Restraints

One of the saddest things we psych nurses do in our jobs is to restrain our patients. We do this when there is danger of patients harming themselves or others. Nobody likes to participate in such an operation, neither the patient nor the staff. And such incidents can be drastically reduced with proper de-esculation methods, approach to patients and other methods.

The fact remains that placing patients in restraints is a part of most psych nurses job in the inpatient setting. Although, in many cases not a big part, fortunately.

In Iceland we only use "human restraints", we do not tie people down or restrain them using anything else but the human body, usually our arms. So coming here and seeing these chairs and tables used to "tie" people down was somewhat shocking. I am unsure if it is wrong though.

In Landspitali:University hospital in Iceland we work in teams, usually of three or four, to overcome and restrain a patient. All staff working inpatient psych are required to attend a week long course learning how to do this in a safe and efficient manner, and then are required to take a recap course for a day, every 6-12 months. The method used originates from the UK, but I have failed to retrieve material concerning its evidence base.

Somehow it feels more humanistic to restrain patients like this. It reduces the risk of staff being overly "trigger happy" since we will be with the patient each moment restraints are necessary. It also secures proper assessment and monitoring reducing the risk for adverse events like asphyxiation, or unnoticed heart attacks.

On the other hand it does take training and certain staffing levels to achieve this, and in certain patient populations, the intimacy of this procedure could be detrimental (e.g. sexually abused women, anti-social patients)either towards patients or staff.

As I said, I am unsure what is best. I would like to hear any input you might have. E.g. on the evidence base of "human restraints" vs. the other kind, your personal experience with either kind, and what you think is most important when approaching this delicate subject.