Psychiatric Crisis Intervention: The Use of Restraints
The management of acute crises in a psychiatric setting generally depends on a continuum of therapeutic measures. This continuum includes an entire spectrum of intervention strategies. One component of the spectrum is mechanical restraint. Throughout history, some form of physical restraint has been used to treat the mentally ill. While mechanical restraints are still widely employed in psychiatric hospitals today, the practice is becoming more and more controversial. As with any therapeutic modality, restraints have their inherent risks and benefits. All of these various factors must be carefully considered if health care is to be delivered in an acceptable manner.
Prior to the 18th Century, methods used to restrain the mentally ill tended toward cruelty (Roper et al., 1985, p. 18). Although in modern times, mechanical restraints are generally applied more humanely, many consider their use outdated, offensive, unnecessary, and even harmful. In fact, research has shown that many if not most nurses actually dislike the technique. It tends to conflict with their basic values such as the "patient having a right to self determination" and the "nurse's responsibility to act in the patient's best interests" (Quinn, 1993, p. 148 162). In the psychiatric setting, the primary reason for the application of mechanical restraints is management of violent or out of control behavior. The mentally ill demonstrate their psychic disturbance in a variety of different ways, one of which is acting out. With the psychotic patient, that acting out can be dangerous and destructive.
There are a variety of theories as to the causes of violence. Some believe that it is learned; others that it is an inherent part of human nature. Regardless, psychiatric conditions frequently associated with the behavior include acute functional or organic psychosis, drug abuse, hysterical and ...