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 ((Scheepmans et al., 2017). 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, and visitors to the unit. Sometimes patients will be restrained when at risk for elopement (Marian, n.d.). There is an increased need for using restraints in hospital and home care settings (Scheepmans et al., 2017).
Certain conditions may make restraint use necessary when caring for patients for their safety: impaired cognition, increased dependency, history of falls or patients at increased risk of falling and impaired mobility. Nonpatient-related factors contributing 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. Clinical providers must attempt to collect a detailed history from the patient and their family members. Physical examination should target 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 that can induce agitation include hypoglycemia, drug or alcohol intoxication, and head trauma (Boyce et al., 2016).
Other methods of de-escalation should be tried when caring for agitated patients. Restraints should be the last resort. Using restraints when caring for patients in healthcare can negatively affect 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 Social consequences include; isolation and feeling withdrawn.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 (Boyce et al., 2016).
Although restraint use can be life-saving 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.