De-escalation Training and the Reduction of Physical Restraints

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Authors

Muskett, Erik

Date of Issue

2024

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en_US

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Abstract

Physical Restraints (PR) are manual methods that restrict the freedom of movement of patients that are a danger to themselves or others. Although PR are sometimes necessary, they are associated with negative physical and psychological outcomes for patients and the nurses who must apply them. PR can cause pressure injuries, pain, joint dislocation, and more serious problems including pulmonary embolism, asphyxiation, and death. PR can also cause decline in cognitive ability, post-traumatic stress disorder, humiliation, and shame. Further, nurses can be physically assaulted during PR, which increases burnout, sick leave, and impacts their psychological well-being and ability to form therapeutic relationships with patients. The need for proper training that decreases violence and aggression is essential for nurses as 25% report being assaulted by patients. De-escalation training programs are a potential solution to violence and aggression in health care settings that teach a combination of strategies intended to reduce a patient’s agitation and aggression. However, there is a small amount of research about the efficacy of de-escalation training programs with no guidance on what constitutes a gold standard for practice. The purpose of this evidence-based practice review is to evaluate if de-escalation training programs reduce the incidence of PR. Nurses can use this information to reduce the incidence of a controversial intervention that causes negative physical and psychological outcomes for themselves and their patients.

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