Nursing Assignment: Analyzing Restraint Use in Mental Health Settings

This nursing assignment analyzes a clinical incident involving the inappropriate use of restraints on a patient in a mental health ward. The report details the incident where a patient was physically restrained for refusing food, despite the availability of alternative approaches. The student reflects on the incident, expressing shock and shame, and relates it to the importance of following restraint guidelines and the potential for re-traumatization. The analysis considers factors like nurse burnout, stigmatization, and the ethical and legal implications of restraint use, referencing the Mental Health Act and the Nursing and Midwifery Board of Australia standards. The assignment reconstructs the event, highlighting breaches of safety guidelines and advocating for alternative interventions such as constructive activities and establishing rapport. The conclusion emphasizes patient rights and the importance of therapeutic relationships to prevent the need for restraints, supported by references to relevant research and guidelines.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of University
Author’s note

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Introduction
People suffering from mental illness face specific safety issues while receiving health
care. However, lack of awareness can be found among the health care professional at all the
levels. One of the patients safety issue includes use of restraints and seclusion. This directly
affects the safe deliver of the care (Slemon, Jenkins & Bungay, 2017). That’s why it is important
to understand the factors that might originate in the system and system that led to such types of
events (Slemon, Jenkins & Bungay, 2017). This reflection will provide an analysis of the event
that took place in my clinical setting followed by asset of recommendation that should be or
should have been done by the nurse to prevent the occurrence of such events.
Reporting
During my placement in the mental health ward, I encountered a 32 years old woman,
who had been admitted in to the psychiatric ward with aggression. As stated by the family
members, he has pushed the informal caregiver, just as she approached her with the food.
Although she had regretted it many times after the incident. However, similar incidents have
been repeated even after this. The patient had stopped taking food and drinks and have fainted a
number of times. While she was under my care during the day time, I did not have to force much
to make her eat some liquid food, but the next day, after my arrival, I was shocked to hear from
his family members, that the nurse in the night shift has applied restraint and had forced her, as
the patient was refusing to take food. This complaint was escalated to the higher authority of the
hospital.
Responding

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I was extremely shocked as well as ashamed of the incident, as the patient was under my care
during the day shift and I could have instructed the nurse in the night shift to be a bit alert and
careful while handling the mood swings of this patient. I was ashamed due to the fact that there
clear restraint guidelines, that are followed if extreme condition comes persists or the patient
becomes extremely aggressive that can harm the health professionals and the other professionals
(Perez et al, 2017). Throughout our nursing course we have learnt that this type of behavioural
management are generally avoided as it can have serious impact upon the patients.
Relating
Through my personal experience, I have noticed that application of physical restraints
further aggravates situations and being physical traumatised have brought back memories of
previous trauma in patients and they have descried the situation to be “re-traumatising”.
Restraints are also perceived to be “anti-recovery” and can make the mental patients fearful of
the treatment. Furthermore, legal issues can also arise, as per the Mental Health Act, 2015,
physical restraints should only be allowed to manage serious imminent harm only when
appropriate and all the other alternative options has been considered (Lanthén, Rask &
Sunnqvist, 2015). Hence, the nurse could have opted for an alternative technique to manage the
disruptive behaviour of the patient. I had witnessed that distracting the patient from the potential
triggers of aggression can be done by keeping the patient in a calm environment. The patient can
be given with some constructive and sensory activities that can keep the patient engaged.
Furthermore, a rapport can be established with the patient such as talking about good experiences
or funny incidents. Most of the patients having delusional thoughts also suffers from trust issues,
with their families. This sort of behaviour would help to create trust between the patient and the

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care provider who might then request the patient to take his food (Lanthén, Rask & Sunnqvist,
2015).
Reasoning
If I try to look this incident from the perspective of the nurse, who had committed this
mistake. Psychiatric nurses are subjected to progressive physical and emotional exhaustion
involving a development of negative job attitudes and loss of empathy for the patients (Hiyoshi-
Taniguchi et al., 2017). If this is kept unchecked burnout might cause a deterioration in the
quality and the quantity of the nursing care. Again excessive workload can also contribute to
burnout among the nurses increasing the chance of clinical errors (Crutchfield et al., 2017).
Another reason for this type of behaviour can be stigmatisation related to mental illness. Many
health care workers are stigmatised by the mental health illness patients and they refuse to
preserve the basic human rights of the patient. Application of restraints not only imparts physical
harm but also destroys the integrity and the dignity of the patient.
Reconstructing
I have analysed this incident and have found that the nurse had breached the safety
guidelines of restraints mentioned in the Australian guidelines, which states that it can only be
applied after considering any other safety measures. According to Ye et al., (2018) unsafe
psychiatric settings or practices contributes to patient safety incidents and the feelings of
insecurity among the patient. According to the standard 6 of the Nursing and Midwifery board of
Australia, nurses are ethically and legally obliged to provide a safe, appropriate and responsive
quality of nursing practice (NMBA, 2017). In this case, the concerned nurse, which I was working
with breached the nursing standard of a registered nurse. Putting restraints on the patient can lead
to distress, fear, generation of the feeling of getting ignored and dehumanisation.

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In order to prevent such mistakes in future nurses should remain updated about
restraint guidelines of the organisation and should apply them after informing the same to the
physician and the family members. Restraints should be adopted as the last resort or if the patient
is inflicting serious harm on the other patients around. Constructive activities or a calm
environment should be maintained.
Conclusion
In conclusion it can be said that health care providers should keep the interest of the
patient in the first place and should be able to preserve the rights and the dignity of the mental
health patients. It is necessary to reflect on personal values and establish a therapeutic
relationship with the patients, such that things can be done without applying any restraints.

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References
Crutchfield, P., Gibb, T. S., Redinger, M. J., Ferman, D., & Livingstone, J. (2019). The
Conditions for Ethical Application of Restraints. Chest, 155(3), 617-625.
Hiyoshi-Taniguchi, K., Becker, C. B., & Kinoshita, A. (2018). What behavioral and
psychological symptoms of dementia affect caregiver burnout?. Clinical gerontologist,
41(3), 249-254.
Lanthén, K., Rask, M., & Sunnqvist, C. (2015). Psychiatric patients experiences with mechanical
restraints: an interview study. Psychiatry journal. http://dx.doi.org/10.1155/2015/748392
NMBA, (2017).Professional standards. Access date: 6.9.2019. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-
standards.aspx
Perez, D., Peters, K., Wilkes, L., & Murphy, G. (2017). Physical Restraints in Intensive Care:
Experiences of Patients, Families and Nurses. Australian Nursing and Midwifery Journal,
24(10), 45.
https://search.proquest.com/openview/aa7f61150fcaff29d3fb583cd357ae70/1?pq-
origsite=gscholar&cbl=33490
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of
risk management culture on mental health nursing practice. Nursing inquiry, 24(4),
e12199. doi: 10.1111/nin.12199

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Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2018). Physical restraints: An ethical
dilemma in mental health services in China. International journal of nursing sciences,
5(1), 68-71. https://doi.org/10.1016/j.ijnss.2017.12.001