Author: Neelam Javed MScN student at the School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan. She did her BScN from Aga Khan University, School of Nursing and Midwifery, Karachi, Pakistan.
Physical restraints are defined as any devices that are used to limit a person’s movement. It is generally used in all hospitals to prevent patients from harming themselves or others. Although physical restraints are necessary to ensure a patient’s and staff’s safety, it has many negative impacts on a patient’s health and well-being, and we can’t neglect a patient’s health. However, it has been observed in a clinical setting that a patient who has been restrained is becoming mentally disturbed, and more aggressive and their prognosis will also become poor. However, physical restraints should be avoided in a clinical setting as it is harmful to the patients from ethical, physical, and psychological perspectives.
Physical restraint is ethically not right for patients as every patient has a right to be respected and autonomous to make decisions for themselves. A study found that physical restraints can raise ethical concerns by limiting the independence of patients, disregarding their autonomy and dignity, and also violating their rights. (Chou et al., 2019). This study identified that physical restraint can be harmful to a patient from an ethical point of view as it can violate the patient’s rights and interfere with the patient’s autonomy and dignity.
Secondly, physical restraints are harmful to patients physically by causing serious physical injuries and self-harm to them. According to Ertugrul & Ozden (2020), “As a consequence of prolonged physical restraint, neurovascular complications, such as edema, redness, numbness, limitation of movement, increase in temperature, color change, and nerve damage, can occur. If neurovascular trauma is not adequately assessed and treated, it might result in the development of ischemia, necrosis, and neurological deficit.” Lachance & Wright, (2019) highlighted the serious effects associated with physical restraints including bruises, edema, aspiration, contractures of joints, and respiratory complications. Both studies have highlighted adverse effects associated with physical restraints, so it should not be encouraged in a clinical setting to save a patient from further complications.
In addition to that, physical restraints can have a harmful psychological effect on patients, as they may feel as if they are being punished and may develop feelings of mistrust and dependence. As a result, they may end up in depression, anxiety, and other psychiatric disorders. Unoki et al., (2018) mentioned in their study that there is an increased risk of delirium and post-traumatic stress disorder due to physical restraints. Hospitalized patients are mentally disturbed due to their current illness, so it is the responsibility of the staff to make patients stress-free rather than giving them more stress by applying physical restraints.
However, there are people who may believe that physical restraints should not be avoided as they will prevent patients from hurting themselves and pulling a vital tube such as an IV cannula, etc. A study found that while physical restraint can effectively prevent further injury by restricting a patient’s movements, it can also be misused for punitive reasons. (Ye et al., 2019). This study highlighted that physical restraint should be used to limit patients to remove their tubing and achieve a patient outcome to be injury-free, but this study also highlighted its negative effects. Therefore, the opponent’s view is unclear. To address this issue, we can employ alternative approaches for handling patients who are agitated. An idea of reducing physical restraints in hospitals was supported by Ye et al., (2021), who suggested the implementation of de-escalation training programs for staff as a means of achieving this goal. Another study also supported this idea and stated that “staff training in verbal and non-verbal de-escalation techniques, the use of psychotherapies (CBT), the modulation of sensory stimuli, and the active participation of the patient in their own care is recommended as a treatment of choice over physical restraints.” (Fernandez-Costa et al., 2020). It is evident from studies that alternative measures such as de-escalation techniques can help in managing aggressive patients rather than using physical restraints.
In conclusion, physical restraints should not be encouraged in a clinical setting as they can be harmful to a patient ethically, physically, and psychologically. Therefore, it is essential to develop awareness programs for healthcare providers that emphasize the adverse effects of physical restraints and change the perceptions of staff related to it. Staff should be well educated about the alternative measures to be taken to protect patients from hurting themselves. There should be enough staffing in a clinical setting so that staff can always give attention to patients so that patients cannot pull any vital tube intentionally or mistakenly. On an institutional level, efforts should be made to develop policies that discourage physical restraints in a clinical setting. It is essential to avoid physical restraints to maintain a patient’s dignity and prevent a patient from physical and psychological trauma.
References
Chou, M., Hsu, Y., Wang, Y., Chu, C., Liao, M., Liang, C., Chen, L., & Lin, Y. (2019). The adverse effects of physical restraint use among older adult patients admitted to the internal medicine wards: A hospital-based retrospective cohort study. The journal of nutrition, health & aging, 24(2), 160-165. https://doi.org/10.1007/s12603-019-1306-7
Ertuğrul, B., & Özden, D. (2020). The effect of physical restraint on neurovascular complications in intensive care units. Australian Critical Care, 33(1), 30-38. https://doi.org/10.1016/j.aucc.2019.03.002
Fernández-Costa, D., Gómez-Salgado, J., Fagundo-Rivera, J., Martín-Pereira, J., Prieto-Callejero, B., & García-Iglesias, J. (2020). Alternatives to the use of mechanical restraints in the management of agitation or aggressions of psychiatric patients: A scoping review. Journal of Clinical Medicine, 9(9), 2791. https://doi.org/10.3390/jcm9092791
Lachance, C., & Wright, M. (2019). Avoidance of physical restraint use among hospitalized older adults: A review of clinical effectiveness and guidelines.
Unoki, T., Sakuramoto, H., Ouchi, A., & Fujitani, S. (2018). Physical restraints in intensive care units: A national questionnaire survey of physical restraint use for critically ill patients undergoing invasive mechanical ventilation in Japan. Acute Medicine & Surgery, 6(1), 68-72. https://doi.org/10.1002/ams2.380
Ye, J., Wang, C., Xiao, A., Xia, Z., Yu, L., Lin, J., Liao, Y., Xu, Y., & Zhang, Y. (2019). Physical restraint in mental health nursing: A concept analysis. International Journal of Nursing Sciences, 6(3), 343-348. https://doi.org/10.1016/j.ijnss.2019.04.002
Ye, J., Xia, Z., Wang, C., Liao, Y., Xu, Y., Zhang, Y., Yu, L., Li, S., Lin, J., & Xiao, A. (2021). Effectiveness of CRSCE-based de-escalation training on reducing physical restraint in psychiatric hospitals: A cluster randomized controlled trial. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.576662
.jpg)
0 Comments