Reflective Journal 1: Nursing Experience on Physical Restraints

This reflective journal, written by a nursing student, details an incident involving an aggressive patient and the subsequent application of physical restraints. The student utilizes the Gibbs reflection cycle to analyze the event, describing the situation, feelings, evaluation, analysis, conclusion, and action plan. The student reflects on the negative consequences of the restraint, including physical and emotional harm to the patient, and the violation of nursing bioethical principles. The analysis highlights the importance of effective communication, alternative strategies for managing aggressive behavior, and the development of skills to handle difficult situations. The student concludes by emphasizing the need to avoid physical restraints in the future and develop skills to handle such situations more effectively, including discussing scenarios with mentors, interviewing healthcare professionals, and conducting evidence-based research. The journal underscores the importance of patient safety, ethical practice, and continuous learning in nursing.

Running head: REFLECTIVE JOURNAL
REFLECTIVE JOURNAL
Name of the student:
Name of the university:
Author note:

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Second reflection: application of physical restraints
Introduction:
Gibbs reflection cycle is one of the most famous models for reflection that is used by
nursing students and professionals to reflect on their experiences. It comprises of six stages and
suggests how a full structure analysis of an event can be done with the use of prompt questioning
in each of the six stages. This assignment would utilise Gibbs reflection cycle for reflecting on
the incident and developing ideas about what went wrong and how it can be developed in the
future.
Description:
During the time of placement, I got the opportunity to serve patients not only with
different disorders but also of various natures. I had gained valuable experiences while tackling
different types of patients. One specific experience that had scared me was treating an aggressive
patient who had suffered from heart disorder and was under treatment. After admission, he was
found to be suffering from metal instabilities as well and therefore, he was supposed to be shifted
to the psychiatric ward after his heart condition would have stabilized. On one night, I had
approached him for his warfarin dose when suddenly he became aggressive and threw away the
medicine tray away from my hand. He was going to attack one of the nurse aides to which I
immediately shouted for help. I ordered the healthcare ward aides to put physical restraint on the
patient. When I arrived n my next allocated shift, the ward supervisor summoned me. I came to
know that he had faced bruises in different sections of the body and even had complained of ill-
treatment and abuse. He requested the authority to change him to another healthcare organization
as soon as possible.

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Feelings:
I was embarrassed when the ward supervisor told me that I had undertaken an unsafe
practice for which the patient was not only hurt physically but also mentally and emotionally. I
felt upset thinking that I still have not developed enough competencies to provide best quality
and safe care to the patients. I also felt guilty thinking that my suggested intervention had
actually resulted in physical and emotional harm of the patient and that I would not follow the
nursing bioethical principles of beneficence and non-maleficence.
Evaluation:
The bad part of the incident was that I applied physical restraint on the patient that had
affected him physically, emotionally and mentally. Physical restraints can be defined as the hard
form of coercion that is observed in the healthcare inpatient settings. Studies severely criticize
the application of physical restraints as they associate them with physical injury as well as even
death because of dehydration, choking as well as circulatory and skin problems (Abraham et al.
2019). This also associated with loss of mobility and strength as well as incontinence and injury
from forcibly trying to get freed from the restraint. Huge numbers of negative outcomes are
associated with these unsafe practices. Some of the psychological and emotional effects that are
found to be associated are feelings of humiliation as well as loss of dignity along with
diminished quality of life (Hofmann et al. 2015). Patients are seen to suffer from increased stress
as well as confusion and fear. Depression, withdrawal, isolation as well as desolation, loss of
hope and internal motivation are found to be also presented in affected patients. Patients also
suffer from anger, frustration and demoralization along with increased agitation, hostility as well
as aggression and learned dependence. I have learnt that application of the restraint resulted in

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loss of self-esteem and dignity of the patient for which he was feeling low and depressed. The
patient was upset with the treatment and threatened for legal action.
Analysis:
Every nursing professional in their careers would be facing difficult patients who may be
manipulative, withdrawn, aggressive as well as abusive. It is the duty of the nurse to learn about
different types of strategies and skills to handle such patients successfully. Many of the studies
have stated that effective communication skills both verbal as well as non-verbal modes are
extremely important for handling such cases successfully (Nordhausen et al. 2019). Many
researchers also opine that the presence of mind and skill to act in the moment may also help
nurses to handle these situations with expertise in place of applying restraints, which proves to be
an unsafe practice. The nursing professionals should be talking softly and she should refrain
from having judgmental attitudes (Cusack et al. 2016). The nurse should try to remain neutral
although it might seem to be difficult with irrational patients. Some distances should be
maintained between patient and nurses and intense eye contacts as this could set them off (Holst
et al. 2017). The nurse should try to demonstrate control over the situation without becoming
demanding as well as authoritative (Mauleke and Wyck 2017). The nurse should try in seeking to
smooth the situation over rather than bullying the patient into better behaviour (Reeves 2017).
The nurses would need to speak in neutral ways with soft voice in a non-proactive and non-
judgmental manner facilitating the patient’s stance and avoiding early interpretations. When the
patient had mood swings and threw my tray, instead of handling the situation softly and with the
above-mentioned process, I started shouting on the patient telling him to calm down (Stutte et al.
2017). All such chaos affected the patient’s minds more making him reckless and nervous. If I

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had the skill and knowledge to handle such situation, such negative outcomes on patient would
never have taken place.
Conclusion:
I need to develop my skills for handling aggressive patients successfully. I have also
learnt that application of physical restraints results in huge number of physical, mental as well as
emotional trauma. This may affect them deeply thereby worsening the health conditions for
which they had been admitted. In my future practices, I would never imply physical restraints
and should always consider of better alternatives when tackling aggressive patients. I would try
to develop skills and knowledge by which I can handle such situation successfully without
undertaking any unsafe practices.
Action plan:
I would try to discuss such scenarios with my mentors to identify the approach that I need
to take when tackling such situations. I would also interview stalwart healthcare professionals so
that I can learn from their experiences and at the same times, apply their advices in my practices.
I would also undertake evidence based searches from the digital library to find out the
recommendations of healthcare researchers in such scenarios. This would actually help me to
develop skills like self-awareness, critical thinking skills, presence of mind, and develop
knowledge about how to react and manage such situations successfully.

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References:
Abraham, J., Kupfer, R., Behncke, A., Berger-Höger, B., Icks, A., Haastert, B., Meyer, G.,
Köpke, S. and Möhler, R., 2019. Implementation of a multicomponent intervention to prevent
physical restraints in nursing homes (IMPRINT): A pragmatic cluster randomized controlled
trial. International journal of nursing studies.
Cusack, P., McAndrew, S., Cusack, F. and Warne, T., 2016. Restraining good practice:
reviewing evidence of the effects of restraint from the perspective of service users and mental
health professionals in the United Kingdom (UK). International journal of law and
psychiatry, 46, pp.20-26.
Hofmann, H., Schorro, E., Haastert, B. and Meyer, G., 2015. Use of physical restraints in nursing
homes: a multicentre cross-sectional study. BMC geriatrics, 15(1), p.129.
Holst, A. and Skär, L., 2017. Formal caregivers’ experiences of aggressive behaviour in older
people living with dementia in nursing homes: A systematic review. International journal of
older people nursing, 12(4), p.e12158.
Reeves, J., 2017. Reducing the use of restrictive interventions by changing staff
attitudes. Nursing Management, 24(3).
Maluleke, B.K. and Van Wyk, N.C., 2017. Experiences of psychiatric nurses of violent
behaviour by female patients with mental illness. Gender and Behaviour, 15(3), pp.9678-9690.

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Nordhausen, T., Abraham, J., Kupfer, R., Köpke, S., Meyer, G. and Möhler, R., 2019. Physical
restraints from the perspective of advocates of nursing home residents-a qualitative
Study. Pflege, pp.1-10.
Stutte, K., Hahn, S., Fierz, K. and Zúñiga, F., 2017. Factors associated with aggressive behaviour
between residents and staff in nursing homes. Geriatric nursing, 38(5), pp.398-405.