Global Journal of Human-Social Science, A: Arts and Humanities, Volume 23 Issue 5

needs. These tasks become exceedingly challenging to carry out safely without the use of some form of restraints for patients who exhibit violent behavior due to severe psychosis and complete detachment from reality. In the pursuit of reporting a "zero restraints" policy, organizations may seemingly achieve this goal by eliminating mechanical restraints. However, in practice, the absence of mechanical restraints often leads to the implementation of physical restraints. This means that staff members are required to physically hold patients, resorting to various techniques that involve exerting control often through the use of pain. This substitution of mechanical restraints with manual restraint techniques highlights the reality that the "zero restraints" claim is misleading and fails to address the underlying the underlying challenges. And that challenge is violence. In essence, to paraphrase Holister, “zero restraints policy” fights for the patients and staff “freedom” to clash and be injured physically and emotionally. The writer personally visited several establishments in Israel and one in Canada that proudly embraced this new policy as a significant step forward. However, none of these places shared any statistics regarding the frequency of staff and patient injuries, levels of satisfaction among staff and patients, or any tangible outcomes associated with this approach. One hospital manager in Israel has explained me: “We have no financial concerns for staff injury. This is because it is not the hospital and even not the Ministry of Health who pays for the disabilities following staff injury. It is the Ministry of Welfare”. Frontline nurses working in "zero restraints" hospitals candidly expressed their experiences to the writer, sharing phrases such as "we are left with no choice but to endure physical abuse," "there are no other nursing job opportunities available around here," and "it feels like nobody cares about us." In Great Britain, since 2015, there have been significant restrictions on the use of mechanical restraints due to a complex "restraint guide" [8]. As a result, the number of mechanical restraints has decreased. However, conversations with a nurse working in Mental Health in England reveal a disturbing job practice: "When we have a violent psychotic patient, we are unable to use mechanical restraints to administer an injection due to complicated paperwork. Consequently, it takes six to eight staff members to physically restrain the patient, pin the patient to the floor, administer the injection, and then hold down for approximately 45 minutes until the medication takes effect." According to an article published in The Guardian in 2017, two out of five workers in the British National Health System experienced abuse or attacks "in the past year." Additionally, one-third of mental health nurses believe that violence has become more prevalent in the past year [9]. The writer was unable to ascertain the patients' perspective on the matter. As a reader, consider the following scenario: if you were a patient exhibiting violent behavior, would you prefer being restrained to a bed within a minute while retaining freedom of movement for your limbs, and having the restraints removed as soon as medication assists in gaining control? Alternatively, would you opt to physically engage in a fight with staff members, being held down until medication takes effect? Similarly, as a nurse facing a violent patient, would you prefer a mechanical restraint tool that safely immobilizes the patient within a minute, or engaging in physical altercations until medication helps regain control? IV. B ad R estraint D esign Unlike the car industry, the restraints are not chosen by the people who use them. The hospital’s leadership team decides which restraints would be used. Typically, neither front line staff nor patients have had the opportunity to influence the decision of the type of restraints used. This explains the lack of progress in restrains design. In my experience poor restraints design is uncomfortable and risky. It also forces staff to restrain patients in physiologically dangerous positions such as prone (face down) or with one arm above the head. In 2015 in England 16.5% of all restraints were applied in a prone position [10]. In Israel the restraint tool has not changed for at least the last 60 years. They use the same, hard, non- ergonomic, inflexible belts attached to the bed frame with a metal bolts and nuts. This is extremely uncomfortable and emotionally traumatic to the patients. It also requires a long time to apply and may cause problems with blood supply to patient’s extremities. Moreover, the long application process while pt is physically violent poses higher risk for staff as well as patient’s physical and emotional wellbeing. On the other hand, long removal time is a threat to patient’s safety during an external emergency, such as in case of fire. One more thing that should be taken into consideration is trauma history while applying mechanical restraints. More than 50% of female patients suffering from mental health issues has sexual trauma history [11]. So, if the restrains are designed when the legs must be apart is more traumatizing to the females with such history. If you think about police handcuffs, they are easy to apply, but are also extremely uncomfortable and can cause psychical and psychological harm [12]. In addition, the pain, stress, and fear caused by the struggle between staff and patient during lengthy process of application of restraints. Further discomfort aggravates the patient’s brain area called Amygdala. Amygdala in the case of acute stress helps to diminish © 2023 Global Journals Volume XXIII Issue V Version I 20 Global Journal of Human Social Science - Year 2023 ( ) A The Impact of Mechanical vs Physical Restraints: A Call for Awareness