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

Abstract

Accessible summary: What is known on the subject: The physical and psychological trauma that can occur as a result of physical restraint is increasingly highlighted in the media and literature across the globe. Despite this, the use of physical restraint continues without a strong evdience base for its value or efficacy. What this paper adds to existing knowledge: A number of common defences for the use of physical restraint are outlined and considered in light of existing research in this area. The potential for adopting restrictive intervention minimization programmes of work is highlighted as a way forward. What are the implications for practice: The implementation of approaches to prevent and reduce physical restraint is required. A combination of factors including the use of advance planning tools, recognition of potential injury and death, and the importance of trauma informed care is necessary. Patients can be severely traumatized by the use of restrictive practices including restraint, and there is an increasing drive to examine, reflect upon, and to reduce the use and impact of these. 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.