Minimizing Seclusion and Restraint on Seniors Units

Minimizing Seclusion and Restraint on Seniors Units

Seniors present a unique set of challenges. Hear from Staff in the Seniors program as they share their thoughts on minimizing the use of seclusion and restraint in this patient population.

This video was used at the 2011 Thought Leadership Forum

Text Transcript

Seniors present a unique set of challenges. Hear from staff in the seniors program as they share their thoughts about minimizing the use of seclusion and restraint in this patient population.

Dr. Ilan Fishler:
Traditionally, with the younger population, or with a population that doesn’t have memory impairment, they can communicate with you what their needs are. But, in the senior population that has significant memory impairment that information has to be gained through other methods. So that’s the biggest challenge. I think the most important thing is to do a really, very comprehensive diagnostic psychosocial assessment and treatment planning, with a full interprofessional team. Most restraint and seclusion is used as a result of not adequately preparing for potential future behaviours based on patients presenting difficulties. So, if you think about what is contributing to a patient’s distress and address it through, with a bio-psychosocial treatment approach. The pharmacologic and un-pharmacologic treatment strategies. That should really reduce the need to use restraint and seclusion as much as possible.

Nazir Hussain – Social Worker:
So sometimes, out of fear, out of frustration, they may manifest some sign of anger and aggression. I always look for what caused that aggression because apparent symptoms that are not produced automatically, they are a result of something deeper. I always try to find the cause and one side is anger, the other side is what can soothe that person, what can help that person stay calm and think about something positive

Nina Tzambezis – Registered Nurse:
Some of the things that we’ve done as far as minimizing the restraints is we have put high-low beds on the units for most of the patients. So, what that means is, the beds are situated closer to the floor so they have that ability to get out of the bed if they want to and they’re not restrained to the bed. We have areas that they are able to roam within the unit. We will give them food, fluids, distract them, walk with them, talk with them, do a one-to-one on them, that sort of thing. As long as you can pin point where the aggression is coming from or if you can see that they’re getting agitated, you will try to find ways to defuse them before they get too aggressive. It can be very challenging, physically and emotionally. From day to day it’s very physical care. You do get somewhat emotionally involved because, especially for some of us, who are here on a daily basis, it can be very wearing. We work well as a team. You know, it’s good to see, we all talk it out, we all share our views, not everybody agrees all the time but we all discuss what we think is right for the patient and you will have a difference in opinion but everybody’s opinion is heard and it’s all validated and appreciated by everybody.

Dr. Ilan Fishler:
I’m going to tell you a little bit about a patient, which really impacted me deeply. He was a relatively young man for our unit, in his seventies, with frontal temporal dementia. He was also a French man and a holocaust survivor who had been transferred from another hospital because he was profoundly aggressive in the course of his dementia. Actually, at the other hospital, it would be typically, six security guards would have to go and hold him down so that nurses could provide care for him because he was incapable of doing it himself, providing the care to himself. For a holocaust survivor, you can imagine how traumatic that would be. Through our careful assessment we were able to see that as being a manifestation of various severe depression on top of the dementia from which he was suffering. Through the use of ECT he actually had a very quick recovery and was eating again and was engaged with other people. We didn’t require, although initially he required wrist to waist restraints to facilitate the provision of care, you know, in a very short period of time, we were able to get to the point where only one staff was providing care and he was again in a trusting environment and obviously wasn’t frightened or threatened by it and it was a very positive outcome.