Physical Restraint in Mental Health Facilities should be a Last Resort

The Mental Capacity Act (MCA) 2005 states that “an act done, or decision made, under this Act, for or on behalf of a person who lacks capacity must be done, or made, in his best interests’. The Deprivation of liberty safeguards are a legal framework introduced into the mental capacity act 2005 (MCA) by the mental health act 2007 (MHA). This legislation protects the rights of people in care homes or hospitals, where the care is imputable to the state, who lack capacity or have a mental dysfunction to make decisions regarding their care and treatment (Jones, 2008 p 383). DOLS ensures against arbitrary deprivation of liberty (dol) which was identified in the Bournewood Case ( HL v UK 45508/99 (2004) ECHR 471). The judgement in this case determined that in order to adhere to the ECtHR, lawful detention needed to meet Article 5 (1) that requires a ‘procedure prescribed by law’ and Article 5 (4) which requires a means to apply to a court to see if deprivation of liberty was unlawful (dols code of practice 2008). As such, the DOLs are designed to protect the rights of people who fall within the scope of the act.

Tim has a long history of mental illness and was admitted to the ward following a deterioration in his mental illness after he lost contact with his son. His mood was elevated and he felt very restless and agitated. Prior to admission, he was found police in a very distressed state. Tim was placed on a section 2 of the mental health act (DH, 2007) and was originally observed generally where a member of staff would have to see him face to face on a hourly basis (NICE, 2005). Under section 2 of the mental health act Tim has lost the right to leave hospital at will and his responsible clinician has not granted him section 17 leave. A person can be detained for up to 28 days and treat against their will (DH, 2007). As Tim was detained it was important for staff to keep him on the ward.

As health care workers we are under a legal obligation to protect an individual from any kind of abuse, whether it is physical, financial, emotional, sexual or psychological .Legislation, policies and procedures exist to promote a safer working environment and reduce the potential for risks occurring. They are tailored for the needs of each setting, known and understood by employers and employees and reviewed on a regular basis.

The use of less lethal weapons that are approved by TDCJ are by using restraints, protective equipment, chemical agents, and less than lethal ammunition. The restraints are defined as a measure or condition that keeps someone or something under control or within limits. Restraints in corrections system are used to escort offenders from place to place and controlling the offenders. The restraints that are approved by TDCJ are hand and leg restraint cuffs and a belt restraint. The officer puts on the hand and leg restraint cuffs which are a pair of lockable linked metal rings hooked together with a chain that is approximately four inches long for hands and twelve inches long for legs. Then belt restraint are used as a strong wrap around the offenders waist that has chains that connect the hand and leg restraint cuffs to the belt restraint. These restraints together keep the offender from having full mobility. Which according to most studies, it has helped prevent attacks on officers (Smith,R.2009). The use of protective equipment such as riot helmets, riot shields, riot batons, and stab vest. These protective equipment are mainly used when an offender or offenders are causing a violent public disturbance, or riot; it was to calm the violent offenders, yet protect the officers from being injured or killed. By having the riot helmets, shields, and batons helps

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.

Restraints prevalence is another NIS that could assist the nurses in the above scenario to identify

Restraints is an intervention used to confine a person to prevent injury to self or others. Different types of restraints include physical, chemical and seclusion. A physical restraint is anything that prevents the patient from being able to freely move. This can include seat belts, wrist restraints, vests, bed rails, etc. A chemical restraint is using a drug for sedation which also restricts movement or freedom. An example of a chemical restraint can be an antipsychotic. These drugs can be used to reduce anxiety, aggression, and violent behavior. Lastly, seclusion is isolating or confining the patient to a room where they cannot leave. This form of restraint is also to protect the patient from harming them self or others. The use of restraints or seclusion can be a useful intervention if all other interventions have failed. Patients should not be harmed with these restraints so it is crucial they are done properly. Patients who are put in restraints

This work is using two original research papers and their findings to analyse the validity of the practice of SR (seclusion and restraint) in psychiatric inpatient facilities. The research papers chosen shed light on this questionable practice by analysing multiple patient characteristics and the events leading to SR. The other chosen research paper evaluates the inpatients perception of SR.

The Joint Commission and Centers for Medicare and Medicaid Service (CMS) have acknowledged, “Physical restraints are considered an infringement of patient rights and a patient safety concern” (Mion, Sandhu, Khan, Ludwick, Claridge, Pile, & ... Winchell, 2010, p. 1279). These organizations have amended and aligned their regulation requirements on the use of restraints which is mainly focused on limiting its use and putting emphasis on staff education and training (Cosper, Morelock & Provine, 2015). The nursing discipline guided by these regulations should aim to improve standards of care and patient outcomes through best nursing practice. “Best practice supports individualized care that permits nursing the person safely and without physical or chemical restraint” (Cotter & Evans, 2010, p.197). The goal of this review is seek evidence to substantiate the implications of such guidelines.

The goal of this paper is to explore the use of restraint in psychiatric care. I realized that while I have first hand experience performing restraints, while I worked as a mental health specialist at Mclean hospital, I haven’t explored much of the research around restraints., I start by describing parts of restraint training, as well as, factors to avoiding restraints. Then, I describe polices and the actual mechanisms of restraint. Followed by, a reflection of how my experience with restraints changed over the year I worked at Mclean. The reflection takes on a more story like tone. To finish the paper I will discuss some research that has been conducted on restraints in psychiatric care and how they can be prevented. I want to make it clear

I strongly believe physical restraints are used to increase the patient’s safety but often has an effect opposite of the intended purpose, which is to protect the patient from injury. Under the review of literature that I have gone through, in my opinion restraints should be used according to the Least Restraint Policy ( J. Williams et al, 2010). The first rule as a nurse is to understand your patient that you are taking care and only then you will be able to figure out the reasons for a patients behaviour and can act accordingly by taking into account the alternative measures. As nurses we should consider the risk of using a restraint and must use our clinical judgment and decision making power to make the best choice for the patient.

The first step in identifying concerns that impede patient care is to educate staff, enhancing their understanding of nursing-sensitive indicators, and how to improve quality of care through recognition of those indicators (ANA, 1999). In the scenario regarding Mr. J, many concerns are identified which makes me question the organizations awareness of nursing-sensitive indicators, hence the lack of staff education. A significant nursing-sensitive indicator acknowledged in this scenario is the use of restraints. What is the reasoning for the use of restraints on Mr. J? What knowledge do the nurses have regarding the use of restraints on patients? Do the nurses understand state and federal regulations and potential risks for both patient and staff associated with the use of physical restraints? What alternatives were recognized and utilized before initiating restraint’s on Mr. J? There appears to be a lack of education amongst the nursing staff relevant to the use

I think you identified good areas in the hospital that could support your concerns of the recent increase in the use of physical restraints as well as the use of sedating medications. Patient safety is always our priority whether we are a bedside nurse or family nurse practitioner. The most up-to-date evidence-based research should remain in continuous efforts to identify the safest and most effective means of restraints. This can be achieved through the case-control study you mentioned in your post. In addition to the information you provided about this specific study design, Curley and Vitale (2016), identifies both its strengths and weakesses. Strengths of the case-control study design include, "inexpensive, shorter time to completion,

During handover of the patient the paramedic received criticism from a doctor implying unnecessary immobilisation of the patient. The immobilisation equipment was removed in the Emergency Department and the patient subsequently began complaining of cervical spine tenderness.