A practical nurse (PN) is assisting in the care of a client on an inpatient psychiatric unit who begins pacing rapidly, clenching their fists, and shouting obscenities at staff. Arrange the following behavioral interventions in the correct sequence from least restrictive to most restrictive.
- 1Initiate verbal de-escalation by speaking in a calm, non-confrontational tone.
- 2Direct the client to a low-stimulation environment, such as an unlocked quiet room.
- 3Offer the client a prescribed voluntary PRN oral medication to help manage agitation.
- 4Place the client in an involuntary locked seclusion room to prevent imminent harm.
- 5Apply mechanical restraints to the client's extremities with the assistance of a crisis team.
Answer
The correct sequence from least restrictive to most restrictive is: verbal de-escalation, directing to an unlocked quiet room, offering voluntary PRN oral medication, involuntary locked seclusion, and finally, applying mechanical restraints.
The principle of the least restrictive alternative mandates that nurses utilize the least invasive interventions to ensure safety before progressing to more restrictive measures. The hierarchy dictates progressing from verbal communication techniques, to environmental milieu changes, to voluntary chemical interventions, to involuntary seclusion, and finally to physical mechanical restraints only in extreme emergencies.
Step-by-Step Solution
Key Concept
Least Restrictive Environment and Intervention Hierarchy