Use restraints much?

skylark, BSN, RN · Nov 4, 2011

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 ....

That's true, restraint has all sorts of bad connotations, linked to institutions, and Victorian England!

Difficult area though - sometimes I have talked to a family and asked if they want to sit with a confused patient, that can work if confusion or disorientation is the problem. BUt the aggressive patient is different, usually we would call security to come sit with them, and once they got to a point where they were too combative, cops were called to remove them. Only problem was they would play up once they got the police cells, start saying they got chest pain, then of course the cops brought them right back to be checked over!

This thread reminds me of the joys of Notting Hill Carnival. I would show up for ER night shift, and pretty well every patient was under arrest, already handcuffed to a gurney, with cops sat there, 1:1.

You always knew it was going to be an entertaining night when there were more cops than nurses . . . . :lol2:

ayla2004, ASN, RN · Nov 9, 2011

We use restranit, have a policy. It is limited to critical care and neuro duet. It is to prevent pt with brain injuries with decreased gcs removing medical devices such as evd, trachey, and ngt or iv/cvc removing these as in there condition they lack capacity to makevdecisons etc. We use them on my ward. Generally we mittens pt hands or hand if one is weak . We are a locked ward more dol using fob in/out as traumatic brain injuries can wander without wandering off to god knows were. I wish we had this on myCOTE ward were pt with dementia wander some, and I.hated iv and my on some pt as they pulled them out ++.

MaryAnn_RN · Nov 9, 2011

We have to complete a Mental Capacity Assessment if considering the use of mits. That is the only physical restraint I've ever seen used. Those are very rarely used and are a last resort.

Meiriceanach · Nov 9, 2011

I work in the ER, and I can put on leathers and tie a slip knot like you wouldn't believe. We use them all the time. People are crazy.

Yiggs · Nov 10, 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.

I have worked on all different units in the hospital at which I work. When I just started a couple years ago it was very common for patients to be restrained, including elderly confused patients. Patients are still being restrained but not as frequently and without discretion as before. JACHO has strict regulations concerning restraint of patients because I think in the past restraints has resulted in the death of patients - whether during or after restraints have been removed. In my hospital we have a specific order form to be completed by physicians and specific forms to be completed by the nurses when we have a patient in restraints.

ExpatHopeful, LPN, LVN · Nov 11, 2011

Yiggs - I assume from your mention of JACHO that you are practicing in the US. In my current US job we also have these strict guidelines and long order and assessment forms, but despite this restraints are still applied.

I'm glad that from your perspective their use is declining, but I find it interesting that other countries (UK and Australia) essentially do not use restraints at all. This was my feeling from my own experience working in the UK which has been validated by the other nurses on this thread.

DavidFR, BSN, MSN, RN · Nov 20, 2011

Similar experience - never used restraints in the UK but have now seen them used here in France.

I think they're useful in preventing self harm and I've never seen them absued just for a quiet life. I have only seen them applied when the patient involved was at real risk of self harm, pulling out lines etc. in life threatening situations.

UK hospitals still have communal bays with nurses often placed at nurses stations where the patients are easily viewed. Naff for privacy, zero dignity but great for observation. French hospitals have patients in single rooms or two bedders along a long corridor. Great for privacy and dignity but naff for observation! I guess you can't have it all. In an isolated single room there's sometimes no choice but to restrain. Most busy acute areas cannot sacrifice one member of staff to sit in the room permanantly.