Community Mental Health Nursing (RCMN)
RESTRAINING THE AGGRESSIVE CLIENT IN THE COMMUNITY
It is an intervention that is used as a last resort to immobilise a client who is aggressive to self, family, community and or properties. It includes the use of medications or minimal mechanical/physical restraint when medications are not readily available. This can be done with the assistance of family members, community, and or the law enforcement agencies.
Purpose
- Prevent injuries to client and others
- Protect properties
- Promote client and community safety
Indications
- Restraining an aggressive client in the community as a last resort to protect the client, family and community.
- Using minimal mechanical or physical restraint when medications are not readily available.
- Preventing injuries and protecting properties while promoting client and community safety.
Equipment
- A Well-Equipped home visit bag including:
- Personal Protective Equipment (PPEs)
- IM/IV Psychotropic/Sedative Medications
- Cotton wool balls
- Syringes and needles
- Alcohol disinfectant
- Safety box
- The assistance of staff or other individuals
- Community Map and or GhanaPost Global Positions System (GPS)
- Manual/electronic area register/ records of the client
- Means of Transportation
Preparation
- Read the map of the community and identify the home of the client.
- Take a home visit bag with emergency psychotropic medications.
- Ensure the availability of personal protective equipment and the assistance of staff or other individuals.
Procedure steps
- Read map of the community and identify home of the client
- Take home visit bag with emergency psychotropic medications
- Announce your presence, enter on response, greet and introduce yourself to client, family and significant others
- Ensure privacy and confidentiality
- Observe the client's environment for safety and establish rapport (refer to procedure)
- Enquire from family what precipitated the onset of the client's aggression or hostility
- Request for more help and instruct each as to their roles
- Approach client in a calm, respectful manner to gain his cooperation and enquire what necessitated his behaviour
- Try to calm client verbally by use of simple and short statements
- If verbal intervention fail, decide on the mood of restraint
- Explain to client and family why restrain is necessary
- Give a cue to the team to approach client simultaneously
- Approach and immobilize client simultaneously in a semi-circular formation with the blanket by holding client's clothing at the waist and above the joints of the limbs
- Speak with client in a firm and calm tone
- Give client specific and concise instruction
- Administer emergency psychotropic medications
- Assess self, client, accompanying staff and others for injury if any
- Observe client for the effect of the medication and restrain
- Wash and dry hands/uses hand sanitizer
- Arrange for transportation to the nearest hospital
- Document assessment before, during and after the restraint and report findings
- Congratulate assistants and family members
- Make follow-up visit if applicable
Precautions
- Restraint is used only as a last resort when verbal intervention fails; explain why restraint is necessary.
- Request more help and instruct each helper as to their roles before approaching the client.
- Approach and immobilise the client simultaneously in a semi-circular formation, holding clothing at the waist and above the joints of the limbs.
- Assess self, the client, accompanying staff and others for any injury after the restraint.
- Arrange for transportation to the nearest hospital and make a follow-up visit if applicable.
Aftercare
- Observe the client for the effect of the medication and restraint.
- Document the assessment before, during and after the restraint and report the findings.
- Congratulate the assistants and family members and make a follow-up visit if applicable.
Nursing considerations
- Ensure privacy and confidentiality and observe the environment for safety.
- Speak with the client in a firm and calm tone with specific and concise instructions.
- Administer emergency psychotropic medications as prescribed and monitor the effect.
Patient education
- Enquire from the family what precipitated the aggression or hostility.
- Approach the client calmly and try to calm the client verbally using simple and short statements.
Documentation
- Document the assessment before, during and after the restraint and report the findings.
References and further reading
Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.
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