How should nurses respond when someone has lost touch with reality as his psychosis worsens and he is deeply disturbed? What lies behind that disturbance? The first part of this film shows 'poor practice', as the nurses both fail to proactively intervene and actually exacerbate the situation by their use of language, tone and non verbal communication. See what you can spot that is unhelpful.
In the second part of the film, the nurses take a very different approach. They attempt to intervene early and, despite Don's anxiety, frustration and anger, are consistent, calm and compassionate as they help Don become less aroused, using a seated de-escalation. When they need to escalate their response, it is done carefully and thoughtfully, with attention to detail as they plan who will do what. A full de-escalation then takes place, allowing the team and Don to remain safe and medication to be administered. Look for what you think is helpful and anything you think could be done differently in such a challenging and potentially distressing situation.
Important note: the guidance and practice for the physical intervention with patients has been changed since the making of this film, when this type of restraint was regarded as best practice. That has now changed and the form of intervention that is safest involves supine restraint i.e. guiding the person onto their back. This is because the risk with the form of intervention demonstrated here i.e. prone restraint, is that the person can have serious limitations placed upon their ability to breathe. However, the key principles i.e.the seated de-escalation, holds used, careful planning, trying everything possible to de-escalate the situation, acting decisively and communicating with the person as clearly and compassionately as possible remain applicable.
If you want to read more about the subject matter of this film, you can try "A Pocket Guide to Risk Assessment and Management in Mental Health", by Chris Hart and published by Routledge. It's available as an e-Book, on Amazon and in book shops.
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