Use Of Restraints In Adolescent Inpatient Care
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Use Of Restraints In Adolescent Inpatient Care Fac Essay, Research Paper Physical Restraint Use in Adolescent Residential Treatment Facilities Physical Restraint Use in Adolescent Residential Treatment Facilities Purpose and ScopePhysical restraints are used in many facilities for multiple purposes. They are used properly and improperly and have been a subject of controversy in many facilities. Their use has caused injury and even death in some cases. There have been multiple position papers formulated by many individual inpatient facilities as well as, most recently, The American Academy of Child and Adolescent Psychiatry and The American Medical Association on the use of restraints in child and adolescent residential treatment facilities. Tasks First there will be a description of the various types of restraints that are used in facilities for psychiatrically impaired adolescents. Second there will be a description of the criteria for the implementation of restraints and the monitoring that takes place while the patient is in restraints. Third, there will be a discussion of restraint use, alternatives and their pros and cons, followed by a summation of what seems to be the most appropriate choice. Forms of Restraints Five-point leather restraints The universally used restraint in facilities for adolescents and indeed many adults consists of system of ‘five-point’ leather cuffs and a waist belt. The wrist and ankle cuffs are three inches wide and made to fit snuggly around the smallest part of the wrist or ankle. They can have locking or non-locking metallic catches that are impossible for the patient to undo with teeth or even one free hand. These are secured to opposite sides of a metallic bed frame that is usually bolted to the floor and has a sturdy plastic mattress on it. Mattress has no metallic parts or other surface points that would injure the patient. A three or four inch wide leather belt is fastened around the waist of the patient, either locked or unlocked, and then fixed securely with one inch leather straps to the bed frame. These leather restraints are very thick; about one quarter of an inch, and the metal is riveted on with flush rivets to prevent injury to the patient. The patient is restrained lying down either face up or face down on the bare mattress. Other restraint systems are used in hospitals and some nursing homes, such as cloth wrist restraints and cloth waist and chest restraints. These restraints are never used with the mentally ill because of the very high possibility that they would be used for self harm. In some juvenile prison facilities five point leather restraints have been utilized with a metal ‘restraint chair’ as a form of coercion and punishment. This is a totally inappropriate use of restraint and its use should be discontinued for these purposes. Seclusion Seclusion is a method of containing adolescents that some mental health providers consider equal to a form of restraint. Seclusion consists of putting the patient in a room devoid of any features that they could possibly harm themselves with. Fixtures are recessed and inaccessible, there are no windows that are breakable. They can have a bare floor or an indestructible mattress of heavy canvas or plastic that is easily cleaned and cannot be taken apart. There is always some form of observation of the patients’ activities in the seclusion room, either directly through an unbreakable window in the door and/or a video camera setup. The patient is searched for any objects they might harm themselves with. Objects as well as clothing that might be used in self-harm are removed. Some facilities place the patient in an indestructible canvas, short sleeved gown. The patient is then allowed to be alone after being placed in the seclusion room. The door can be locked or left open depending on the discretion of staff and the volatility of the patients’ behavior.