Physical management of a patient is only a last resort if verbal de-escalation fails.  The standard of care and the facility's own Crisis Prevention Manual require caregivers to attempt to de-escalate the situation verbally when a patient is acting out inappropriately and to obtain assistance from at least one more person when physical management of a patient becomes absolutely necessary.

  When the patient came to the nurses station and began demanding a snack in a loud voice it was the nurse who invaded the patient's space and squared off with the patient toe-to-toe and initiated the physical contact that ensued.  Placing a patient in a headlock presents a significant risk of positional asphyxia which can be fatal. COURT OF APPEALS OF MICHIGAN November 28, 2017

  A registered nurse who worked in the mental health unit of an acute care hospital had his license placed on probationary status for two to five years and was fined $250 for grabbing a psychiatric patient, taking him down and putting him in a headlock.  The Court of Appeals of Michigan ruled against the nurse and in favor of the state Department of Licensing and Regulatory Affairs that imposed the sanctions.

  The incident was captured on the hospital's video surveillance system in the unit.  Nonetheless the import of what transpired had to be filled in with testimony from other nursing personnel on duty nearby who did not support the nurse's version of the events.   The nurse claimed the patient approached the nurses station, pounded on the counter and demanded food repeatedly in a loud voice that would have seemed threatening to other patients and then spit at the nurse when he told the patient there was nothing available to eat.  The video evidence did not support the nurse's claim that the patient was pounding on the counter.   A nurse who was working at the nurses station did not see the patient spit at the nurse.   She said it was the nurse who approached the patient, confronted the patient and then grabbed him.

  Even the behavioral healthcare expert who testified for the nurse admitted that every effort must be made to deescalate a situation with a patient verbally before physical restraint is initiated.  The nurse's expert also faulted his own client for provoking the patient by approaching him, invading his personal space and standing toe-to-toe with him, even if it was the patient and not the nurse who first physically touched the other.

  The nurse was faulted for attempting to go solo to restrain a patient physically rather than waiting for assistance from at least one more staff person.  A greater number of staff persons involved means less likelihood of injury to the patient, caregivers or other patients in a takedown.  Before he grabbed the patient the nurse did tell the other nurse at the nurses station to go get help, but he did not wait for help to arrive before he went ahead .

  A headlock is the only way one person acting alone can restrain another person and a headlock is never acceptable with a patient due to the extreme risk of positional asphyxia, which can be fatal. The hospital had carefully trained its professional and non-licensed staff in crisis techniques and had its own Crisis Prevention Manual for staff to follow.   The Court ruled that the facility's protocols for crisis prevention intervention were the standard of care, violation of which would be considered negligence and incompetence by a nurse. Department v. Weitherspoon, 2017 WL 5759799 (Mich. App., November 28, 2017).

More references from nursinglaw.com

http://www.nursinglaw.com/psychrestraint.pdf

http://www.nursinglaw.com/psychiatric-patient-asphyxiation.pdf

http://www.nursinglaw.com/restraint-combative-patient.htm

http://www.nursinglaw.com/take-down-patient.htm

http://www.nursinglaw.com/takedown.htm