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New Study Explores the Psychological Harm of Restraints on ED Patients

With agitated and violent patients, providers often have no choice but to use restraints. That’s why new research is exploring the effects of restraints and how to avoid using them in the future.

Sadly, with agitated and violent patients, providers often have no choice but to use restraints for both parties’ safety. That’s why new research explores the consequences of these decisions and proposes ways to mitigate the effects.

The study, published in JAMA Network Open, analyzed interviews with 25 patients restrained at one of two urban emergency departments in the Northeast United States. Participants were white, black, and Hispanic, and eight were women. Many reported a history of alcohol or drug use and mental illness. Most participants attributed their escalating behavior that led to restraints to one of these conditions; only three said it was due to a confrontation with staff.

How Do Patients Feel When They’re Restrained?

Researchers noted three salient themes from the interviews: “harmful experiences of restraint use and care provision, diverse and complex personal contexts affecting visits to the ED, and challenges in resolving their restraint experiences, leading to negative consequences on well-being.”

Overall, researchers found that participants craved empathy and engagement from staff, especially while restrained. They also felt “violated and dehumanized,” authors wrote and didn’t understand the clinical decisions that led to using restraints. The lasting effects of the restraints included healthcare avoidance, mistrust of the public health system, and emotional trauma. One patient was admitted to the ICU as a result of being restrained.

Naturally, the challenge posed by these patients is a systemic one. For example, there are limited primary sources that attempt to understand what these patients feel during a crisis and as their conditions worsen. 

The study starts to fill this gap with some heart-wrenching quotes from participants:

“You took all my clothes off; you had me laying on the bed strapped down with no clothes, no cover, no nothing. My privates are wide open, people just walking by, and you won’t give me no clothes or shut the curtain,” said one participant.

“I felt like nobody really cared. I felt like I was in prison, in the bed. I’ve never been to jail before, so my first experience of it was scary for me. I’d never been restrained before. I never had anyone hold me from my rights, you know? I cried, you know, I felt like I was alone in the bed with the straps on my wrists, my ankles,” said another.

What Can Staff Do To Help Patients Needing Restraints?

The research acknowledges that clinicians in busy emergency rooms often don’t have the time to give these patients the one-on-one care they need. In addition, many staff members are frightened or frustrated by such patients because of previous verbal and physical assaults. Approaches that consider both the employees’ and patients’ safety will be the most effective. In addition, there are actions that individual clinicians can take to mitigate the effects of agitated behavior and restraints.

First, recognize that these patients don’t go to the ED willingly and are usually stressed when they arrive. If possible, provide psychological support to prevent their emotions from becoming exacerbated. Next, explain to patients why the restraints are necessary, and try to stay with them while they’re in this situation. Previous research has found that talking through clinical processes promotes trust in the healthcare system. The authors posit that sedatives may be a more effective option. An earlier study looking at an Australian ER found those who received sedatives reported feelings of respect, dignity, and trusting relationships with staff members. Last, proactively trying to de-escalate situations is ideal. Learn to recognize the signs that a patient is on the way to acting violently; the Brøset Violence Checklist (BVC) is an effective, evidence-based tool. And when the patient enters the setting, try to develop an individual crisis prevention plan. This will help you understand the individual’s unique triggers and successful interventions.

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