individuals (Gaynes, 2016). This provocation can be avoided by either taking other patients away from the vicinity of the patient or by having the patient in a new area in the facility where other patients are not present or do not reside. In order to properly deal with the situation the creation and allocation of a therapeutic environment is key (Gaynes, 2016).
Assessment of the Client (James) and a Discussion on the Issue of Risk Assessment within the Mental Health Settings
The use of restraint is not an effective way of managing and engagement considering the many discussed negating effects associated with it. However, it would be highly effective to use a third person approach to deal with the rising levels of agitation that have been displayed by the client, James. The third party approach can be employed when a non-partisan approach is used whereby the client is assessed by a non-judgmental individual (Gaynes, 2016). The nurse (in this case me) should maintain a calm and supportive appearance and employ the components of a therapeutic communication throughout the conversation with the client (Wong, 2015).
However, for the purposes of safety, other members of the healthcare team and security personnel should be stationed in the background in case the client’s condition warrants attention or if he becomes a threat to the healthcare provider in question. The client may view other members of the healthcare team as a threat and may react as a defense mechanism (Wong, 2015).
The use of listening skills when dealing with the client is also essential when looking forward to de-escalating the situation. It is highly important to listen to the patient in a non-judgmental and empathetic manner (Dahm, 2017). The rise in anger and suspicion hamper the perceptual field of the client and lead to impairment in the thinking process. It is highly crucial to inform the client that you are willing to help but it is highly essential that he maintains calm. It is important to state for instance that, “I am willing to help you but I cannot help you when you are screaming and yelling.” It is crucial to maintain personal awareness during the process of engagement with the client. This is because of the fact that one is prone to react to the clients agitation and behavior during the process of engagement (the medical personnel should maintain consciousness of his or her feelings and control them appropriately to avoid the escalation of the situation) (Gaynes, 2016).
Assurance is another important aspect to consider when dealing with the patient. This is because the client may be behaving in this way because he feels threatened by a specific stimulus or situation. Assuring the client that he is safe and that there are no forces coming against him acts as type of positive reinforcement in managing and controlling the client’s current state and reducing the much increased instances of agitation and worry. It is important to provide choices that promote or offer positive reinforcement to the client and aid in managing his situation appropriately (Flammer, 2015). This positive reinforcement does not have to be something of material nature, but can also be an encouragement or receiving a reward of some sort in-order to improve co-operation from the client.
In case the use of third party interventions does not prove effective in the management of the client and calming him down, the use of physical restraint may be viewed as an appropriate option to maintain and control the client’s current state (Costemale-Lacoste, 2018). Early intervention can aid in the cumulative effects of self-harm or harm to other patients within the facility.
Assessment of the client (James) and a discussion of the issue of risk assessment within the mental health settings.
James is a potential threat or harm to both himself and other members of the facility. In the assessing of James as the client, it is important to consider his reaction when referring to other patients as hit men and his desire to strike them first or hit them. It is important to consider the cumulative effects that come into play if and when he desires to fight other clients. His representation of a grandiose disorder (a false fixed belief that others are after him) may cumulatively make him a threat to other patients and thus he may end up harming them. The assessment of his gestures and body language during the assessment procedure is also significant as it may show his desire to harm other patients.
During the assessment process it is important to approach him in a non-judgmental manner and with empathy and respect. Fighting with the healthcare provider or persistent thought that there are forces against him and he must fight against them, may mean that other methods of managing the situation have to be deployed in this situation incase reassurance and the use of the third-party approach prove ineffective.
In the risk assessment of clients in mental health facilities, such as the case with James, there are a variety of factors that have to be put into consideration to avoid the worsening of the client’s condition. Some of this factors that have to be put into consideration include the avoidance of harm to the patient by himself (that is threat to self) and the creation of harm to others by the client in question (that is threat to others) (Fistein, 2009). In order to achieve this goal, it will be necessary to ensure that appropriate safety and security mechanisms have been initiated in case the client begins or shows signs of being threat to peace.
The existence of threat to self can include instances whereby the client poses a risk to himself by having suicidal ideations. The client can move from the mere thought of committing suicide to actually committing suicide. This is possible when the client presents with auditory delusions, especially hearing voices telling him to kill himself. This situation should be handled with extreme precision and speed through appropriate pharmacological and psychological interventions.
Self-neglect is another cumulative issue within the assessment mechanism for patients’ or clients with psychiatric anomalies (Roper, 2015). The key reasons why self-neglect should be considered in psychiatric health units is because of the inability of the client(s) to seek food and other basic amenities for himself or herself. Self-neglect is key in assessing clients as it shows their response and perception to their own health and pattern of living.
Under the laws and legislations of Queensland, mental health patients are considered an important subset of a genre of patients. They bear specific rights which need to be followed and kept to the later. Mental health patients have a right to privacy and also to confidentiality according to the legislations in Queensland Australia. In addition, mental health patients have a right to refuse treatment. Compounding to this, all the patients within psychiatric units are considered legally competent unless they are considered otherwise through the process of legal proceedings (Roper, 2015).
Further compounding to this legislations governing the protection and management of patients within mental facilities are the legislations that govern restraint of patients. Patients within mental facilities are also protected against inhumane restraint mechanisms. At the highest level, a least restrictive method of restraint is always the epitome rule in mental facilities (Wong, 2015). Strict guidelines for restriction are provided for in legislations. These restrictions include the facts that state that restriction is deemed necessary when: when the behavior is physically harmful to patients and to others; when the use of restrictive measures are insufficient; when there is a decrease in sensory overstimulation; and when the patients anticipates that control environment will be helpful and requests seclusion (Simpson, 2014).
The key issue law that govern psychiatric settings basically delve on the protection of the patients. In order to avoid the existence of liability in cases where there is a patient crisis it is important that one responds to the client needs appropriately. It is also necessary to avoid assuming the client. However, a boundary should be drawn to avoid interruption when dealing with the client. Complying with the basic standards of care and the rights of the patient are also necessary for overall client progress along the continuum of care. Adherence to the basic standards of nursing care is also necessary for client care through the treatment process.
Documentation can also not go without being considered. Appropriate and effective documentation should be performed for every activity that is performed for and to the patient to avoid getting into medical or legal based complications. What the health provider such as the nurse has done and has been doing for and to the client should be appropriately documented and written in a way that can be read.
In secluding patients in mental health facilities it is highly important to consider the safety of the facility in which the particular patient is going to be placed in. It is highly important to make sure that the room is padded on all the sides with appropriate cushions to prevent the patient from knocking himself or herself on the walls and end up harming or hurting himself or herself (McLaughlin, 2016). It is also highly crucial to make sure that the hands or limbs that would be used to hurt oneself are properly put on restraint (McLaughlin, 2016). There are special attire designed for physical restraint of patients within seclusion units.
Compounding to this facts, it is also important to maintain continuous monitoring of the patients in the facilities to prevent them from harming themselves. A small window and continuous surveillance and observations of the patient should be provided for to avert the likelihood or occurrence of an incidence within the facility.
Conclusion
Seclusion and restraint are important aspects to consider in the administration of care in mental health facilities. In addition to the fact that seclusion and restraint provides safety to the patient, it also protects other clients from the patient and the health care provider. However, seclusion and restraint comes with negating effects to the psychological effects of the affected patient. Patients may experience depression from the fact of being left alone. Conversely, seclusion and restraint is deemed necessary for overall client management.
References
Costemale-Lacoste, J. F. (2018). Predictive factors of seclusion duration in patients hospitalized in psychiatry settings. A prospective multisite study in the DTRF Paris-Sud. . L’Encephale.
Dahm, K. T. (2017). Interventions for Reducing Seclusion and Restraint in Mental Health Care for Adults: A Systematic Review.
Fistein, E. C. (2009). A comparison of mental health legislation from diverse Commonwealth jurisdictions. International journal of law and psychiatry,, 32(3), 147-155.
Flammer, E. &. (2015). Impanct of the temporaneous lack of legal basis for involuntary treatment on the frequency of aggressive incident, seclusion and restraint among patients with chronic shisophrenic disordres. Psychiatrische Paxis, 45(5), 260-266.
Gaynes, B. N. (2016). Strategies to De-escalate Aggressive Behavior in Psychiatric Patients.
Knox, D. K. (2012). Use and avoidance of seclusion and restraint: consensus statement of the American Association for Emergency Psychiatry Project BETA Seclusion and Restraint Workgroup. . Western Journal of Emergency Medicine, 13(1), 35.
McLaughlin, P. G. (2016). Use of coercive measures during involuntary psychiatric admission and treatment outcomes: Data from a prospective study across 10 European countries. PloS one, 11(12), e0168720.
Roper, C. M. (2015). DEFINING SECLUSION AND RESTRAINT: LEGAL AND POLICY DEFINITIONS VERSUS CONSUMER AND CARER PERSPECTIVES. . Journal of law and medicine,, 23(2), 297-302.
Simpson, S. A. (2014). Risk for physical restraint or seclusion in the psychiatric emergency service (PES). General hospital psychiatry, 36(1) 113-118.
Wong, J. K. (2015). Use of seclusion in psychiatric intensive care units. Mental Health Practice, (2014+), 18(7), 14.
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