The use of physical restraints in mental health.

of restraints in mental health setups brings forth ethical issues. However, this method is being used for highly agitated and violent patients in psychiatric hospitals in order to protect the patients and others for possible physical harm. 1,2 In all circumstances, the least restrictive restraint that is effective should be used and restraints should never be used for the sake of convenience. 3 In saying this, is it imperative that healthcare workers understand and follow proper protocol and procedures when restraining a patient to ensure safety and dignity of the patient. 4 Failure to follow proper protocol can have major consequences for the patient and also for health authorities and staff in the form of legal ramifications. 5 Restraint of a patient can come in many different forms. Broadly, these can be classified into chemical, physical and environmental restraints. There are many steps that can be taken prior to resorting to the use of restraint for a patient. The initial assessment of a patient must ensure the behaviour or action is not the result of a dangerous organic source. 6 If a potentially dangerous organic cause is found is it imperative to treat rather than focusing the attention on restraining the patient. Clinical judgment must be applied to determine if it is safe to proceed with the clinical evaluation after potential life threatening causes have been ruled out. Verbal de-escalation strategies should be attempted prior to the use of any form of restraint. Practice guidelines are crucial for guidance in controversial topics such as physical restraints. There are no guidelines generated from international platform. In lieu, institutions are required to examine the literature and produce institutional guidelines. As a result of this restraint practices varies significantly from one institution to the next. At our institution (Memorial University of Newfoundland) the usage of physical restraint is guided by two policy guidelines. The initial guideline is a nursing practice policy that discusses the usage of physical restraints in addition to chemical and environmental restraints. The policy is targeted to the general medical population. The second guideline is aimed specifically at the mental health patient population and focuses on the utilization of emergent use of 5-point restraints. Both policies outline the following key areas of restraint use to be: a. Assessment b. Consent c. Application d. Discontinuation e. Documentation a. Assessment:-Policy stipulates that physical restraints should only be utilized when agreed upon by …