Use Of Restraints In Adolescent Inpatient Care — страница 3

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be alleviated at that time but frequent use of these restraints has the potential to cause psychological harm to the patient. It promotes a feeling of helplessness and underscores to the patient that he is not in control of himself or his situation. Unfortunately in many in treatment facilities for children and adolescents, the choice of restraint, when it becomes an unavoidable necessity, is dictated by what is available. In a smaller facility without adequate staffing or a safe seclusion room, five point leather restraints often end up being used on the child without adequate justification. Seclusion rooms or as they are sometimes called ‘quiet rooms’ can be an effective way to keep the ‘out of control’ child or adolescent from self harm or harming others. These too

have the potential for abuse and their use needs to be justified. A properly set up seclusion room gives the patient an opportunity to vent his feelings on the room instead of himself, his fellow patients or the staff. He can yell, bang on the walls, kick, or otherwise physically vent his frustrations while being observed and unable to hurt himself. He may experience feelings of confinement but not feel helpless. The seclusion room can also be utilized with an unlocked door. This acknowledges that the patient has some control over his behavior. He can utilize the time alone to think about his feelings and come out when he feels he can control himself. Patients can request to spend time in the seclusion room when they feel out of control or unable to behave with others. The

seclusion room takes on a new use, not as a place of confinement but as a place of safety for the patient. Some of the same pitfalls involved in five point leather restraints are also present with using seclusion rooms. The ‘hands on’ procedure needed to put a violent patient into a seclusion room can provide the touching that some patients crave. Constant observation while in the seclusion room provides an intense form of attention also and some patients’ will act out deliberately to get this attention. Medicating patients as a form of restraint has many advocates. It is certainly less labor intensive in the long run and has fairly immediate results and requires no special equipment or rooms. It appears to be ideal form of restraint in many respects and is the restraint

method of choice in many inpatient facilities for adults. The problems of utilizing medication restraint on children and adolescents are many. Before any medications are given to children it is recommended that they undergo a thorough physical exam that includes an EKG, EEG, metabolic blood work and a urinalysis to screen out potential problems that may arise from giving the medication. Even with this careful screening and titrating psychotropic medications to begin dosing there can still be side effects that are deleterious to the child. Few medications are tested by drug companies on the child and adolescent population for obvious reasons and therefore utilizing these on them can be very tricky. So many medications have just appeared on the market for adults we have no idea on

how they will effect physical growth, mentation or the long-term effects of giving them to growing children. The legalities of medicating the adolescent inpatient are strictly governed and protected by law whether the child is a ward of the state or has come from a loving family. Parent or guardian must be contacted whenever a new medication is used, its use justified and permission given. Medicating the ‘out of control’ child does not give the child the opportunity to learn to think about, understand and seek to control himself. It provides an almost instantaneous relief from an uncomfortable situation and leads to the patients’ belief that a solution to uncomfortable feelings and behavior lies in taking a drug of some form. It can also lead to the child feeling helpless,

disoriented and further out of control. Conclusion Five point restraints take away the possibility of self-harm but teach the child that staff is in control, leaves them helpless and fosters a distrust of authority figures. It tells the child that they cannot control themselves. Medication, at first glance, has a lot going for it as a method of restraint and certainly staff like it. It is a quick solution and in an adult setting may be the restraint that is most appropriate. For the adolescent or child it is just taking too great a health risk to justify its use. Although inpatient child and adolescent populations are being medicated daily with psychotropics it is being done along with a careful continuous monitoring of the patients’ physical and mental state. The child is also