Gunawardena Ramith, Smithard David G
King's College Medical School, Strand, London WC2R 2LS, UK.
Consultant Physician, Queen Elizabeth Hospital, Lewisham and Greenwich Trust, Woolwich, Greater London SE18 4 QH, UK.
Geriatrics (Basel). 2019 Sep 4;4(3):50. doi: 10.3390/geriatrics4030050.
Restraint in modern non-psychiatric-based healthcare is often regarded as a rare occurrence. It is deemed to be used as a last resort to prevent patients from directly harming themselves. However, techniques are used in modern day practice which are considered direct and indirect restraints with the justification of maintaining patient safety, but they are often not classified as "restraints". Examples of these include the use of bed rails or tables to prevent patients from "wandering" and to reduce the risk of falls and injuries. More indirect techniques would involve passive interactions with patients or leaving mobility aids out of reach. Staff subconsciously restrain patients and reduce their liberties despite agreeing that patient autonomy should be upheld-a necessary evil to maintain a duty of care. Whilst the use of restraints is often justified to ensure patient care and prevent injury, it is not without consequence. There are physical and psychological health risks such as pressure sores from the inability to mobilise, or the brewing of anger and frustration when denied access to everyday actions. The reasons why restraints are used, whilst stemming from maintaining patient safety, are often due to low staffing levels and the inability to constantly watch at-risk patients due to a large workload. Inadequate training is another factor; by improving education in direct and indirect restraint and providing alternative methods, more ethical decisions and positive outcomes can be implemented. Healthcare professionals are reluctant to use restraint but often conduct it without realising it; assessing their understanding of restraint and providing education to raise awareness of the consequences of direct and indirect methods would result in positive steps toward reducing their use at the same time as looking to provide alternatives to uphold patient care whilst maintaining their dignity and liberty.
在现代非精神科医疗保健中，约束措施通常被视为罕见情况。它被视为防止患者直接伤害自己的最后手段。然而，在现代医疗实践中，一些技术被用于维护患者安全，这些技术被认为是直接和间接的约束措施，但它们通常不被归类为“约束”。这些例子包括使用床栏或桌子来防止患者“游荡”，并降低跌倒和受伤的风险。更间接的技术包括与患者进行被动互动或将助行器放置在患者够不到的地方。尽管工作人员认同应维护患者自主权，但他们在潜意识中仍会约束患者并限制其自由——这是履行护理职责时的无奈之举。虽然使用约束措施通常是为了确保患者护理并防止受伤，但这并非没有后果。存在身体和心理健康风险，例如因无法活动而导致的压疮，或者在被剥夺日常行动权利时产生的愤怒和沮丧情绪。使用约束措施的原因虽然源于维护患者安全，但往往是由于人员配备不足以及由于工作量大而无法持续照看有风险的患者。培训不足是另一个因素；通过加强直接和间接约束方面的教育并提供替代方法，可以做出更符合道德的决策并取得积极成果。医疗保健专业人员不愿使用约束措施，但往往在不知不觉中就实施了；评估他们对约束措施的理解并提供教育，以提高对直接和间接方法后果的认识，将朝着减少其使用迈出积极的步伐，同时寻求提供替代方法以维护患者护理，同时维护他们的尊严和自由。
