Balancing the use of Restraint

Shedding light on the use of restraint in a mental health setting, Sanaz Riahi presented the findings of an integrative review at the latest Grand Rounds session.   The review was completed on research studies available about the factors influencing the decision to use restraint by mental health nurses.

Excited to share the findings, Riahi indicated that there is no standard definition for restraint as used in a mental health setting.  “However the consensus is that restraint is usually a measure designed to confine a patient’s bodily movement,” shares Riahi.

Restraint can be mechanical, physical or manual, the use of seclusion or chemical. The focus of this integrative review was on mechanical, physical and or manual restraint.

“Restraint is usually used when there are cases of violent behaviour, abscondment, patient agitation, property damage, self-harm or refusal to take medication,” adds Riahi.

Examination of the literature about the use of restraint shows that there is increasing evidence of negative impact as a result of its use, such as anger in both patients and nurses.  “In addition, there remains lack of evidence to demonstrate the effectiveness of the use of restraint in a mental health setting,” explains Riahi, while also conceding that there are gaps in the literature.

On the other side, there are emerging themes that are identified as the factors positively affecting the decision making of the mental health nurses.  The first of which is safety for all. In one study, 70.5 percent of nurses agree that restraint was necessary for use to ensure that both nurses and patients are safe. 

Other themes that emerged include seeing restraint as a necessary intervention and a “necessary evil”, that it should only be used as a last resort, and that it was needed to maintain control in a difficult situation.

There were also some interesting findings about staff mix and how this influenced the decision to place a patient in restraint. “In one case 51 percent of nurses responded that when there was insufficient staff or inexperienced staff on a particular ward, the decision to use restraint differed,” shares Riahi.

The overall findings of the integrated review are that the use of restraint is paradoxical.  “While there is increasing evidence of negative impact on patients and staff, there is also the strong feeling that the use of restraint is necessary, usually for safety reasons,” says Riahi.

To conclude the presentation, the audience was reminded that there are a number of alternatives to restraint that are used in a mental health setting in general, and in particular, at Ontario Shores.