Nirjhari Chhaya

Using Restraints - Implications on Nursing Practice

N01007956

Review of Attitudes, Opinions, Behaviors, and Emotions of the Nursing Staff Toward Patient
Restraint
M. Gelkopf, Z. Roffe, N. Werbloff, and A. Bleich
Issues in Mental Health Nursing (2009) 30(12), 758-763
Nirjhari Chhaya
N01007956
March 04, 2015
NURS 150: Practical Nursing Theory 2

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Nirjhari Chhaya

Using Restraints - Implications on Nursing Practice

N01007956

Using Restraints - Implications on Nursing Practice

Introduction:
Restraints are a means of controlling a patients behavioural or physical activity; they
could be physical, chemical, or environmental restraints. The use of restraints raises many ethical
concerns in nursing practice. There are many different opinions as to whether the use of
restraints should be allowed, and under what circumstances it is okay to use restraints. Nurses
play a substantial role in determining if the patient needs a restraint or not, therefore it is critical
that nurses have the correct outlook when considering the use of restraints. There are three
important implications of restraints on nursing practice. These including having the required
skills and education to work with restraints, having the correct tools to attend to situations that
require restraints, and having the right attitude for the use of restraints.
The article I have selected is Attitudes, Opinions, Behaviors, and Emotions of the
Nursing Staff toward Patient Restraint, by M. Gelkopf, Z. Roffe, N. Werbloff, and A. Bleich. I
selected this article because I wanted to gain an understanding of how nurses perceive the use of
restraints. This article discusses the attitudes and opinions nurses have about restraints as well as
about the patients receiving them. The article also focuses on the on the different categories of
nurses involved, based on gender, the unit they worked in, as well as the amount of experience
they had. The main point the article is trying to make is that there should be other alternatives
and if restraints are used, then nurses need to be properly skilled to use them.
Required Skills and Education:
Continuous learning is a vital part of the nursing practice. It is important to have the right
skills and education to complete any procedure and to provide competent care. With the use of
restraints comes a great responsibility because it is essentially taking the patients rights away. If

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Using Restraints - Implications on Nursing Practice

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nurses do not have the correct skill set, they will not know how to deal with a situation correctly.
In the article, Attitudes, Opinions, Behaviors, and Emotions of the Nursing Staff Toward Patient
Restraint the author states, Goren and Curtis (1996) examined staff beliefs regarding seclusion
and restraint in hospitals. They found that constant use of forced interventions when the staff
projected low confidence for coping with violent behavior, led to responding with avoidance or
compulsory treatment of the violent patientcharacteristics that may correlate with an unskilled
staff and highlights the necessity for the nursing staff to acquire the appropriate skills (Gelkopf,
Roffe, Werbloff, Bleich, 2009, p. 6). This proves that staffs that lack the appropriate skills to deal
with patients who fit the criteria of being put on restraints are more likely to use restraints as
they do not know how to deal with the situation otherwise. This is a matter of great concern as
this means that patients safety and rights are compromised due to the lack of knowledge of the
nursing staff. Under the Quality Practice Setting of the CNO Practice Standard Document on
Restraints it is stated that in order to maintain a quality practice setting and supports for
professional nursing practice, it is important to educate the staff on the nursing process as it
relates to least restraint practices and client rights (College of Nurses of Ontario, 2010). This
reiterates the importance of having sufficient and correct education in the maintenance of
professional nursing practice and providing competent care. Therefore, having the proper
knowledge and skills is important to the nursing practice, in general and specifically concerning
the use restraints.
Correct Tools:
In order to complete any task it is first important to have all the correct tools to do that
task. The same principle can be applied in nursing practice specifically when dealing with
restraints. Having the correct tools does not mean having the right type of restrain, but rather
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Using Restraints - Implications on Nursing Practice

N01007956

having alternatives to those restraints. Restraints are supposed to be used as a last resort and
therefore, it is important to have other tools to deal with patients. First and foremost, the most
important tool is to have adequate staffing. In the article Nurses' Physical Restraint Knowledge,
Attitudes, and Practices: The Effectiveness of an In-Service Education Program, the author
states, "Several studies also found that inadequate staffing increased restraint use frequency"
(Huang, Chuang, Chiang, 2009, p. 2). This proves that not having enough staff to take care of the
patients can put patients at risk of being put on restraints. This is neither fair to the patients nor to
the staff and therefore, it is important to have adequate staffing. Therapeutic communication is
another tool can be used as an alternative to restraints. Using restraints is the last resort, but if the
problem can be solved with the use of communication, it is both beneficial to the patient and the
nurse-client relationship. In the article Patient restrictions: Are there ethical alternatives to
seclusion and restraint?, the author presents an alternative method to using restraints and states,
"Nurses being present and conversing with patients give patients a feeling of safety and comfort,
and also potentially give nurses a better insight into what is happening with and to the patient.
Being present and having a conversation also enable patients to feel that nurses are trying to
support and understand patients experiences" (Kontio, Vlimki, Putkonen, Kuosmanen, Scott,
Joffe, 2010, p. 7). It is evident that the nurse-client relationship is an important part of the
understanding the problem and finding a solution. Thus, being with the patient and talking to
them to can prevent violence and therefore prevent the use of restraints. Having other tools to
cope with violence and other behavioural activity can also reduce the likelihood of restraint use.
The article Attitudes, Opinions, Behaviors, and Emotions of the Nursing Staff toward Patient
Restraint, states, "A large number of staff noted that acquisition of tools for coping with violence
would help reduce the number of restraints' (Gelkopf, Roffe, Werbloff, Bleich, 2009, p. 5).

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Using Restraints - Implications on Nursing Practice

N01007956

Therefore, having the correct tools is important for competent nursing care especially with
regards to restraints.
Right Attitude:
Having the right attitude towards restraints is critical in determining when a restraint
should be used. If nurses do not have the right attitude towards the usage of restraints they might
use it in situations that do not require them for example, they might use it to punish the patient
for bad behaviour. The article Promoting Safety: Alternative Approaches to the Use of Restraints
from the RNAO Clinical Best Practice Guidelines, states that "Karlsson, Bucht, Eriksson, &
Sandman (2001) found there was a significant relationship between nurses decisions and their
attitudes toward restraint use" (Registered Nurses' Association of Ontario, 2012, p. 36). This
highlights that a nurse's attitude towards restraints plays a role in deciding whether they will use
them or not. It is important for nurses to understand the correct reasons for using a restraint, so
the patient's safety and rights are not hindered. From the study of nurses' attitudes towards
restraint in the article Attitudes, Opinions, Behaviors, and Emotions of the Nursing Staff toward
Patient Restraint, it was noted that a significant percentage of nurses thought that patient's
troublesome actions are a reason for restraints (Gelkopf, Roffe, Werbloff, Bleich, 2009, p. 2).
This shows that nurses may sometimes use restraints for the wrong reasons. It is ethically wrong
to use restraints as a means of controlling troublesome actions. This can affect the patient's
healing process negatively as well as create potential problems with self-esteem. This will also
be considered the unjust use of power the nurses have over the patients, which can hinder the
therapeutic nurse-client relationship, as well as proper care of the patient. In some cases, this
may even aggravate the troublesome behaviour and other actions the patient would not normally
take. This can increase the risk of injury for both the patient and the nurses involved in the care.

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Using Restraints - Implications on Nursing Practice

N01007956

Therefore, it is essential to the nursing practice that the nurses choose the correct reasons to
apply restraints.
Conclusion:
The article was very insightful and helped me understand how nurses perceive restraint
use. The article not only talked about how the nurses felt about the use of restraints, but also
presented the reasons why nurses use restraints and under what circumstances the nurses use
restraints. After reading the article, in my understanding the three most significant implications
on the nursing practice include having the adequate knowledge and skills to deal with patients
that require restraints, having the correct tools to ensure that other alternatives are taken into
considerations before applying restraints, and having the right attitude to facilitate the proper
treatment of the patients. All these factors play a major role in determining whether the use of
restraints is required or not. Restraints are a last resort if nothing else works, hence it is important
to keep in mind than alternatives can be used which provide the right care, and uphold the
patient dignity.

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Using Restraints - Implications on Nursing Practice

N01007956

References
College of Nurses of Ontario. (2010). Professional Standards, Restraints. Revised June 2009.
Toronto, ON: College of Nurses of Ontario. Retrieved from
www.cno.org/Global/docs/prac/41043_Restraints.pdf
Gelkopf, M., Roffe, Z., Werbloff, N., & Bleich, A. (2009). Attitudes, Opinions, Behaviors, and
Emotions of the nursing staff toward patient restraint. Issues in Mental Health Nursing,
30(12), 758-763.
Huang, H., Chuang, Y., & Chiang, K. (2009). Nurses' physical restraint knowledge, attitudes,
and practices: the effectiveness of an in-service education program. Journal Of Nursing
Research (Taiwan Nurses Association), 17(4), 241-248.
doi:10.1097/JNR.0b013e3181c1215d
Kontio, R., Vlimki, M., Putkonen, H., Kuosmanen, L., Scott, A., & Joffe, G. (2010). Patient
restrictions: Are there ethical alternatives to seclusion and restraint? Nursing Ethics,
17(1), 65-76. doi:http://dx.doi.org/10.1177/0969733009350140
Registered Nurses' Association of Ontario (2012). Promoting Safety: Alternative Approaches to
the Use of Restraints. Toronto, ON: Registered Nurses' Association of Ontario. Retrieved
from http://rnao.ca/bpg/guidelines/promoting-safety-alternative-approaches-use-restraints

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