EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 1

Attitudes, Opinions, Behaviours, and Emotions of the Nursing Staff Toward Patient
Restraint
Derek Smits
Student No: N00760491
Date Submitted: March 3, 2015
NURS 150
Professor:____________
Humber College ITAL

EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 2

The issue of patient restraint use is a highly controversial topic in the hospital
settings and it can create various emotions, attitudes, opinions and behaviours amongst
the nurses and patient relationships. Restraints are used to control a patients behavioural
or physical activity. There are several types of restraints including physical,
environmental, and chemical. Physical restraints are restraints that can limit the patients
body movement through the use of a seat belt or bed rails that cannot be opened by the
patient. Environmental restraints are restraints that control the mobility of a patient by
using a time-out room or by simply locking the door. Lastly, chemical restraints are
restraints that contain psychoactive medication and are used to control the clients
behaviour. In the articles, Attitudes, Opinions, Behaviours, and Emotions of the Nursing
Staff Toward Patient Restraint by Marc Gelkopf and Nurses feelings and thoughts
about using physical restraints on hospitalized older patients by Yeu-Hui Chuang,
portray the relationships between nurses and restraints that are being used and how it can
affect their own nursing practice. The three implications provided by Gelkopf for nursing
practice is understanding the safety of the client and their behaviour, understanding the
emotional aspects of restraint on patient and nurse, and using the least form of restraint
possible.
Understanding the safety of the client and their behaviour is an essential aspect
that should be considered by the nurse before giving a restraint. In Gelkopfs article,
according to the nursing staff, the main reason for applying restraints to a patient was
endangerment of the patients self and their surroundings, as well as their bothersome
behaviour (Gelkopf, 759). In addition, the College of Nurses of Ontario (CNO), have a

EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 3

practical standard involving the use of restraints. Firstly, the standard explains that
understanding the clients behaviour should be taken into consideration to accurately
determine if that particular client needs a restraint or not (College of Nurses of Ontario,
2009). Secondly, an intensive nursing assessment is used to identify certain factors that
can influence the clients difficult behaviours, by which restraints may be considered
(College of Nurses of Ontario, 2009). Lastly, the standard identifies that if the client
claims to be too difficult based on their strengths, abilities, and medication that they are
on than the client should be placed on a restraint (College of Nurses of Ontario, 2009).
On the other hand, the safety of the client should be considered before the nurse can give
a restraint. According to Gelkopf, some claim that patient restraints are effective in
controlling violent behaviour and that it is safer than pharmacotherapy (Gelkopf, 758). I
agree with Gelkopf because nurses should be able to cope with violent patients and
recognize the therapeutic effects of restraints in order to respond in a correct manner.
Additionally, Gelkopf discusses that physical restraints are used as a psychiatric
intervention to protect psychiatric inpatients from self-harm or harm to others, by
securing a safe environment for the patients and staff (Gelkopf, 758). Also, the CNO
states that, developing an individualized plan of care to meet clients goals, such as
increased safety and decreased agitation (College of Nurses of Ontario, 2009). Both the
CNO and Gelkopf mention that their goal is to increase the safety and decrease the
agitation. Therefore, restraints should only be used when the client and the clients
surrounding are at high risk of harm.
Another, important implication to consider for nursing practice is for the nurse to
understand the emotional aspects that surround the use of restraints on patients. I believe

EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 4

that the emotional feelings of the nurse could influence their decision on whether or not
to use a restraint on a patient. In both articles, Yeu-Hui Chuang and Gelkopfs key points
coincide on the basis that when nurses understand their own feelings and thoughts toward
restraint use and learn to shake it off, than personal feelings will not be involved in
patients care and a professional attitude towards care can be maintained (Chuang, 492). I
agree with both authors because as a nurse personal feelings should not be involved while
caring for a patient, but it is better to think about what the patient may be feeling.
According to Gelkopf, the past experiences of nurses who feel fear anxiety,
helplessness, and hopelessness when treating potentially violent patients may influence
their decisions to use physical restraints (Gelkopf, 763). A large majority of nurses
claimed to feel an emotion of pity and guilt towards the patient being restrained (Gelkopf,
761). In other words, that the nurses felt like they were doing something wrong by
placing restraints on patients. Furthermore, the nurse needs to critically think about what
to do in that particular situation regarding their decision for the use of restraints. In
Gelkopfs article, within the survey, he mentions that 76.1% of nurses considered
restraints as a method for calming patients (Gelkopf, 760). Although, within the survey,
about 20% of nurses believe that the use of restraints harm the patient and that it can be
perceived as an act of punishment. The fact that 20% of nurses within the survey consider
patient restraint use as punishment can negatively affect the treatment process and
potentially convey to the patient that they are indeed being punished and humiliated.
Additionally, Gelkopf states, that this type of message could cause violent reactions
because the patient does not understand that restraint is an act of a therapeutic measure
(Gelkopf, 762). Also, it is important for the nurse to understand the emotional responses

EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 5

the patient experiences while being restrained. In the article, nurses within the survey
believe that patients feel anger, fear, degradation, sadness, and helplessness when placed
on a restraint. Although, Yeu-Hui Chuang states, Nurses felt they were in the middle of a
tug-of-war, attempting to balance moral and safety issues (Chuang, 491). However,
Gelkopf states that nurses play a significant role in the decision making process to apply
a restraint, which is why another staff member should participate in the process (Gelkopf,
758-759). Collaborating with other health care professionals (HCP) and understanding
the emotional aspects of patient restraints can help brainstorm whether the client needs a
restraint, and what type of restraint should be applied. Therefore, it is important to
understand the emotional feelings for both patient and nurse that surround the use of
restraints.
The third and final implication identified by Gelkopf regarding the use of
restraints for nursing practice is using the least form of restraint possible. As mentioned
before, nurses within the survey felt that patients feel emotions of anger, fear,
degradation, sadness, and helplessness when placed within a restraint. Using a restraint
may be the best option for that patient; however, the least form of restraint may allow the
patient not to feel these negative emotions. Furthermore, when the nurse uses the least
form of restraint they are also considering an alternative measure in controlling the
clients behavioural or physical activity. According to the CNO, Nurses need to assess
and implement alternative measures before using any form of restraint (College of
Nurses of Ontario, 2009). I agree with the CNO because using the least form of restraint
possible is better for patients autonomy and dignity and creates an improved nurse-client
relationship. Additionally, some associations across the world go as far as moving toward

EMOTIONS OF THE NURSING STAFF TOWARD PATIENT RESTRAINT 6

the future elimination of restraint use (Gelkopf, 758). Above all, I agree with Gelkopfs
key point regarding using the least form of restraint possible because it follows the
nursing practice standards of the CNOs quality of care. This key point can help improve
nursing practice because not all patients give consent to the use of restraints, so using the
least form of restraints possible allows the patient not to feel helpless. Also, the CNO
mentions that nurses cannot use any form of restraint without consent from the patient,
unless it is in an emergency situation (College of Nurses of Ontario, 2009). Therefore,
using the least form of restraint and considering alternative measures is the best option
for patient.
In conclusion, the issue of patient restraint use is a highly controversial topic in
hospital settings and it can create various emotions, attitudes, and opinions amongst the
nurse and client relationships. I have learned that nurses need to truly care for the
patients safety and well-being and not to be emotional attached to patients while
applying restraints. If the restraint is going to help the patient with the state that they are
in, than the restraint should be applied. Above all, the three nursing implications
identified in Gelkopfs article are there to help improve nursing practice and give nurses
feedback of what their doing and how the patients feel. Concluding that the proper use
of restraints and other alternative measures should be enforced on nurses, so that they
understand how to use them, and what patients may need them.

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References
Restraints.(2009,January1).Retrievedfrom
http://www.cno.org/Global/docs/prac/41043_Restraints.pdf?epslanguage=en

Chuang,Y.(2005).Nurses'feelingsandthoughtsaboutusingphysicalrestraintson
hospitalizedolderpatients.JournalofClinicalNursing,486494.
Gelkopf, M., Roffe, Z., Werbloff, N., & Bleich, A. (2009). Attitudes, Opinions,
Behaviors, and Emotions of the nursing staff toward patient restraint.
Issues in Mental Health Nursing, 30(12), 758-763.