An inmate suffers from PTSD caused by severe sexual abuse during ...

[Yolanda]

An inmate suffers from PTSD caused by severe sexual abuse during which she had been restrained by the perpetrator's girlfriend.
 
  One day she sees an inmate who reminds her of the perpetrator's girlfriend and has a flashback, during which she attacks the inmate. Correction officers place her in restraints per the jail's protocol. Which short-term response by the nurse would likely be most therapeutic? a. Support the use of restraints as needed to control violent outbursts and assure the safety of all inmates.
  b. Plan to meet with the patient to debrief her and help her calm after she is released from the required period of restraint.
  c. Contact a supervisor authorized to make an exception to the restraint policy and explain that an alternate response is needed to calm this particular inmate.
  d. Confront the corrections officers who initiated the restraints, explain the inappropriateness of this action, and request the inmate's release.

Question 2

The emergency department nurse realizes that the husband of a patient appears increasingly irritable as he waits alone in the waiting room. Which intervention would best prevent further escalation?
 
  a. Periodically update the husband about his wife and what is being done for her.
  b. Explain that waiting is necessary because patients are treated in order of need.
  c. Reassure him that everything possible is being done and suggest ways to relax.
  d. Suggest that he return home and await an update from the physician in 3 hours.

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Answer to Question 1

C
The optimum outcome in this situation would be to minimize the duration of the restraint episode; the patient and others are at risk of injury until she is able to calm, and the restraints will likely worsen and extend the inmate's distress and agitation. Supporting the use of restraints ignores the need of select inmates to be managed with alternate responses that do not paradoxically worsen the situation instead of help it. Meeting with the patient to calm her after her release would be the second most helpful response because it does not shorten the duration of the patient's restraint. Confronting the officers is unlikely to be successful, since they are following proper procedures; accusing them of improper actions will likely increase defensiveness rather than expedite the inmate's release from restraint.

Answer to Question 2

A
Waiting without information about what is occurring, especially for one already worried about an ill spouse, is very anxiety provoking. Some persons would interpret this waiting as neglect, a sign that staff do not care, leading to increasing frustration and anger. Providing periodic updates on the patient's condition and what is being done to help her keeps the spouse involved and reduces misperceptions. The other options fail to address specifically the dynamic underlying the spouse's escalating frustration, because they do not fill in the unknowns with specific information. Asking him to wait 3 hours at home would only compound his anxiety. Suggesting that he relax could be perceived as implying that his response is unreasonable, which would likely be perceived as criticism, frustrating him further and likely increasing his anger.