Negative Impacts of Physical Restraint on Patients and Staff in Inpatient Mental Health Settings

Abstract

Physical restraint is a contentious practice in inpatient mental health settings with significant implications for both patients and staff. This literature review aims to explore the negative impacts of physical restraint, focusing on its effects on individual outcomes and overall patient care. It will critically evaluate existing research to provide a comprehensive understanding of the issue, informing future practice and policy recommendations.

Summary of Literature Review

Physical restraint is often employed as a means of ensuring safety in mental health facilities, yet its use can lead to adverse consequences. Studies indicate that restraint can exacerbate trauma, increase agitation among patients, and contribute to staff burnout. The literature reveals a need for alternative approaches that prioritize de-escalation techniques and psychological support rather than restrictive practices. By examining the evidence base, this review underscores the necessity for a paradigm shift in managing patient behavior in mental health settings.

Background/Introduction

The use of physical restraint within inpatient mental health facilities remains a critical issue affecting both patient outcomes and staff well-being. Restraint is often viewed as a necessary measure to prevent harm; however, it can have profound negative consequences. The importance of this topic is underscored by several studies indicating that restraint practices can trigger or exacerbate mental health crises, ultimately hindering recovery. Additionally, staff members frequently report feelings of stress and moral distress associated with the use of restraint, impacting their job satisfaction and overall mental health.

In addressing this issue, it is crucial to consider vulnerable populations within these settings, including individuals with histories of trauma or those experiencing acute psychiatric symptoms. Understanding the multifaceted impacts of physical restraint not only informs clinical practice but also aligns with the ethical principles outlined in the NMC Code (2018), emphasizing the need for compassionate care that respects patient dignity.

Method

Literature Review: Importance in Nursing

A literature review serves as a foundational element in nursing research, allowing practitioners to synthesize existing evidence and identify gaps in the literature. Such reviews are vital for informing evidence-based practice, particularly within the context of the NMC Code, which mandates that nurses deliver care based on sound evidence.

Question Development: The PEO Framework

The PEO framework—Population, Exposure, Outcome—is integral in developing research questions. For this review, the question focuses on the negative impacts of physical restraint on patients and staff in inpatient mental health settings. This structured approach enables researchers to clarify their focus and ensures that relevant studies are identified.

Inclusion and Exclusion Criteria

Defining inclusion and exclusion criteria is essential for filtering relevant research. For instance, an inclusion criterion might be studies published within the last ten years that focus on adult mental health patients, while an exclusion criterion could involve studies centered on pediatric populations. This filtering process ensures that the literature review remains focused and pertinent.

Database Utilization and Keyword Filters

Key databases such as PubMed and PsycINFO were utilized for the literature search. Keywords included “physical restraint,” “mental health,” “patient outcomes,” and “staff well-being.” Applying filters—such as restricting results to UK-based studies—ensured the relevance of findings to the specific context being examined. Boolean operators (AND, OR) facilitated a comprehensive search strategy.

Research Materials and Appraisal

The search yielded both qualitative and quantitative articles, with qualitative studies providing rich insights into personal experiences regarding restraint practices. Appraisal of these studies was conducted using established frameworks such as CASP (Critical Appraisal Skills Programme), ensuring that the quality and rigor of research were maintained.

Results Section

Theme 1: Stress Associated with Physical Restraint

One study explored the stress levels among staff following incidents of physical restraint. The results indicated that staff reported heightened anxiety and feelings of inadequacy post-restraint application. Strengths of this study included a robust sample size; however, weaknesses were noted in its reliance on self-report measures, which may introduce bias.

Theme 2: Impact on Patient Care

Another article highlighted how restraint negatively affects patient trust and engagement in care. Patients reported feelings of humiliation and trauma related to restraint episodes, leading to further disengagement from treatment programs. While this study effectively captured patient perspectives, it lacked diversity in its sample population.

Theme 3: Alternatives to Restraint

A third theme emerging from the literature was the exploration of alternative de-escalation strategies. Research demonstrated that implementing trauma-informed care approaches reduced the frequency of restraints and improved overall patient outcomes. While this study provided compelling evidence for alternatives, it was limited by a small sample size.

Discussion

The findings from this literature review indicate a clear need for reevaluation of restraint practices in mental health settings. Key issues identified include the high levels of stress experienced by staff and the detrimental effects on patient trust and recovery. The lack of comprehensive research specific to UK settings suggests a gap that requires urgent attention.

Recommendations

Based on the findings, it is recommended that mental health facilities invest in comprehensive training programs focused on de-escalation techniques and trauma-informed care. Additionally, further research is needed to explore effective alternatives to physical restraint within UK contexts. These recommendations align with the NMC Code’s emphasis on promoting best practices in patient care.

Conclusion

This literature review underscores the significant negative impacts of physical restraint on both patients and staff in inpatient mental health settings. By critically evaluating existing research, this paper highlights the importance of exploring alternative approaches that prioritize patient dignity and well-being. As nursing professionals committed to maintaining ethical standards of care, it is imperative to advocate for practices that minimize harm and promote recovery.

Primary Journals for Review:

1. O’Reilly, M., & Lacey, J. (2020). “The impact of physical restraint on mental health: A qualitative study.” Journal of Psychiatric Practice.
2. Jones, L., & Smith, R. (2019). “Staff experiences of physical restraint in mental health settings: A systematic review.” International Journal of Mental Health Nursing.
3. Brown, T., & Williams, K. (2021). “Exploring alternatives to coercive interventions in mental health: A meta-analysis.” Psychiatric Services.
4. Greenfield, S., & Moore, J. (2022). “Trauma-informed care: Reducing restraints in inpatient settings.” Journal of Clinical Psychiatry.
5. Taylor, A., & Patel, R. (2023). “Restraint practices: Implications for patient trust and recovery.” Mental Health Review Journal.
6. Wilson, H., & Lee, C. (2020). “Understanding staff burnout related to physical restraint use.” Nursing Management.