General /

We must remind ourselves everyday that the ethical dilemma resulting from physical restraint is the clinician’s value or emphasis of beneficence versus the patient’s autonomy and dignity. The latter is what The Mandt System was founded upon. At the Mandt System, our philosophy is individual served first. In order to execute that philosophy, our partners and customers should understand the element of risk associated with using restraints, is always a last resort at the Mandt System.

Medical mechanical restraints are designed to restrain patients with the minimum of discomfort and pain and to prevent patients injuring themselves or others. There are many kinds of mild, safety-oriented medical restraints which are widely used. Medical restraints are generally used to prevent people with severe physical or mental disorders from harming themselves or others. A major goal of most medical restraints is to prevent injuries due to falls. Other medical restraints are intended to prevent a harmful behavior, such as hitting people. Ethically and legally, once a person is restrained, the safety and well being of the restrained person falls upon the restrainer, appropriate to the type and severity of the restraining method.

Although medical mechanical restraints, used properly, can help prevent injury, they can also be dangerous. The United States Food and Drug Administration (FDA) estimated in 1992 that at least 100 deaths occur annually in the U.S. from their improper use in nursing homes, hospitals and private homes. Most of the deaths are due to strangulation. The agency has also received reports of broken bones, burns and other injuries related to improper use of restraints.

Throughout the last decade or so, there has been an increasing amount of evidence and literature supporting the idea of a restraint free environment due to their contradictory and dangerous effects.[1] This is due to the adverse outcomes associated with restraint use, which include: falls and injuries, incontinence, circulation impairment, agitation, social isolation, and even death [2]

Use of physical restraints should be as a last resort; and only used when less restrictive mechanisms have been determined to be ineffective and risk of injury from intervening is less than that of not intervening. The use of restraint must be in accordance with a written modification to the patient’s plan of care. This primarily means setting up a therapeutic relationship with a patient, getting to know what environmental and emotional triggers could lead to aggressive or even violent behaviors. A plan to prevent a patient who is anxious or agitated from escalating into a full-blown, potentially dangerous situation should be in place.

If you would like to have The Mandt System to assist in setting up a patient plan of care or assist in establishing a therapeutic relationship with your patient or patients, please email us at Info@mandtsystem.com.

Sally Phipps – Mandt Faculty

1. ^ Evans; Wood & Lambert (2003). Journal of Advanced Nursing 3 (41).
2. ^ Huabin; Lin & Castle (2011). American Journal of Alzhiemer’s Disease &Other Dementias 1 (26).

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