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

Duxbury, JA (2015) The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible? Journal of Psychiatric and Mental Health Nursing, 22 (2). pp. 92-101. ISSN 1351-0126

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Abstract

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. This paper 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. 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 traumatized by the use of restrictive practices and there is a growing momentum to promote models that incorporate trauma informed care (TIC) and person centredness.