Introduction
In the health sector, physical restraints are commonly used within psychiatric wards or with very aggressive patients. However, there has been a growing concern that the practice is harmful compared to its purpose, especially in the wards. Physically restraining psychiatric patients was initially introduced to reduce incidences of physical harm to the patients and the medical staff. Over the years, the approach has brought significant side effects in the health sector. Activists and medical practitioners have stood their ground in trying to stop the practice. Different practices have been initiated to counter the emotional and physical strain that the use of physical restraints causes on the psychiatric staff. Reports indicate that the intervention has gradually been impacting the efficiency and reliability of the healthcare personnel at their workstations. This paper discusses the issue of physical restraints and how staff attitude and behaviour towards patients affects their violent nature in psychiatric wards.
Quality Issue
The matter of physical restraints has become a big issue in the health sector. Physical restraint is a dictatorial mediation to minimise personal harm to patients and healthcare staff (Duxbury et al., 2019). However, there is an urgent need to establish new intersession practices since it is a root cause of why healing processes take longer. According to Celofiga et al. (2022), the most common intervention for aggressive behaviour in psychiatric facilities is de-escalation, although it has not had much impact and has many inconsistencies. The approach is much suited to physical restraints since verbal and non-verbal interventions have a higher success guarantee. Research into abuse in psychiatric wards indicates that restrictive interventions have not been used as the last initiative with aggressive patients (Duxbury et al., 2019). Physical restraints have been used for punishment, humiliation, and to cause pain to the patients. Therefore, it would be true that restrictive interventions have ultimately caused more harm than good in psychiatric care, and it is high time that new programs for better care be introduced.
Understanding the Problem
Several factors evidence the existence of the problem linked to the discussed issue. Thus, according to the Care Quality Commission (CQC) (n.d.), physical restraints should be used only in exceptional circumstances and as a last resort after all other options have been explored. Physical restraints are a controversial but sometimes necessary form of intervention used in the healthcare setting to ensure the safety of patients or staff (CQC, n.d.). When physical restraints must be used, the CQC (n.d.) recommends that healthcare staff follow a set of best practices. The healthcare staff must be aware of the relevant legal framework and the appropriate use of physical restraints (CQC, n.d.). Additionally, the healthcare staff are recommended to use the least restrictive form of restraint possible, monitor the patient’s condition regularly, and use the least intrusive form of restraint for the shortest time (Eales, 2020). Only under these conditions, the measure can be used and viewed as appropriate.
Furthermore, there are specific recommendations on how and why to use the intervention. The CQC (n.d.) encourages healthcare staff to be aware of physical restraints’ potential risks and side effects. Healthcare staff must be vigilant in monitoring a patient’s condition while in physical restraints and should be prepared to respond quickly to any changes in the patient’s condition (CQC, n.d.). In conclusion, physical restraints can be an effective intervention, but it is vital for healthcare staff to be aware of the relevant legal framework, the potential risks and side effects, and the best practices for using physical restraints. By following best practices, healthcare staff can ensure that physical restraints are used when absolutely necessary and in a manner that is respectful and considerate of the patient’s safety and comfort.
Other authors also evidence the importance of physical restraints and the ability to use them. For instance, Duxbury et al. (2019) say that restraint is a critical skill for staff working in an acute psychiatric ward. While it should always be used as a last resort, it is vital to recognise the positive impacts of restraint on staff and patients (Celofiga et al., 2022). The first positive impact of restraint on workers in an acute psychiatric ward is that it ensures the safety of the staff and other patients in the ward (Social Care, Local Government and Care Partnership Directorate health, 2014). Sometimes, a patient may become agitated and violent, which could pose a risk to other patients and staff (Social Care, 2014). In these scenarios, using restraint can help diffuse the situation and protect those in the ward. It can help to prevent physical injury and keep the ward under control of any accidents.
Moreover, the necessity of restraints in acute psychiatric wards can be understood by analysing their overall impact on the situation. For instance, Celofiga et al. (2022) assume that one of the evidence impacts of restraint in an acute psychiatric ward is that it can help to de-escalate a situation. In some cases, a patient can act aggressively and threaten others, and using restraint can help to de-escalate the situation and reduce the risk of violence. It can provide a calming effect on the patient, allowing them to gain control of their emotions and become more open to conversation and other forms of communication (Celofiga et al., 2022). The third benefit of constraint for acute mental unit staff is that it can assist keep patients safe from harming themselves (Celofiga et al., 2022). Patients may become distressed and attempt to harm themselves, which requires additional measures.
It means that the usage of restraints can be justified from the perspective of patient care and the necessity to protect them. The use of restraint can help to prevent self-harm and ensure the patient remains safe and uninjured (Duxbury et al., 2019). It can provide the patient with a sense of security and safety, making them feel secure in their environment and more open to treatment (Duxbury et al., 2019). Overall, the current body of knowledge proves that the use of restraint in an acute psychiatric ward can have positive impacts on both staff and patients. It can help to ensure the safety of staff and other patients, de-escalate a situation and protect the patient from self-harm. Recognizing the beneficial effects that constraint can have on patients is crucial, even if it should always be employed as a last choice.
Problem Evidence
In such a way, numerous authors prove the necessity of using restraints in the acute psychiatric setting because of the positive impacts it might have on all actors involved in care delivery. According to Social Care, Local Government and Care Partnership Directorate Health (2014), restraint is necessary for managing acute psychiatric wards, where patient behaviour can become unpredictable and potentially dangerous. However, the use of restraint negatively impacts staff, which can have long-term consequences for their health and well-being. The first impact of restraint on staff is psychological, as restraint is a stressful experience, even when used as a last resort to protect the patient and other staff (Duxbury et al., 2019). The decision to use restraint is often a difficult one, and staff may experience feelings of guilt or anxiety afterwards.
Additionally, physical restraint can be traumatic for both the patient and the staff member involved. Celofiga et al. (2022) admit that the employment of this measure can lead to feelings of fear and helplessness, which can have a lasting impact on staff members long after the incident has ended. The second impact of restraint on staff is physical, as physical restraint is physically demanding and can lead to muscular aches, strains, and sprains (Celofiga et al., 2022). Additionally, Celofiga et al. (2022) admit that in many cases, the use of physical restraint can place the staff member at risk of injury from the patient. This risk is incredibly high in cases of violent behaviour or aggression, where staff may be exposed to the risk of physical harm (Celofiga et al., 2022). The third impact of restraint on staff is social, implying an interaction between all actors. The use of restriction can lead to tension between staff members and patients, creating an uncomfortable work environment (Bynoe et al., 2021). This tension can lead to interpersonal conflicts between staff members, which can have a negative effect on morale.
Moreover, the existing literature shows that the use of restraint can impact employee motivation. Thus, Bynoe et al. (2021) say that the use of this measure can lead to increased workloads for staff, which can lead to burnout and a decrease in job satisfaction. In conclusion, the employment of restraint in acute psychiatric wards is necessary to protect the safety of patients and staff. However, it is essential to be aware of the negative impacts that restraint can have on staff, both psychologically, physically, and socially. Organisations need to take steps to mitigate these impacts, such as providing staff with training on how to safely use restraints and offering support for staff who have been involved in a restraint incident.
Evidence of Alternatives
Although physical restraints might be necessary for some situations, they can cause distress and physical injury and result in burnout or feelings of guilt among staff. For this reason, Bynoe et al. (2021) view the reduction of restrictive care as the major tendency in mental health services. It emerged due to the healthcare providers’ attempts to find alternative, non-physical methods of restraint when treating patients with various mental issues. For instance, Eales (2020) states that new training guidance requires nursing staff to be competent in safe holding and restraint; however, it encourages them to avoid it and use proactive and non-restrictive approaches when possible. It means that there are attempts to find alternatives and minimise the use of this practice.
Thus, the encouragement of non-restrictive methods of care is the first possible alternative that was considered to avoid ethical concerns. This could include providing more individualised care and attention to the patient, as well as implementing activities that can reduce aggression levels (Eales, 2020). Furthermore, Eales (2020) admits that the shift towards a new approach is documented in the Future Nurse standards, encompassing previous attempts to replace restraints. Thus, providing a safe and comfortable environment, and offering physical and emotional support, can all help to reduce the need for physical restraints. The second alternative is pharmacological interventions and rapid tranquillisation (Dickinson & Clark, 2020). It is a form of medical restraint, meaning it is less restrictive and humiliating for patients (Dickinson & Clark, 2020). It can be used in emergent situations and protect both clients and staff.
In addition to these two approaches, the existing body of literature highlights the importance of educating healthcare staff on the safety and effectiveness of using non-restrictive methods of care. For instance, Celofiga et al. (2022) emphasise the necessity of training on the principles of de-escalation, as well as training on how to recognise and respond to potentially problematic behaviour. Furthermore, training staff on how to use restraint alternatives, such as pharmacological interventions, could help to reduce the need for physical restraints.
Conclusion
Altogether, the use of restraint remains a disputable issue in healthcare. Although it might be necessary in some situations, it can lead to ethical issues, increased job stress among nurses, burnout and a decrease in morale, job satisfaction and motivation. In conclusion, the use of restraint in acute psychiatric wards can have several negative impacts on staff. Furthermore, the employment of restraints can promote a lack of trust between staff and patients. For this reason, there is an attempt to shift to other practices that can help to attain positive outcomes.
At the moment, investigators offer several alternatives that might be effective. These include proactive, non-restrictive practices focused on interaction with patients, considering their needs, and reducing aggression levels. In complex situations, medications can be used; however, nurses are recommended to find better approaches and avoid ethical issues that might emerge. Thus, introducing better measures will improve the recuperation processes of patients as well as the motivation and efficiency of the staff.
References
Bynoe, S., Collin, J., & Clark, L. L. (2021). Reducing restrictive practice: a pertinent issue for children’s services. British Journal of Nursing, 30(1), 70–73. Web.
Care Quality Commission. (n.d.). Brief guide: Restraint (physical and mechanical). Web.
Celofiga, A., Plesnicar, B. K., Koprivsek, J., Moskon, M., Benkovic, D., & Kumperscak, H. G. (2022). Effectiveness of de-escalation in reducing aggression and coercion in acute psychiatric units. A cluster randomised study. Frontiers in Psychiatry, 13. Web.
Dickinson, T., & Clark, L. L. (2020). Rapid tranquillisation: An issue for all nurses in acute care settings. British Journal of Nursing, 29(15), 880–883. Web.
Duxbury, J., Baker, J., Downe, S., Jones, F., Greenwood, P., Thygesen, H., McKeown, M. Price, O., Scholes, A, Thomson, G., & Whittington, R. (2019). Minimising the use of physical restraint in acute mental health services: the outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’). International Journal of Nursing Studies, 95, 40-48. Web.
Eales S. (2020). Restrictive practice: should all nurses be competent in safe holding and restraint? British Journal of Nursing, 29(3), 170–171. Web.
Social Care, Local Government and Care Partnership Directorate health. (2014). Positive and proactive care: Reducing the need for restrictive interventions. Gov.uk. Web.
