Nurse and Caretaker Perspectives on Restraint in Psychiatric Settings: A Legal and Ethical Analysis

It is a common misconception that restraints are necessary to keep both the patient and others safe. In fact, the UK has successfully managed without such measures, emphasizing a more compassionate and ethical approach to patient care.

The Perspective of UK Nurses

The Royal College of Nursing (RCN), in their 2008 guidance on restraint, clearly states that vest belt or cuff devices, which are commonly used in many countries outside the UK, including Europe, the USA, and Australia, are not acceptable in the UK. UK nurses firmly believe in the necessity of encompassing patients' freedoms and dignity during their care.

Types of Restraint in the UK

While in the US, nurses might leave patients in what could be termed as barbaric five-point restraints, which are almost impossible to escape, the options available to UK nurses are more humane and carefully controlled. These restraints include:

Specially designed mittens in intensive care settings Everyday equipment such as heavy tables or belts to prevent patients from getting out of their chairs Bedrails to prevent older persons from getting out of bed Controls on freedom of movement, such as key fob locks and keypads

Nurses understand that these restraints should never be used as a threat, punishment, or as a time-saving measure. Instead, they should be used to ensure the patient's safety through conversation and human contact.

Legal and Ethical Guidelines for the Use of Restraints

A US nurse committed to the 'tie them up and leave' approach must be aware of the legal implications. According to The Mental Health Act Code of Practice 1983, updated in 2015, restraining a patient by tying them up, whether with tape or using their garments, must never be done. Any restraining action without the patient's consent is a criminal offense, and the nurse responsible could face criminal prosecution, fines, or even imprisonment, depending on the severity.

Conclusion

Nurse and caretaker perspectives on restraint in psychiatric settings highlight the importance of understanding the legal and ethical implications of using restraints. The use of such measures must be carefully controlled and ethically justified, and nurses must prioritize patient dignity and well-being. For those dealing with psychiatric patients, staying informed about the latest practices and legal guidelines is crucial to providing the best possible care.

It is essential to recognize that every patient is unique, and the decision to use restraints should be made thoughtfully and as a last resort. The UK provides a successful model for how to manage patient care ethically and humanely without the use of restrictive measures.