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The use of physical restraints in Australian hospitals has been a common practice for many years. However, this is a very controversial issue at the present time, with pressure on hospitals to reduce the use of physical restraints. According to Best Practice (2002, p. 2), in Australia, approximately 10% of acute care patients were restrained physically in 2002. In residential care, up to 50% of patients were restrained (Best Practice, 2002, p. 2). This equates to a large number of patients in hospitals being restrained. Nurses have a responsibility to protect their patients from harm and to make sure the environment is always safe for their patients. For this reason, in certain situations, the use of physical restraints still has to be practised in hospitals.
In this essay, the following definitions will be used. According to Braun and Lipson (1993, p. 46), physical restraint refers to any material or equipment attached to a patient’s body to restrict the patient’s freedom of movement or normal access to their own bodies or the environment around them. Secondly, according to Lusis (2000, p. 145), an acute care setting is a ward in which patients with severe injuries or illnesses receive medical treatment intensively. Finally, for the purposes of this essay, nurses and patients refer only to hospital nurses and patients in acute care settings.
This essay will discuss the reasons why nurses need to restrain patients in specific circumstances, especially in acute care settings, and the essential procedures that need to be followed before the use of physical restraints can be justified.
The environment in hospitals is not always safe for patients. Therefore, the use of physical restraints has become a normal practice for protecting patients and controlling disruptive behaviour in acute care settings (Smith, Timms, Parker, Reimels, & Hamlin, 2003, p. 26). In particular situations, it will be necessary to use physical restraints. There are three main reasons for the use of physical restraints in such situations.
The first reason why nurses need to restrain patients in hospitals is to prevent the risk of injury. According to Forrester and Griffiths (2005, p. 87), nurses should foresee and predict the possible risks of injury to patients. Moreover, it is essential for nurses to have the practical knowledge to understand the side effects of whatever they are doing with the patient (Braun and Lipson, 1993, P. 109-110). For example, nurses may bind a patient’s body to his bed or wheelchair to prevent the risk of him falling out of his bed or slipping from his chair (Barazovski & Roisn, 1997, p. 1). This means nurses should decide on the appropriate response to risk based on their observation and take all precautions to ensure the safety of their patients.
Secondly, the prevention of violence is also important (Braun & Lipson, 1993, p. 107). The use of physical restraints in the management of violence is not only for psychiatric patients but also for patients in acute settings. For example, in the case of intensive care units, patients will receive continuous medical treatment over a 24 hour period. Moreover, patients are likely to face the possibility of death. This situation makes patients nervous or excessively anxious. Because of this, patients tend to show psychiatric symptoms, such as delusion and hallucination (Wright, 1999, p. 461). These symptoms may lead to patients being violent to themselves or other patients or even staff (Doenges, 1998, pp. 219-222). It is necessary for nurses to prevent violent outbursts by patients in order to maintain the individual’s state of health and overall safety in the hospital (Fry & Johnstone, 2002, p. 67). This means that the health of patients should be taken care of and every precaution taken so that they do not face any danger of injury unrelated to their illness.
The final reason is to guarantee that patients do not interfere with their own medical treatment (Braun & Lipson, 1993, p. 107). According to Fry and Johnstone, nursing practices must be responsible for protecting medical treatment (2002, p. 124). For instance, nurses should prevent patients from touching the vital lines, such as nasogastric tubes, catheters and i.v. cannulas (Barazovski & Roisn, 1997, p. 1). The disruption of these vital lines could cause the death of the patient if they are pulled out by patients who are out of control. Therefore, nurses must pay attention to this possibility and be prepared to consider physical restraints as a preventive measure.
Physical restraints should be used only as a last resort to restrict patients’ behaviour (Lusis, 2000, p. 147). Therefore, there must be a set procedure to be undertaken by nursing staff to show that physical restraint is really warranted. According to Braun and Lipson (1993, p. 107), there are four points to observe before the use of physical restraint.
Firstly, nurses need to collect accurate data and analyse this information carefully in order to assess the situation (Braun & Lipson, 1993, pp. 107-109). In other words, to make the decision to restrain patients, nurses need to identify the potential for injury or harm to their patients (Lusis, 2000, p. 147). This means nurses must perform comprehensive and appropriate health assessments of all patients in hospitals (Braun & Lipson, 1993, p. 107). Careful analysing is the most important part of this process because it will ascertain the reasons for restraining particular patients (Lusis, 2000, p. 147). Therefore, nurses need to assess the patients and their conditions correctly in order to avoid unnecessary restraint.
Before the use of physical restraints, nurses should also have plans and goals to achieve the most effective care. It is necessary for nurses to consider the correct balance of comfort, freedom of movement, safety and independence for the patients during the period of physical restraint (Braun & Lipson, 1993, p. 109). In other words, although patients may be physically restrained, they must be allowed some free movement, albeit in a limited sense. This means nurses need to observe their patients who are restrained frequently in order to keep the patients safe. These considerations should be included in the care plans made for each patient. In addition, it is also important for nurses to decide when patients should be released from physical restraint (Braun & Lipson, 1993, pp. 109-110). In brief, a patient care plan with clear objectives is an important factor when considering the use of restraints.
Thirdly, before nurses do apply physical restraint, they should be aware of the negative side effects of such a procedure (Braun & Lipson, 1993, pp. 109-110). It is extremely important for hospitals to educate their staff about these side effects (Braun & Lipson, 1993, p. 110). This means nurses should understand how to restrain patients properly and be informed as to which parts of their bodies tend to suffer from the side effects of standard restraints. It is also necessary for nurses to be familiar with the various types of physical restraints that are available and know the patient’s behaviour patterns and needs (Lusis, 2000, p. 147). Therefore, a detailed knowledge of restraint equipment and techniques is essential for all nurses before applying restraints.
Finally, family members of patients should be involved before physical restraints are used (Braun & Lipson, 1993, p. 110). In other words, family members must be informed of the reasons for using physical restraints. Furthermore, it is essential to obtain consent from the patient and their families for the use of any form of physical restraints (Braun & Lipson, 1993, p. 110). These procedures are necessary for the emotional good of the patients and their families. In addition, nurses are protected from disputes with patient families and are therefore free to continue their care of the patients with confidence. Family involvement and consent are essential.
In conclusion, the use of physical restraints is an inevitable practice in special situations, such as the prevention of risk of injury, the management of violence and the facilitation of medical treatment. Before the use of physical restraints, nurses must assess all the information gained by their observation carefully. To involve the patients and their families is also an extremely important part of the process. In addition, it is necessary for nurses to consider the human rights of their patients and the ethics of nursing. The use of physical restraints cannot be avoided in some circumstances. However, nurses are required to evaluate the situation appropriately in order to minimize the use of physical restraints and ensure the best care for their patients.
References
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