Professionals who interact with high-risk populations have changed their philosophies over the years in how they manage outbursts. A growing body of literature now supports only rare and minimal restraint applied exclusively to prevent harm—with a larger vision toward eliminating the use of seclusion and restraint.
For example, the American Psychiatric Nurses Association (APNA) has adopted a detailed, evidence-based position statement, outlining the need to maintain the safety of individuals and staff in treatment environments alongside good standards of care. They give serious consideration to the ethical tug of war between the clinician’s responsibility to prevent harm and the patient’s own right to autonomy.
Among the recommendations that APNA has crafted, two key points stand out:
“Seclusion or restraint must be used for the minimal amount of time necessary and only to ensure the physical safety of the individual, other patients or staff members and when less restrictive measures have proven ineffective.”
“Individuals who are restrained mechanically must be afforded maximum freedom of movement while assuring the physical safety of the individual and others. The least number of restraint points must be utilized and the individual must be continuously observed.”
Making the call to de-escalate an outburst with use of restraint is never an easy decision, even when staff members are extremely well trained and follow written protocol. Decisions must always be patient-centered.
Support the safety mission
Centers that serve high-risk populations should be prepared with the right furniture to support the safety mission. Pieces should be specifically designed for the purpose—not retrofitted with do-it-yourself workarounds.
At Furniture Concepts, we offer a number of Molded Plastic Beds that are built for secure environments. For each selection, field-installed restraint hardware is available as an option, and many can be bolted down to the floor for added safety. They contain no ligature points and cannot be disassembled.
These beds are truly tough. The Endurance Bed was tested by an independent laboratory and has demonstrated the strength to withstand 2,000 pounds of weight without any damage or distortion.
Our molded plastic floor-mount chairs are also extremely tough. The Sentinel Chair , and the Sabre Chair can withstand 800 pounds of weight. Groups of chairs can also be bolted together to create secure, sectional seating.
When it isn’t possible to bolt a chair to the floor with the concealed pilot holes, another safety-standard option is to add weight to the chair. The weight ensures the chair can’t be picked up or thrown. A ballast door included in many of our molded plastic chairs allows for access to the hollow interior where heavy sand bags can be tucked away.
Secure environments require appropriate furniture to ensure the safety of the individuals and the staff. Furniture Concepts offers a selection of specially designed contract furniture choices that meet the needs of high-risk populations.
You can read the Position Statement on the Use of Seclusion and Restraint from the American Psychiatric Nurses Association, updated March 13, 2018, by clicking on the link.