The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Abstract

Aggression is reported to be prevalent in psychiatric inpatient care and its frequency towards healthcare professionals is well documented. While aggression may not be entirely avoidable, its incidence can be reduced through prevention and the minimization of restrictive practices such as physical restraint. The study aims to explore three common 'defences' to account for the use of physical restraint; to challenge each defence with regard to the evidence base; and to identify how services are responding to the challenge of reducing the use of restrictive interventions. Following a number of investigations to highlight serious problems with the use of physical restraint, it seems timely to examine its efficacy in light of the evidence base. In order to do this, three key defences for its use will be challenged using the literature. A combination of interventions to minimize the use of restraint including advance planning tools, and recognition of potential trauma is necessary at an organizational and individual level. Patients can be severely traumatized by the use of restrictive practices and there is a drive to examine, and reduce the use and impact of using these models that incorporate trauma informed care (TIC) and person centredness.

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

“…This has been criticised by progressive organisations, staff and service users (Rose et al . , ), prompting initiatives to minimise restrictive practices (Duxbury , Moran et al . , Muir‐Cochrane and Gerace , Paterson and Duxbury , Watson et al .…”

An integrative review exploring decision‐making factors influencing mental health nurses in the use of restraint

“…Some of the physical injuries identified in studies include coma, abrasions, bruises, and fractured bones, as well as, deaths due to asphyxiation, cardiac arrest, strangulation, drug overdose or interaction, blunt trauma, choking and neglect secondary to the use of restraint and seclusion (Mildred ). Sailas & Fenton () argue that continuing the use of restraint must be questioned from within well‐designed and reported randomized trials that are generalizable to routine practice (Duxbury ).…”

What factors influence the decisions of mental health professionals to release service users from seclusion?

“…There is an increasing body of literature evaluating ways in which seclusion is used to manage violence and aggression in mental health care (Duxbury ). However, this is the first integrative review to focus solely upon the factors considered by mental health professionals when making decisions to release service users from seclusion within inpatient settings.…”

“…), or result in more injuries to service users and staff (Moylan & Cullinan ). However, this is disputed and not supported by evidence (Duxbury ).…”