RESTRAINING THE AGGRESSIVE PATIENT ON THE WARD

REQUIREMENTS #

1. Assisting nurse(s) (depending on the degree of aggression)
2. Tray for IM injection:
   1. 10mls sterile syringe
   2. Two (2) sterile hypodermic needles
   3. Receiver for sterile cotton wool swabs
   4. Cleansing lotion
   5. Receiver for used cotton wool swabs
   6. Medication(s) to administer (according to prescription)
   7. Patient’s treatment chart
3. Patient’s folder (Electronic/Manual)
4. Straitjacket, leather straps, belt etc.
5. Blanket/thick cloth
6. Seclusion room

STEPS #

1. Advance Preparation
   1. Develop goals to contain/control the aggressive behavoiur
   2. Select the restrain approach to use
   3. Explain carefully to patient and family (if present) the importance of restraint
   4. Identify assisting nurses needed and tell them their roles
   5. Prepare equipment to be applied for the selected restraint approach
2. Establish rapport( refer procedure) and explain procedure to patient
3. Inform the patient on the type of restraint selected and anticipated duration
4. Call the assisting nurses and remind them of their roles
5. Assemble and bring the prepared equipment to be used for the selected restraint approach (e.g. sedative and tranquilizers, leather straps, straitjackets etc.)
6. Give a cue to the team to approach patient simultaneously
7. Lead team to approach patient in an appropriate manner (e.g. from the front, in a semi-circle formation, etc.)
8. Speak to patient in a firm but calm tone giving him specific and concise direction
9. Direct patient towards nearest wall or floor
10. Hold blanket between you (nurse) and patient if he/she is holding any dangerous object
11. Grasp patient simultaneously by the clothing at the waist and above the joints of the limbs (the great joints)
12. Carry patient to bed/chair and apply selected restraint approach i.e. physical (e.g. leather straps) for the period required to calm him/her down or chemical (e.g. administer prepared injection) or environmental(e.g. put patient into seclusion if prescribed)
13. Assess any injuries to patient, other patients or staff
14. Assess the effects of the restraint on the patient
15. Ensure that all equipment used are cleaned/disinfected and stored accordingly
16. Perform hand hygiene
17. Continue to observe the effects of medication/seclusion protocol on patient at frequent intervals
18. Document assessment before and after the restraint in nurses’ note and patient’s folder