Scheepmans et al. define physical restraints as any actions or devices which healthcare workers or caregivers use to restrict a patient’s freedom in any way.1 At times, it is hard for healthcare providers to define the term restraints. Sometimes administering prescribed medications can be a form of chemical restraint.
The use of restraints relies on the clinical provider's judgment of the immediate risk the patient poses to themselves, other patients, the staff working on the unit, as well as visitors to the unit. Sometimes patients will be restrained when they are at risk for elopement.2 There is an increased need for the use of restraints in both the hospital and home care setting.1
Certain conditions may make restraint use necessary when caring for patients for their own safety: impaired cognition, increased dependency, history of falls or patients at increased risk of falling and impaired mobility. Nonpatient related factors which may contribute to the use of restraints include staff skills and abilities, state legislation associated with restraint use, and staffing ratios for the hospital or facility.
Emergency room clinical providers must consider all possibilities when caring for agitated patients, including underlying psychiatric disease, alcohol abuse, drug intoxication or other life-threatening disorders, including metabolic disorders. It is imperative that clinical providers attempt to collect a detailed history from the patient and their family members. Physical examination should be targeted towards identifying the patient’s underlying cause of the agitation. Any underlying medical conditions should be addressed accordingly to obviate the need for unnecessary treatments. Examples of medical conditions which can induce agitation include hypoglycemia, drug or alcohol intoxication and head trauma.3
When taking care of agitated patients, other methods of de-escalation should be tried. Restraints should be the last resort. The use of restraints when caring for patients in the healthcare setting can have negative consequences for both the patients and clinical providers. Consequences can be physical, social and psychological.
Examples of physical consequences of restraint use include; pressure ulcers, incontinence and bruising. Social consequences include; isolation and feeling withdrawn. Psychological consequences include; depression, anger and fear. Restraint use can negatively affect family members by evoking feelings of anger, worry and guilt. Healthcare providers can also be negatively impacted by their feelings of guilt.3
Although restraint use can be lifesaving when taking care of an altered, violent or psychotic patient, there can be adverse effects associated with the use of restraints. For example, mechanical restraints can inhibit further rapport with the patient. In addition, the application of restraints can be traumatic for the patients and cause them to be more withdrawn.