Psychiatric Mental Health Nursing by Videbeck

204 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS

continued from page 203

Using a low voice may help to calm the client or

prevent increasing agitation. The client may be

disoriented or unaware of what is happening.

The client’s ability to understand the situation

and to process information is impaired. Clear

limits let the client know what is expected of

him or her.

Firm limits must be set and maintained. Bargain-

ing interjects doubt and will undermine the limit.

Direct communication will promote cooperation

and safety.

Physical safety of the client is a priority.

Staff members must maintain self-control at all

times and act in the client’s best interest. There is

no justification for being punitive to a client.

Physical safety of all clients is a priority. Clients

should not assume a staff role; other clients are not

responsible for controlling the behavior of a client.

Other clients may be frightened, agitated, or

endangered by an aggressive client. They need

safety and reassurance at this time.

Consistent techniques let each staff person know

what is expected and what to do in advance of

this highly stressful situation and will increase

safety and effectiveness.

Consistent techniques increase safety and effec-

tiveness. Transporting a client who is agitated

can be dangerous if attempted without sufficient

help and sufficient space.

Talk with the client in a low, calm voice. You may

need to reorient the client; call the client by

name, tell the client your name and where you

are, and so forth.

Tell the client what you are going to do and what

you are doing. Use simple, clear, direct speech; re-

peat if necessary. Do not threaten the client, but

state limits and expectations.

*When a decision has been made to subdue or re-

strain the client, act quickly and cooperatively

with other staff members. Tell the client in a

matter-of-fact manner that he or she will be re-

strained, subdued, or secluded; allow no bargain-

ing after the decision has been made. Reassure

the client that he or she will not be hurt and that

restraint or seclusion is to ensure safety.

*While subduing or restraining the client, talk

with other staff members to ensure coordination

of effort (eg, do not attempt to carry the client

until you are sure that everyone is ready).

Do not strike the client.

Do not help to restrain or subdue the client if you

are angry (if enough other staff members are pres-

ent). Do not restrain or subdue the client as a

punishment.

Do not recruit or allow other clients to help in

restraining or subduing a client.

If at all possible, do not allow other clients to

watch the situation of staff subduing or restrain-

ing the client. Take them to a different area, and

involve them in activities or discussion.

*Develop and practice consistent techniques of

restraint as part of nursing orientation and con-

tinuing education.

*To provide consistency among all staff members,

obtain or develop instructions in safe techniques

for carrying clients. Obtain additional staff assis-

tance when needed. Have someone clear furniture

and so forth from the area through which you will

be carrying the client.