Academic journal article East Asian Archives of Psychiatry

Psychosocial Correlates of Patients Being Physically Restrained within the First 7 Days in an Acute Psychiatric Admission Ward: Retrospective Case Record Review

Academic journal article East Asian Archives of Psychiatry

Psychosocial Correlates of Patients Being Physically Restrained within the First 7 Days in an Acute Psychiatric Admission Ward: Retrospective Case Record Review

Article excerpt


Appropriate usage of physical restraint has challenged psychiatric nurses on ethical and practical levels. Physical restraint has been used frequently to manage challenging behaviour and to safeguard both patients and staff. Clinically, patients' characteristics seem important enough to predict the use of physical restraint. It is worthwhile examining the psychosocial profile of patients undergoing physical restraint in the acute psychiatric admission ward. A review of the extant literature shows that there have been very few studies on the psychosocial correlates of patients receiving such treatment. It would therefore be interesting to examine whether there are any significant psychosocial factors exhibited by patients via the use of physical restraint. Through understanding patient profiles, it is intended that psychiatric nurses will be able to identify the high-risk group for physical restraint. This would allow them to promptly provide intensive nursing care so as to minimise the application of physical restraint.

Guidelines for Physical Restraints

Systematic literature review on physical restraint of adult psychiatric inpatients indicates that, by physically restraining a patient, the use of physical force is applied to prevent or restrict a patient's movement. Mechanical devices for physical restraint include straps, cuffs, belts, and some other external devices to restrict a patient from moving. In the psychiatric setting, mechanical restraints involve strapping a patient to a bed in the supine position with wrist and ankle cuffs, with or without a belt across their waist. This is known as the 'four- or five-point restraint'. (1) Hence, physical restraint in this study is defined as "the use of mechanical devices including safety vests, magnetic limb holders, magnetic shoulder straps, pelvic holders, magnetic waists and abdominal belts applied to the patient's wrists, ankles, shoulders, waist and body that restrict freedom of movement or being secured to the bed or chair". (2)

In the UK, the Royal College of Nursing offers guidelines stating that physical restraint should only be used when all other methods of managing the identified problem are considered not suitable or have failed. (3) In Ireland, however, there is no legislation about restraining adults. (4) In Australia, guidelines for the use of restraint vary across different states. (5) In Israel, psychiatric nurses are allowed to restrain patients independently. (6) Nurses in Canada are prohibited from using any form of restraint without consent from the client or decision-maker, except in some emergency situations. (7) In the US, the JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and the HCFA (Health Care Financing Administration) have both stated clearly that "Seclusion and restraint must be a last resort, emergency response to a crisis situation that presents imminent risk of harm to the patient, staff, or others". (8) In China, there are no nationwide standards concerning physical restraint. (9) In Hong Kong, strict standards and regulations have been applied regarding the use of physical restraint. Nurses are required to complete special documentation and observe the process of restraint application. (10)

Prevalence Rates of Physical Restraint

According to the study by Stewart et al, (11) there is a lack of reliable estimates on the prevalence of physical restraint. Since then, various methods of calculating the rate of physical restraint use have been developed with no consensus reached. (12) Some studies have suggested that the prevalence rates of physical restraint were very low in psychiatric settings, while other studies have recorded high prevalence rates of physical restraint, with 1 in 3 patients (or more) being restrained during their hospital stay. (13) In the US, Canada, Finland, Switzerland, the Netherlands, and Hong Kong, physical restraint is defined as any type of physical restraint applied during the last (or past) 7 days of a patient's stay at the hospital, including trunk or limb restraint and chair restraint preventing rising, but excluding use of bedrails. …

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