Task Solutions on Restrictive and Defensive Practises: NUR340

Assessment 3: Advance Mental Health
[Student Details]
This paper aims to explain the use of restrictive an …

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Assessment 3: Advance Mental Health
[Student Details]
This paper aims to explain the use of restrictive and defensive practises in mental
health care, and alternative strategies used by nurses to manage the violence or aggressive
behaviour of patients. Nurses face challenges in mental health care services due to the
violence and aggressive behaviour of patients; the aggression and violence are common in
mental or aged care settings; therefore, health professionals and nurses need to manage the
situation using the restrictive or defensive practice. Restrictive practices are against the
human rights; thus, nurses need to use alternative strategies to reduce restrictive practise
while managing the aggressive behaviour of patients (Barr, Wynaden & Heslop, 2019).
Restrictive and Defensive Practises
Providing care to older adults is rewarding; however, situations become challenging
for nurses and care providers when mental health patients involve in violence or show
aggression. Mental health problems include serious disorders that create psychosis, and
patients have symptoms such as delusion, hallucinations, and aggression. Some serious
consequences of these symptoms include violence, self-harm, and attack on health
professionals. Existing researches show that nurses follow restrictive practises to manage
these situations and reduce the harm to both self and patient. There are different types of
defensive and restrictive practises reducing risk in mental health care services (Slemon,
Jenkins & Bungay, 2017).
Restrictive practises are against the human rights and freedom of patients while
ensuring the safety and protection of patients. These practises limit aperson ’sability to move
and harm others by restraints that can be chemical, physical, and environmental restraints
(McKeown et al., 2020). According to Wahlbeck (2015), restrictive practises can prevent the
behavioural risk that may lead to self-harm such as suicide while there are several reasons
such as limiting the rights of patients and their liberty that cause legal concern. In some
situations, these practices become important to ensure the safety of clients and health
providers; hence lawful consent is required to use these practises in specific cases.
Restrictive practises are against the basic rights of patients, while defensive practises
do not include high risk and dishonour patients; for example, locking acustomer in aroom to
prevent the violence is arestrictive practise that affects patients’ respect and dignity and is
against the rights of the client, and observation and documental do not include any harm.
Similarly defensive practise includes defensive medicine that does not affect the dignity
while this is also against the rights of clients (Brophy, 2016). Mellow et al. (2018), found that
defensive practises allowing nurses to manage the aggression of patients in mental health care
services. Nursing observation and documentation are also defensive. Considering the risk of
violation of patients ’rights and dignity Aged Care Quality and Safety Commission (ACQSC)
recommends the health profession avoid these practises instead they can use alternative
Seclusion is arestrictive nursing practice that restricts the patient’s movement as they
are locked in an isolated room. Nurse and other health professionals are only allowed to use
seclusion in critical situations when all other interventions fail to show any improvement
(Noorthoorn et al., 2016). According to Goulet, Larue & Dumais (2017), seclusion is against
the right of the patient and increases the burden of patients. Similarly, Oster et al. (2016),
found suggest that seclusion should be avoided when managing aggression as itdeteriorates
patient condition. It raises ethical challenges for nurses, and increase the risk of fall and
injuries, while some scholars support the use of seclusion by arguing that seclusion can help
to control violence that cannot be managed by other interventions.
Restraints are the part of nursing defensive or restrictive practises that allow them to
manage the violence in mental health care. The restraint that anurse use could be achemical
restraint in the form of medicine, environmental restraint, and physical restraint. Physical
restraint is much more effective to control the patient during the violence and aggressive
behaviour; however, itcauses more challenges to patients. The use of physical restraints does
not allow patients to move freely. When patients become violent and try to harm others;
health professionals use physical restraint. For example, locking the patient in aroom, using
equipment to restrict their movement, and holding their hands (Hammervold et al., 2019).
According to Kinner et al. (2017), physical restraints are necessary to mitigate the risk for
other patients while there is arisk if the increased burden on patients that can deteriorate the
patient health or affect their mental health, in some cases use of restraint may lead to the
death of mental health patient; therefore, Royal Commission Australia aims to reduce the use
of restrictive practices in Australia. In addition, other challenges that apatient may face when
they are treated with restraint are shame, loss of dignity, and fear increase the depression and
anxiety of patients.
Restraints have been introduced to reduce the risk for both patients and others;
however, existing evidence revealed that restraints are not effective to reduce the harm to
patients in mental health care. Slemon, Jenkins & Bungay (2017), found that mental health
patients treated with restraint still have ahigher risk of fall and injuries while the use of these
practises increasing the severity of symptoms. Restraint also includes apharmacological
intervention to treat the behavioural condition. Those who suffer from severe mental illness
usually become aggressive and controlling and managing can be challenging; thus, health
professional uses medications to change the behaviour and mood of patients. According to
Bahramabadi et al. (2017), anti-psychotic drugs are effective for the management of
psychosis conditions including aggression and delusions; however, they may have negative
consequences that increase the burden on patients. Therefore, restraints or restrictive practises
are not effective as itdoes not reduce the risk for patients.
Documental is part of nursing defensive practices where anurse document patients’
details including cues and signs of risks, and behaviour of patients. Nursing documentation is
amore detailed view of patient clinical status including nursing observation. It held the
nurses to develop effective communication and improve clinical decisions as they have
written analyses of patients. In addition, documents allow nurses to keep the patient safe, and
improve the quality of services; similarly, they note the changes in patients ’behaviour
(Doody et al., 2018). According to Hariyati et al. (2016), documentation is adefensive
approach that includes awritten clinical account of the patient, and itcan be used to improve
the health of patients. Therefore, nurses need to follow adocumentation approach to note the
aggressive behaviour of patients that can be used to discuss with doctors and other health
professionals to improve multi-disciplinary communication.
Nursing Observation
Observation is part of nursing that allows the nurse to monitor and record the clinical
cues and symptoms that can be harmful to both patient and others. In mental health care,
observation is used as adefensive approach to improve clinical decisions when patients show
aggression; however, observation follows certain principles that need to be followed. In
addition, itis important when observing apatient in seclusion (Bee et al., 2015). When nurses
observe patients, they require to utilise the clinical information and knowledge to work with a
person-centred approach. Sweeney et al. (2018), found that observation is essential in mental
health nursing; however, itdepends on the skills and knowledge of nurses. Nurses need to
follow clinical guidelines while observing apatient in mental health service, and these
guidelines work as the base of their observation as they observe the clinical cues, signs of
deterioration, and changes in behaviour of patients. Observation in the mental health unit also
aloe nurses to focus on the physical health and needs of patients; hence, nursing observation
should be purposeful. According to Fisher, Newton & Sainsbury (2021), observation is an
effective tool to prevent unnecessary diagnoses and reduce the risk for patients. When nurses
observe apatient in mental health care itincludes monitoring the potential risk factors,
behaviour of patients that require further intervention. Nursing observation also helps the
clinician use alternative approaches to manage the aggression.
Alternative Strategies
Managing the safety of patients and reducing the risk of harm to others is vital in
inpatient psychiatric care. Safety in psychiatric care and mental health services has become a
topic of debate. Existing literature on the nurses ’perception of their responsibilities to
manage the risk and safety in mental health care provides insights into the use of risk
management or alternative strategies. Alternative strategies developed in healthcare focus on
the patients ’rights and dignity while aiming to reduce the risks. These strategies are different
from the restrictive practices that do not violate in-patients ’rights. Considering the high risk
and negative consequences of restrictive practises, the Australian healthcare system is
reducing the use of restrictive practises in adult mental health care that has evolved the
alternative strategies. Evaluation of these strategies has shifted the safety disclosure and ithas
become apriority of health professionals to give priority to patients ’safety. Alternative
strategies to manage aggression, and reduce risk in psychiatric care include the use of sensory
rooms, safe wards services, and de-escalation techniques (Baker et al., 2021).
SafeWards is introduced to improve the quality and safety of mental health care.
Conflicts can arise in any situation between the health patient and doctor, and health
professionals, the patient-nurse relationship is also crucial to providing effective care;
however, itbecomes challenging for nurses to provide care and support the client when they
become aggressive or violent. Therefore, mental health services have safewords reduce the
risk of conflicts and eliminate the problem. The safe wards focus on the improvement of the
environment where patients are treated. It does not only include the physical environment;
however, provides accommodation including the patient-nurse relationship, and involvement
of staff in the care to improve the patient-nurse interaction. When patients are provided with
an environment where they feel safe and comfortable, and these factors can be moderate then
ithelps to improve the interaction between nurse and patient (Price et al., 2016).
Communication De-escalation
Communication de-escalation is an effective alternative strategy followed by mental
health nurses to manage the mental health patients who how aggressive behaviours. It has
been found that lack of proper communication creates conflicts and increases the risk of
anger; hence, health professionals follow communication de-escalation to defuse the
aggression. In this method, nurses develop therapeutic relationships with clients with anon-
judgemental approach and show empathy. The situation can be dangerous when managing
the aggressive behaviour of residents, the calm communication is used by the professionals to
manage the aggressive behaviours of patients (Price et al., 2018). Hallett et al. (2016), found
that communication is important in de-escalation where nurses need to follow aperson-
centred approach to find out the root cause of the problem; for example, the reason why
residents become aggressive. In addition, health professionals can follow this as an
alternative to environmental restraint.
Sensory Rooms
Sensory rooms are also known as therapeutic rooms for mental health treatment that
include therapeutic spaces and designs that promote positive change and self-organization. In
the therapeutic spaces, avariety of clinical instruments are included which helps to keep the
patient calm and improve the sensory output of patients (West et al., 2017). According to
Bj örkdahl et al. (2016), mental health services have sensory rooms to focus on the patients ’
recovery including self-care and resilience. Sensory rooms are an effective approach and
alternative to the seclusion, unlike the seclusion, sensory rooms do not affect patients ’rights,
self-respect, and dignity, and provide an improved physical environment that assists to
manage behaviour and aggression. Sensory rooms foster atherapeutic environment that is
self-nurturing and effective in mental health care.
In conclusion, mental health nurses face challenges during the care of residents in
aged care services or mental healthcare. Patients with mental health illnesses show aggression
and negative symptoms that are challenging to manage; for example, patients who have
schizophrenia, and other psychotic disorders are confused with reality and believe that their
hallucinations are true; they show aggression and become violent. In those case health
providers use restrictive practises such as restraints that can be amedication to control
aggression or physical restraint such as locking the patient in aroom. These practices have
become more coommon; however, raised the risk to patients ’dignity and self-respect.
Therefore, alternative approaches have been introduced to ensure that patients’ rights are
protected while managing the violence and aggression. These strategies include sensory room
that provide atherapeutic environment, and safewords.
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