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Student ID: 822 664 991

Nursing 260 Scholarly Assignment: Journal Article Review

Student: Tanesha Smith
Student ID: 822 664 991
Date Submitted: February 26, 2014
NURS160: Practical Nursing Theory 2
Professor: Sylvia Wojtalik
Humber College ITAL

Student ID: 822 664 991

Research conducted by Lev Hasharon Mental Health Centre, the Department of

Psychiatry at the Sheba Medical Centre, and the Sackler Faculty of Medicine, located in Israel,
examines the Attitudes, Opinions, Behaviours, and Emotions of 111 Nursing Staff toward Patient
Restraint. The article reveals that there are a number of factors why some nurses tend to resort to
restraining a patient, such as violent behaviour, and why others are less motivated to use physical
restraint, arguing that it is too intrusive; however, restraint tends to be utilized more frequently
for the overall safety and security of the patient, faculty, environment, and other patients as part
of patient care, according to the overall opinions of nurses that took part in this study. The article
aims to highlight nurses attitudes, emotional responses and environmental concerns when faced
with the challenges in determining when to utilize restraint as a psychiatric intervention tool.
This article was chosen because it provides insights into the decisions and circumstances that up
and coming nurses will likely encounter when they enter the institution of patient care such as
hospitals, clinics, treatment facilities, and mental health centres, etc., in determining when to
utilize restraint as an intervention tool.
Although the objective of restraints is to be used as a psychiatric intervention to protect
psychiatric inpatients from self-harm, and harm to others and environment, there are differing
attitudes towards the use of physical restraints amongst nurses. The main criteria for applying
restraints to a patient, according to the nursing staff, were endangerment of the patients self and
surroundings. At the same time a considerable percentage of nurses believe that a patients
bothersome actions are a reason for restraint, (pg.759). The study shows that nurses in closed
wards resort to restraining a patient for a variety of reasons: limit violent behaviours, refusal of
treatment, and if the patient requests restraint or request by patients family to ensure safety and
security. It should be noted that, in this study, more men work in closed wards than women

Student ID: 822 664 991

(67.5% vs. 13.8%). Open ward nurses restrained less than their counterparts who work in closed
wards.
The nursing environment also determines the attitudes regarding restraint. Some nurses
believe that the use of restraints is appalling, and should only be use as a last resort. According to
CNO, best practice standard states: ``least restraint means all possible alternative interventions
are exhausted before deciding to use a restraint. Least restraint policy does not mean that nurses
are required to accept abuse,`` (Restraints, College of Nurses of Ontario, 2009, pg.4) There are
significantly less nurses (20%), in this study who believes that restraint is degrading, punishing
and harmful to the patient. Most nurses in this study believe that restraint calms the patients and
reduces or avoids violent incidences. The study finds that more men than women resort to
physical restraint regardless of the environmental conditions. When dissecting all areas of the
study, men significantly resort to restraint than women regardless of their qualification. The
study also highlights the fact that when men are present in the environment there are fewer
incidents of violence. Furthermore, the female nurses tend to call the men when a patient is in
crisis and needs to be restrained. As a result, the per cent of restraint incidents are higher
amongst the male nurses.
The study also addresses the emotional impact on nurses and patients while restraining.
76.1% of nurses use restraints to calm the patient, while 74% of nurses feel pity while restraining
the patient. The difference in gender emotional response of the nurses is also worth noting:
women feel more emotional negativity than men when restraining a patient. The vast majority
of nurses believe that patients feel anger towards the staff (92.5%), fear (87.9%), degradation
(85.8%), sadness (83.3%), and helplessness (80.4%), (pg.761). Patient restraint conjures up
emotional responses possibly in every nurse and possible every patient. The emotional responses

Student ID: 822 664 991

range from anger to satisfaction before, during and after the restraints. Some nurses believe that
the impact on the patient takes away their self-determination and may trigger anxiety going
forward. While other nurses feel a sense of accomplishment in keeping the patient safe and
stabilized.
In reviewing the article, Attitudes, Opinions, Behaviors, and Emotions of the Nursing
Staff Toward Patient Restraint, as well as, the Journal of Clinical Nursing, there are comparable
attitudes, opinions, and behaviours pertaining to the use of restraints contained in both article and
journal that shows some correlation to my clinical practice in the hospital Rehab Unit where I
currently care for geriatric patients. When it comes to restraints the responsibility falls on the
nurses who then have to decide when to restrain a patient. Understanding the clients behaviour
is essential for accurately determining the need for restraints, (Restraints, College of Nurses of
Ontario, 2009, pg.5). Physical restraints such as, belts and locked doors, is the traditional method
of restraining geriatric patients in institutional care. However, there are various other types of
restraints applied in clinical practice such as removing a patients mobility aid and direct
restraints that includes chairs, trays, rails on sides of the bed, restraint vests, bed linen, wrist and
waist restraints (Gallinagh et al. 2002, Evans et al. 2003, Hamers et al. 2004). Some nurses feel
that the method of restraints are too restrictive, however, it keeps the patients safe from serious
injury and the nurses maintain control of patient care procedures. Although I have not witness
any restraints being applied in clinical, the importance of education and training is essential in
my development as a practical nurse and future clinical experiences. Restraints are used to
prevent patients from injury and re-injury, as well as to prevent escape from care facility and to
maintain control. As a practical nurse it is imperative that we try alternative measures such as,
use calm, simple statements, and physical cues as needed, assign confused or disoriented patients

Student ID: 822 664 991

to rooms near nurses` station; observe patients frequently, attend to patients toileting, food, and
fluid needs, evaluate all medications the patients are receiving, and ensure effective pain
management (Potter, Perry, Ross-Kerr, et al. Canadian Fundamentals of Nursing, 5th Edition.
Mosby Canada, 2014, pg.812). Along with lowering patient`s bed, floor mattress, and equipping
patients with bedside alarms can dramatically reduce incidence of restraints and physical and
emotional harm to patient.
The study done by Lev Hasharon Mental Health Centre concludes that educating nurses
and the multidisciplinary staff to deal with violent inpatients by recognizing the therapeutic value
of restraints would better equip nurses with the skills to manage patients who are at-risk to
themselves, others, and environment. Thus, the recognition of the therapeutic value in restraints
may reduce the emotional and physical effect that nurses and patients feel when restraint is
applied. Restrain or not to restrain involves a cognitive, emotional and experiential decisionmaking response. Training and coping mechanisms influence frequency of attempt or decision to
restrain. The institution, as a whole, needs to invest more in skills training involving the
multidisciplinary staff and nurses in order to understand patient behaviours and possible
precipitators such as language barriers, religious beliefs and respect of patient rights. That is why
it is important that as a nurse in training to understand when restraint should be applied and what
impact it has on the patient. This may then lead to the use of alternative measures that are less
restrictive. In addition to promote legislation or streamline hospital policy and procedures and to
promote best practice for new and seasoned nursing staff.

Student ID: 822 664 991

Reference
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.
Saarnio, R., Isola A. (2010). Nursing staff perceptions of the use of physical restraint in
institutional care of older people in Findland. Journal of Clinical Nursing, 19, 31973207.
College of Nurses of Ontario (CNO). (2009). Practice Standards: Restraints. Toronto, ON:
CNO., (pg.4-8).
(Potter 812) Potter, Perry, Ross-Kerr, et al. Canadian Fundamentals of Nursing, 5th Edition.
Mosby Canada, 2014. VitalBook file.