Assistive personnel on a behavioural unit
Can do
- Observe and report behaviour
- Take and record vital signs
- Sit with a person on close observation or one-to-one
- Escort to activities and meals
- Assist with hygiene and eating
- Record intake, output, food and fluid
- Help keep the environment calm
- Alert you immediately to any change
Cannot do
- Administer any medication
- Perform the assessment, or the AIMS
- Screen or assess suicide risk
- Give medication teaching or any patient education
- Evaluate a response to treatment
- Take primary responsibility for a person who is unstable or deteriorating
- Provide counselling or interventions needing nursing judgement
- Initiate or discontinue a restraint
Delegate specifically or do not delegate at all. Name the task, the boundaries, what to report and when to report it. “Stay within arm's length, do not leave him even for a moment, and tell me straight away if he refuses fluids or starts shaking” is a usable instruction. “Keep an eye on him” is a wish. You remain accountable for the outcome either way, so the specificity is protecting the patient and you at the same time.
The line that changes everything
A PRN a person accepts is treatment. The same drug given against their will to control behaviour is a chemical restraint. The pill does not change; its legal and ethical status does. A chemical restraint requires an emergency justification of imminent danger to self or others, a time-limited order that can never be written as PRN, a face-to-face evaluation within one hour, continuous or frequent monitoring of airway, circulation, vital signs, hydration, toileting and skin, documentation of the less restrictive measures already tried, and discontinuation at the earliest possible moment.
Restraint and seclusion are never used for discipline, punishment, coercion, retaliation, staff convenience or in place of adequate staffing. They are not treatments — they are failures of the environment that we sometimes cannot avoid, and each one earns a debrief with the person afterwards. De-escalation comes first, every time: reduce stimulation, offer space, lower your voice, offer a genuine choice, offer food, a walk or the PRN, keep one person talking and keep an exit path for both of you.