Use restraints much?

Silverdragon102, BSN · Oct 28, 2011

I worked for over 15 years in the UK in hospital and part from one instance in 86 where we covered someone's hands (at family request) because they kept pulling their PEG tube out we never used restraints on anyone.

bobby123 · Oct 29, 2011

I worked in the UK for 8 years in both hospitals and nursing homes but I've never seen any physical/equipment restraint applied to patients. The closest to restraint that I saw was the use of the bedside table -' so they won't get up from the chair by themselves' excuse - shunned by the UK profession of course. I had to deal with demented aggressive patients, having to call on security, asking staff to follow a patient around, putting IV cannulas 4-5 times a day for the same patient because she kept pulling it out and she gets terrible hypoglycaemic episodes, having to follow a demented patient and clean after him while he is 'dumping' on the floor and walls. It's why the UK came up with beds that can go as low as the floor so patients can roll to a soft surface...and all this in an Older Person's ward (elderly for most people but just for political correctness, I guess). It actually feels good to share that experience because now I'm in Australia and we use all sorts...from poseys to soft shackles, mittens and for that special someone - hard shackles.

Don't mean to judge UK nurses over the subject but I've seen the benefits of using restraints in my work. I now work in Ortho and it helps us help patients prevent further injuries, not just patients already diagnosed with dementia before admission but also postop delirium cases.

ExpatHopeful, LPN, LVN · Oct 29, 2011

Thanks for confirming my suspicion, that this is indeed a UK-US difference. I felt strange being totally unfamiliar with restraints despite my experience, when restraining patients is so common here.

I suppose I'll have to wait until I have some experience with using restraints here before I judge which is the better system. At the moment I sort of cringe inside at the thought of tying another human being down as if they were a dog. I can see how dementia/delirium/aggression leads to interrupted medical treatment, but maybe that's a sign that they less agressive interventions. Or do you think that's being too naive? My colleagues also say that restraining patients physically generally aggravates their agitation. So how is that ultimately helpful?

I guess I'm just trying to come to terms with this before I have to apply restraints on a patient here. At the moment it seems so barbaric to me.

Silverdragon102, BSN · Oct 29, 2011

I hate the thought of restraints, Now in Canada and i know where I work we use wheelchair restraints on a couple of patients otherwise we use alarms that indicate a issue letting us get to the person before injury (in most cases) happens, but have to follow a strict guideline and strict protocol and i work very much with elderly and dementia.

Silverdragon102, BSN · Oct 29, 2011

This I think is a good subject to discuss.

I do believe there are other options that can be used before restraints like looking at what triggers the patient. Is it another patient/nurse/family member/other multidisciplinary team member/friend? What sort of things calm the patient down? What can be done to prevent recurrence?

JDZ344 · Oct 30, 2011

So here is a question for you UK nurses....
I worked as an HCA for several years in England on a med-surg ward and cannot recall EVER seeing restraints placed on a patient. Certainly, I never applied them. While we did not have alcohol/drug detox patients on our ward we had many with dementia/delirium and never put them in restraints. Now I am starting work as an RN back in the states and am finding that it is apparently very common to put patients in restraints here. Do you use restraints much where you work? I can't figure out if I was just on a very unique unit or whether this is a UK-US difference in nursing practice.

We are not allowed to use restraints in my UK hospital.

Now I am told that psychiatric wards use types of restraint- how true that is, I couldn't say as I have never worked psych.

ExpatHopeful, LPN, LVN · Oct 31, 2011

Hmmm, it seems here that chemical restraints are considered to be a greater deprivation of liberty than physical restraints. Unless a patient has a psychiatric diagnosis we are essentially never supposed to use chemical restraints from what I can tell.

Personally, I think I would prefer to be sedated if I was agitated than tied up, but I guess I can see how altering someone's mind could be considered the greater violation.

@Silverdragon - there is indeed a long list of behavior modification strategies that must be tried and proven not to work before physical restraints can be applied at my hospital. Having family or friends sit at the bedside, offering physical distractions, etc.

Zombi RN · Oct 31, 2011

Do you still not use restraints in the UK in critical care, IE when the patient is intubated to keep them from extubating themselves?

How interesting.

allnurses Guide · Oct 31, 2011

Do you still not use restraints in the UK in critical care, IE when the patient is intubated to keep them from extubating themselves?
How interesting.

It depends where you work, our critical care do use restraints as a last resort, we have 1:1 care for ITU patients so its easier to prevent the need to use restraints.

ceridwyn · Nov 2, 2011

To consider physical restraints in Australia is usually,considered horrific and very last resort. Even cot sides are considered restraints, though post op this little indiscretion is overlooked and considered also duty of care. Fixed tables on chairs in long term care are restraints and these must be removed after meals, if residents use these to eat.

ICU is also 1:1 and are not restrained unless thought appropriate and must be given the okay by consulting Doctor.

ZippyGBR, BSN, RN · Nov 3, 2011

Now I am told that psychiatric wards use types of restraint- how true that is, I couldn't say as I have never worked psych.
Interestingly, we used to use a lot more chemical restraint at our place than we do now. They are massively cracking down on it. The person has to be a serious threat to themselves or others before the nurse is allowed to sedate.

physical restraint has a bad reputation in the UK due to past misuse as has the misuse of antipsychotics etc ( often in LTC settings to reduce the need to staff properly)

the 'restraint' on psych areas witll be 'control and restraint techniques' the 'open hand' parts of what they teach Police / prison officers i.e. locks how to put someone to the floor safely , how to 'sit on' someone safely ....