Physical Restraint Use in the Hospital Setting: Unresolved Issues and Directions for Research

Abstract

Although the use of physical restraint has declined in nursing homes, the practice remains widespread in hospitals. The use of physical restraint in hospitals was reviewed to identify the current clinical, legal, and ethical issues and the implications for policy and further research. Clinicians use physical restraints to prevent patient falls, to forestall disruption of therapy, or to control disruptive behavior, but they vary in how they determine to institute these restraints. The evidence to support the reasons for their determinations is not compelling. Fear of litigation remains a powerful motivator. The ethical dilemma of autonomy versus beneficence has not been resolved satisfactorily for patients in this setting. The lack of large-scale studies in any of these areas makes it difficult for policy makers to determine whether it is necessary to address hospital physical restraint practices through additional regulation.

Prevalence and Variation of Physical Restraint Use in Acute Care Settings in the US

“…Practitioners' use of physical restraints (PR) in healthcare settings is a controversial practice that occurs in developed countries worldwide (Choi & Song, 2003; Hamers & Huizing, 2005; Jehan, 1999; Karlsson, Bucht, Eriksson, & Sandman, 1996; Lee, Chan, Tam, & Yeung, 1999; Minnick, Mion, Leipzig, Lamb, & Palmer, 1998; Molassiotis & Newell, 1996; Werner & Mendelsson, 2001). Although intended to protect patients, physical restraint can have direct deleterious effects, e.g., pressure ulcers and death (Berrol & Berrol, 1988; Di Maio et al, 1986; Dube & Mitchell, 1986; Lofgren, MacPherson, Granieri, Myellnbeck, & Sprafaka, 1989; McLardy‐Smith, Burge, & Watson, 1986; Miles & Irvine, 1992; Miles & Meyers, 1994; Mion, Minnick, Palmer, Kapp, & Lamb, 1996; U.S. Department of Health and Human Services [USDHHS], 1992).…”

Organizational Characteristics and Restraint Use for Hospitalized Nursing Home Residents

“…Over the past 10 years, federal agencies and professional organizations have advocated the reduction or elimination of physical restraints in acute care settings 3–5 . Practices and outcomes of physical restraint use in hospital settings have been identified as research priorities, 6 but the extent of physical restraint use in hospitals remains unknown because no formal regulatory mechanism for tracking prevalence exists. The few studies of physical restraint use in hospitals indicate a prevalence rate ranging from 3.4% to 18.5%, with adults aged 65 and older more frequently restrained 7–13 .…”

“…Nurses are most often the personnel who initiate restraint use 8,11,15,18–21 and do so for reasons of patient safety, mostly associated with fall risk, treatment interference, and behavioral phenomena 7,10,11,13,19–21 . Restraint use occurs despite any substantive link between restraint use and prevention of injury 6,22 …”

Contenção física no hospital psiquiátrico: estudo transversal das práticas e fatores de risco

“…As condições psiquiátricas que usualmente requerem indicação de contenção física são agitação psicomotora, confusão mental e agressividade ou violência em relação a si próprio, a objetos e/ou a outros e que não responderam às intervenções menos invasivas 14 , e a prevenção de quedas 18 . Apesar de as indicações serem consensuais entre os especialistas, as evidências empíricas de que a contenção física seja uma intervenção segura e eficaz são insuficientes 19 .…”

“…Isso envolve a descrição da incidência de seu uso e dos fatores associados, da técnica utilizada e dos riscos e benefícios de seu uso. Embora já exista um razoável corpo de publicações internacionais sobre as práticas da contenção física [1][2][3][4][5][6][7][8][9][10]12,[14][15][16][18][19][20][21][22][23][24][26][27][28][29] , no Brasil, de nosso conhecimento, existem poucas análises descritivas 11,17,30,31 . O objetivo deste estudo foi avaliar o uso da contenção física no contexto de um hospital psiquiátrico público de Belo Horizonte, descrevendo a frequência e as técnicas de sua utilização, as características dos pacientes submetidos e os fatores de risco associados.…”