Morales E, Duphorne P L
Ft. Lyon Veterans Administration, Colorado, USA.
J Psychosoc Nurs Ment Health Serv. 1995 Oct;33(10):13-6. doi: 10.3928/0279-3695-19951001-04.
Following the review and discussion of alternative measures in the use of four-point restraints and seclusion on an acute psychiatric inpatient unit, the staff increased the use of "least restrictive" measures with aggressive patients. This involved increased attention to escalating behavior and using alternatives. Although early recognition did not guarantee success in every situation, patients were included in making choices and being in control of which option to take. When staff became more knowledgeable about the use of alternatives, they were more comfortable offering patients choices and did not wait until restraints and seclusion were necessary. It was beneficial to review the rationale for the use of seclusion and restraints with both patients and staff. Specific approaches for early recognition and intervention focused on verbal control, limit setting, and decreased stimulation. It is important that staff have a clear understanding of their range of treatment strategies from most to "least restrictive" measures during stressful times when patients become confused, angry, or frightened and may lose control. Patients must be made aware of their choices during this cycle and understand the consequences of their behavior. Planning educational inservice programs for staff to address this content and share approaches to specific situations can be effective. Staff debriefing following an incident is crucial to discuss reactions to the use of restraints and seclusion and to plan for the use of alternative measures in the future. All patients need a chance to express themselves. As staff we must take time to stop, look, and listen. We must be aware of our own thoughts and feelings and think of choices. What are the ¿least restrictive¿ measures? We need to work with patients in considering a range of measures without taking unnecessary risks or disregarding issues. We must work with our patients so that we all can learn a valuable lesson. Why not give our patients a chance?
在对急性精神科住院单元使用四点约束和隔离的替代措施进行审查和讨论之后，工作人员增加了对攻击性患者使用“限制最少”措施的频率。这包括更加关注行为升级情况并采用替代措施。尽管早期识别并不能保证在每种情况下都取得成功，但患者被纳入到做出选择以及掌控采取何种选择的过程中。当工作人员对替代措施的使用有了更多了解后，他们在为患者提供选择时会更自在，并且不会等到必须使用约束和隔离措施时才行动。与患者和工作人员一起回顾使用隔离和约束措施的理由是有益的。早期识别和干预的具体方法集中在言语控制、设定界限以及减少刺激方面。重要的是，在患者变得困惑、愤怒或恐惧并可能失去控制的压力时期，工作人员要清楚了解从最“限制最少”到最“限制最多”的一系列治疗策略。在此过程中，必须让患者了解他们的选择，并明白其行为的后果。为工作人员规划教育在职培训项目以涵盖此内容并分享应对特定情况的方法可能会很有效。事件发生后对工作人员进行汇报对于讨论对使用约束和隔离措施的反应以及规划未来使用替代措施至关重要。所有患者都需要有表达自己的机会。作为工作人员，我们必须花时间停下来、观察并倾听。我们必须意识到自己的想法和感受，并思考各种选择。什么是“限制最少”的措施？我们需要与患者共同考虑一系列措施，同时不冒不必要的风险或忽视问题。我们必须与患者合作，以便我们都能学到宝贵的一课。为什么不给我们的患者一个机会呢？
