panic states, alcoholic intoxication, homosexual panic, and psychopathy (Guirguis, 1978, p. 295). The signs of impending violence must be detected early and dealt with promptly. Two warning signals include increasing irritability and verbal outbursts. These behaviors may eventually require some form of de escalation. Potentially violent patients merit close attention by hospital staff. When their behavior attains crisis proportions, physical containment techniques must be administered (Department of Human Services, 1991, p. 1).
These techniques may include the use of body holds to temporarily control the patient. Although sufficient personnel must be present, the degree of force used should be the minimum required to manage the problem. Moreover, it should be applied in a way that attempts to calm the patient. Provocation of a further aggressive reaction should be avoided. Clothing rather than limbs should be targeted. When limbs are grabbed, they should be held near a major joint. This reduces leverage and the possibility of fracture or dislocation. Removing the patient's shoes and placing them on the floor also enhances safety. A variety of different holds may be applied, however, pressure should never be applied to a patient's chest, throat, or neck (Guirguis, 1978, p. 297).
Holds can subsequently be followed by the application of mechanical devices which restrict freedom of movement through immobilization of all or part of the body. Some of the different types of physical restraints include soft limb restraints, wrists and ankle restraints, chest/vest restraints, mittens, camisole jackets, and the geriatric chair. Leather or plastic restraints are generally used for the control of extremely combative hysterical patients. Two-point restraints refer to the application of locked wristlets. Four-point restraints include wristlets and anklets binding all four limbs. On nonpsychiatric wards, belts tend to be th...