A protocol for lifting measures restrictions on freedomscarried by nurses from CH Le Vinatier, goes beyond the simple execution of medical prescriptions. It positions the nurse as an actor in the adjustment or lifting of these measures, as close as possible to daily clinical observation.
Reducing the use of isolation and restraint constitutes a major challenge in psychiatry today. In this context, the deployment of a protocol for lifting these measures, carried out by nurses from CH Le Vinatier (PULM: Psychiatrie Universitaire Lyon Métropole), marks a significant evolution of practices. This protocol is based on a structured, continuous and traced clinical evaluation which allows the teams to intervene directly in the lifting decision, in a secure and defined framework. It is based around a standardized assessment of the patient based on an evaluation scale and a clinical assessment which makes it possible to objectify the patient’s abilities to benefit from a relaxation of these constraints. The decision is then validated as a team.
Build on evidence
The integration of psychometric tools constitutes a real asset of this evolution of practices. This involves relying on evidence in connection with the Decree relating to the activities and skills of the nursing profession of December 24, 2025. These standardized scales of agitation and/or hetero-aggressive risk (1) reduce subjectivity, secure practices and promote homogenization of evaluations within teams. Far from dehumanizing the care relationship, these tools reinforce the clinical readability and legitimacy of nursing decisions while deploying a common vocabulary (semiology, indicators). It’s about no longer being content with saying “patient goes up » or “I don’t feel it” but to precisely describe their behavior and symptoms to best adjust the clinical decision. This model has multiple benefits.
– For the patient, it promotes a reduction in the duration of isolation and/or restraint measures and better consideration of their clinical progress.
– For nurses, it enhances their clinical skills and strengthens their autonomy.
-For the institution, it is part of a quality approach and compliance with current recommendations to reduce the use of isolation and restraint (tending towards zero restraint) which is part of an establishment policy around coercive measures (ETHIC: Avoid isolation / Transform practices / Humanize / Impel / Contain differently)
How to deploy this protocol?
This dynamic requires:
- Training nurses in the use of psychometric tools,
- Collective appropriation of protocols
- Maintaining close collaboration with doctors
- Implementation of monitoring via an evaluation of professional practices and support in the field.
The support of the General Management, the Care Directorate, the President of the Medical Commission and the Quality Department of the establishment are determining factors which favor the implementation of this approach. A first deployment carried out in three adult entry units reveals unequal appropriation of the system by caregivers. Several parameters must be considered: team dynamics and the care paradigm, the notion of risk-taking or task slippage, a significant medical presence which does not always encourage the team to use this protocol… Obstacles were thus brought to light: fear of making the wrong decision or even a feeling of lack of legitimacy, which shows the importance of supporting the teams in this approach.
Nevertheless, the feedback remains positive and highlights the reduction in isolation and/or restraint measures, flexibility, the speed of implementation of the protocol and an enhancement of nursing skills. Decisions to lift measures could be taken during the week and during the weekend at varying times. The majority took place at the end of the day or on Sunday. The time slot between noon and 2 p.m. also appears several times. Currently the deployment of this protocol is continuing on four units including psychiatric emergencies (UPRM), with qualitative and quantitative feedback planned for the end of 2026, which should ultimately allow it to be validated.
For more information: deCLIC@ch-le-vinatier.fr Frédérique ROLLET, CSS Pole Urgence (Frederique.rollet@ch-le-vinatier.fr) or Sandy MATHIEU, IPA PAPV/ Project Manager on the Reduction of Coercive Measures (Sandy.mathieu@ch-le-vinatier.fr)
(1) Broset Violent Checklist within the protocol/ Linaker & Bush Iversen (1995). Roger Almvik and Phil Woods 2000
