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abstract
Tackling the problem of aggression and violence in health care is high on the agenda for healthcare professionals. In an endeavour to protect both patients and staff alike when managing aggressive behaviour, the use of physical restraint is under scrutiny, particularly as a result of the reported deaths of a number of patients whilst being restrained. The challenges of employing this type of intervention, implications for safe and effective practices and the need for the suitable training of staff are explored in this paper.
key words aggression physical restraint guidelines training mental health safety protection
Introduction
The incidence of patient aggression and violence in mental health settings is reportedly on the increase and raises many questions as to the safety of both patients and staff. In the United Kingdom, the Healthcare Commission (2005) recently completed a national audit of violence on a range of mental health and learning disability wards and units and found continued levels of violence to be significant. In 2002/03, the National Audit Office (NAO) recorded a total of 95,501 assaults on National Health Service staff compared to 65,000 in previous years (NAO, 2003). The use of restraint when managing violent patients is one area that is of particular concern when endeavouring to address this problem and this paper examines the recommended principles and practice of physical restraint, the identified reasons for its use, the associated legal frameworks, perspectives on its efficacy and priorities for training in the light of current events. These factors clearly contribute to the debate as to the value and safety of existing practices for the protection of patients with mental health problems and the nursing staff who care for them when faced with aggression.
Background
The use of physical restraint in healthcare to counter aggression is not uncommon yet little is known about how it is used or taught in practice. Given the difficulties associated with managing aggression and the recent death of an inpatient whilst being restrained, the need to explore this practice and its effect has never been greater (Blofeld, 2004). Since the 1980s, prompted by the Ritchie Report (1985) on the inquiry into the death of Michael Martin whilst being restrained, healthcare staff have been trained in methods of physical restraint (Ritchie,...