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#NURCHAT

#NurChat - Restraint: an issue for all nurses?

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Did you miss the latest #NurChat Twitter debate about whether restraint is an issue for all nurses or not? Let us sum it up for you…

As an adult nurse spending most of my career in elderly care I have never encountered the restraint of a patient so I felt a little out of my depth when this #NurChat was suggested by @nursiedeb. I went into the discussion feeling that even though I would not be able to contribute much, as I have no experience in this area, I would certainly learn a few things; however I found that in fact I do have experience in restraint.

 

The #NurChat started by asking participants how they would define restraint?

@alabcien tweeted “Sedated & physically. Restrained for own safety or others”

@Ramck001 stated “Restraint: The imposed limitation on the individual’s ability to move freely for the safety of the individual or those around them.”

@nursiedeb tweeted “We have to make a distinction between physical restraint which is rare and chemical restraint which is widespread”

Most of the Nurchatters agreed that restraint is not just a physical act.

 

Chemical restraint - the use of medication - was discussed in depth.

Concerns were expressed that this from of restraint is not always questioned.

@studentnurdse said “When I was HCA saw nurses use chemical restraint often. Now as student I’d always question it, it should definitely be last resort”

@alabcien tweeted “My NHS those who need chemical restraint have to have AI Act form in situ for legal reasons”

@onesize_fitsall added “Chem restraint can often cause patient distress that can lead to more episodes of challenging behaviour!”

 

The use of antipshychotics in the elderly was discussed.

@nursemaiden stated “big debate on use of anti psychotics in elderly care at moment and their over use”

@missseapeaches added “I feel they can b overused and often prescriptions are not checked enough and sedatives reduced”

@nursemaiden replied “big programme by institute of innovation and improvement to reduce their use”

There was a lot of empathy expressed for the person undergoing the restraint; Nurchatters agreed how terrifying it must be for the individual undergoing restraint of any sort.

@missjjo said “imagine how awful we would feel, I’d be terrified”

@nursiedeb added “I can’t imagine the utter terror of being pinned down by people I think are trying to hurt me”

 

NurChat asked about the use of everyday nursing objects to restrain, such as tables and bed rails?

@onesize_fitsall tweeted “so long since I’ve been on gen ward, are bedsides still used; just increases height patient falls from”

@alabcien added “bed rails are to stop patients falling out of bed for their safety we have it asked in our risk assessment”

@nursemaiden said “yes bed sides still used but patients can still climb out! I’ve seen beds pushed up against wall for safety”

 

NurChat asked about prisoners in hospitals and whether it is acceptable to restrain them?

NurChatters expressed confusion over why sedated and ventilated patient/prisoners are sometimes restrained.

@MentalHelathCop (a police inspector) joined the chat and stated “Spent many shifts in A&E / wards restraining prisoners whilst medical care considered. Comms between NHS / CJ are key”

He went on to add “Comms are key - depending on the prisoner / medical issue, I might not give you a choice! Your safety too!” and “Know of case where PT sedated MH unit and transferred A&E (injured) came around from sedation punched DR.”

 

To conclude the discussion, NurChat asked what the key principles were that participants could take away to ensure patient dignity and safety when restraint is used? Full details of participant’s ideas can be found on the NurChat blog.

For me, one of the key principles that I will take away from this chat is that although I may not have experience with physical restraint there are many other forms of restraint that are going on all around me during my working life, from the use of medication and bed rails to persuading an elderly lady to “please sit back down”.

This was a fascinating chat that challenged the way I think. Restraint of patients is an issue for all nurses, not just those in high risk areas, and we all need to be aware of the legal, moral and safety issues surrounding it.

Teresa Chinn heads up NurChat for Newcross Healthcare Solutions - Nurchat is a fortnightly twitter chat for nurses exploring different topicsthatvary enormously.Anyone can suggest a NurChat discussion subject simply by tweeting @NurChat or by visiting the NurChat blog.

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