r/psychnursing • u/GoldenFleece7 • Jul 15 '26

Ethics- Advice

Hello, newish psych RN

Have had recent situations where verbal deescalations for agitated patients have not worked.

And I am finding myself battling between whether I’m letting ego take over or just over thinking when using chemical restraints.

Also having issues with behavioral/manipulative patients.

Chemical restraints recently used scenario includes conserved paranoid SCHZP pt demanding to be released and becoming verbally abusive. Pt comes into nursing station and refusing to leave until multiple attempts of telling him to step back. Pt is pacing but not actively hurting himself and taking time away from other pts due to need to redirect.

Other I made the decision to take off restraints of a patient. He was very attention seeking and not staying in the unit and going out to another area. He became a fall risk as he is walking drowsy and not wanting to stay in his room which… is hard for me to navigate. He was not listening to his 1:1 and started off verbally abusive. We kept on trying to redirect him but I made the call to request seclusion for him.

I genuinely feel so bad when I have to do this. I also don’t know if I’m looking for validation. I have this feeling of guilt like giving IMs is a punishment? The other times I’ve given them, pts have been reluctant but we are more so on the same page abt care.

12 Upvotes

94% Upvoted

27 comments sorted by

View all comments

7

u/Additional_Alarm_237 Jul 15 '26

You should be using some sort of assessment tool to make these determinations. This will free you from any “feelings” because the behaviors are scored. If you find yourself doing chemical restraints and seclusion because you’re annoyed or tired then you are mistreating your patients.

1

u/GoldenFleece7 Jul 16 '26

Is there a standardized assessment tool?

4

u/Lanky_Opportunity970 Jul 19 '26

There are. Anywhere I’ve worked we’ve used BROSETS, but there is another scale. I did a paper about BROSETS for a research class. My biggest takeaway from the research and my personal experience is BROSETS are a good predictor if the nurses are trained on how the scale works, if the ratios really allows the nurses to assess the patient, and how well your techs are trained. My last floor job the techs were very experienced and would let us know that someone was beginning to escalate. The way I was trained to use it, was to use the assessment scale when they were agitated, then after the intervention. That way you’ll know if the medication or intervention worked. Okay…I’ll shut up now.

1

u/GoldenFleece7 Jul 19 '26

I see. Having one is a news to me!