Psychiatric Mental Health, part 3: Torts and Restraints

by Cathy Parkes July 22, 2021

Full Transcript

Hi. I'm Cathy with Level Up RN and welcome to our channel. If you have not already done so be sure to subscribe. We have hundreds of free videos to help you with all of the key concepts and facts you need to know in nursing school.

In this video, we are going to cover torts as well as restraints and seclusion.

So when it comes to torts, we have intentional torts and unintentional torts.

Intentional torts are willful acts that violate a patient's rights. So there are five intentional torts. I'm going to go over here.

The first is assault. Assault is where you make a threat against a patient that makes them fearful. So a threat is the key part of assault.

Battery is where you touch a patient without consent and it causes patient harm.

So in my mind assault and battery kind of sound the same and it can be confusing to differentiate the two.

So the way I remember is A comes before B.

So A is for assault and that's where you threaten the patient. And then B is where you carry out that threat and actually do patient harm.

So assault is the threat. Battery is the harm. It's the following through of that threat.

Another intentional tort is false imprisonment. This is where you inappropriately confine a patient with restraints or even a chemical restraint, such as a sedative, when it's not appropriate.

So a nurse who puts restraints on a patient for his or her own convenience, that would be an example of false imprisonment.

The fourth intentional tort that I want to go over here is invasion of privacy. This is where you violate a patient's right to confidentiality, so perhaps you share patient information with a family member of the patient's without getting permission from the patient first.

So that's a big no-no. So if you get a call from a patient's mom, dad, son, brother, whoever, and they're wanting information about the patient, you may not provide that information unless the patient has explicitly told you that you can do so. Okay?

Then we have defamation of character. This is where if you make derogatory remarks against the patient, and it harms the patient's reputation, that would be considered defamation of character.

Now let's talk about unintentional torts.

Unintentional torts are unintended acts against a patient that cause harm.

So the difference between negligence and malpractice, which are unintentional torts, can be a little confusing, so I'm going to try to break it down here.

Negligence is failure to provide care that a reasonably prudent person would do under similar circumstances, whereas malpractice is negligence by a professional, so like a nurse.

So as a nurse, you have a duty to a patient, and you need to provide a certain standard of care. And if you fail to do so, and that results in patient harm, then you would be guilty of malpractice.

So for example, if there is a patient in a hospital with a bedsore, which we call a pressure injury, and there are orders for wound care and also orders to shift the patient's weight every two hours.

If, as a nurse, you don't do that, you fail to provide the wound care and you don't reposition the patient every two hours, and that wound deteriorates and causes sepsis - so that's the patient harm - then you would be guilty of nursing malpractice.

So hopefully, that's helpful. So malpractice is negligence on the part of a professional.

Alright. Now let's talk about restraints and seclusion.

So restraints and seclusion should only be applied when the patient poses an imminent threat to themselves or to others.

Restraints can include physical restraints such as mittens, limb restraints, belts, and vests, or they can be chemical restraints such as benzodiazepines and anti-psychotic medications.

So before we apply any restraints, we, of course, want to try alternative ways to calm down the patient so that we don't have to do so.

So this would include using simple, non-threatening language, setting clear boundaries, reducing environmental stimuli, providing diversions to the patient, and perhaps offering the patient PRN medication such as an anti-anxiety medication if that is ordered.

In an emergency, a nurse can apply the restraints. However, an order for those restraints needs to be given by the provider as soon as possible after their application.

We always want to use the least restrictive restraints possible to solve the situation, so in many cases that includes mittens. Mittens are least restrictive.

While your patient is in restraints, you need to assess them, like lay eyes on them every 15 minutes, and then every 2 hours you need to take their vital signs, you need to provide range of motion exercises, you should check their skin integrity like under the restraints, and provide fluids and toileting.

The timing, like the requirements, may vary according to the facility, but in general, it's about every two hours.

And they are not messing around with these things needing to be provided every two hours.

And you need to document those things clearly in the patient's chart because it is likely that those will be audited.

You always want to remove restraints right away, as soon as the patient is no longer requiring those and is no longer a threat to themselves or to others.

In terms of the orders for restraints, providers must do an in-person assessment within 24 hours of initiation of the restraints or seclusion.

PRN orders are not allowed.

So the provider can't write an order that says, "Apply restraints PRN agitation or violence," right? There's no as-needed order for restraints.

And a new order is required every 24 hours if restraints are still needed.

And in terms of documentation, like I shared here a minute ago, you need to be documenting the rationale for why the patient's in restraints, how long they've been in restraints, and what care was offered and provided to the patient.

So those things are going to be really important.

Okay, time for a quiz, little knowledge check.

So I want you to name that tort. Okay? So number one, if you make a threat against a patient, what tort is that?

The answer is... assault.

Number two, if you inappropriately confine a patient with restraints, what do we call that?

We call it... false imprisonment. All right?

So hopefully you did well with that little knowledge check. If not, go back and watch the video.

And next up, we will be talking about the nurse-client relationship and therapeutic communication. Thanks so much for watching!

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