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Having recently left medical/surgical nursing to work in a psychiatric hospital, I witnessed something that upset me terribly. A patient who'd been involuntarily admitted was forced to take antipsychotic medication and placed in restraints for several hours. The nurse-manager said that the patient had threatened a social worker and was considered a risk to others until the medication took effect. Are the hospital's approaches violating patient rights, or should I shed some of my ideas about the use of restraining patients and forcing medications on them?-M.H., VA.


If a patient is a risk to himself or others, the staff must be able to provide care without threat of physical harm. However, the law on restraints is strict for all patients-including psychiatric patients, who are especially vulnerable to restraint abuse. For example, a medical practitioner must order restraint use, and only if she believes it's the only reasonable option to protect the patient or others from harm.


When restraints are necessary, the least restrictive type should be used for the shortest time possible, and the patient must be closely observed and repositioned as needed to protect him from injury. Restraints must never be used simply for the staff's convenience.


If a true safety issue existed at your facility, the restraints may have been necessary. In such a situation, the order should specify how long restraints can be used, such as a 4-hour limit for an adult. The time can't be extended without a new order. The hospital should have a protocol for checking that restraints are positioned and used properly, hourly for example.


Psychiatric patients have the right to consent or object to medications and treatments, so when the patient regains control of his behavior, he also regains the right to refuse medications and restraints.


Restricting restraint use

You can find tips, standards, and guidelines on restraint use at these Web sites:


* American Psychiatric Association: http://www.psych.org


* American Psychiatric Nurses Association: http://www.apna.org


* The Joint Commission: http://www.jointcommission.org


* National Association of Psychiatric Health Systems: http://www.naphs.org


* National Association of State Mental Health Program Directors: http://www.nasmhpd.org