Physical Restraint Practices Research Articles

Clinical application of body restraint reduction strategy in critically ill patient

Objective To evaluate the effect of physical restraintreduction strategy on improving the physical restraint practice of critical patients. Methods Using convenient sampling method, the inpatients in the Intensive Care Unit (ICU) of the Emergency Department of a ClassⅢ Grade A hospital in Beijing in 2017 and 2018 were selected as the research objects. According to the length of stay, the inpatients in 2017 were divided into two groups: the control group (n=282) , the intervention group (n=263) , the control group was given regular physical restraint strategy, and the intervention group used the developed physical restraint reduction strategy to implement the physical restraint. The rate of physical restraint, time of physical restraint, delirium, unplanned extubation and skin abnormality were compared between the two groups. Results In the intervention group, the rate of physical restraint was 23.57%, and the rate of unplanned extubation was 1.14%, which was lower than that in the control group, the differences were statistically significant (χ2=26.830, 4.142; P 0.05) . Conclusions The strategy of body constraint reduction is helpful to reduce the rate of body constraint, the time of constraint and the rate of unplanned extubation. Key words: Intensive Care Unit; Critically ill patient; Physical restraint; PR reduction strategy

"Catching your tail and firefighting": The impact of staffing levels on restraint minimization efforts.

WHAT IS KNOWN ON THE SUBJECT?: Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face-to-face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de-escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. ABSTRACT: Introduction Safe staffing and coercive practices are of pressing concern for mental health services. These are inter-dependent, and the relationship is under-researched. Aim To explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. Methods Thematic analysis of semi-structured interviews with staff (n=130) and service users (n=32). Results Five themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes-"insufficient staff to do the job"; "detriment to staff and service users"; "a paperwork exercise: the burden of non-clinical tasks"; "false economies"; and, "you can't do these interventions." Discussion Tendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developments that would enable reductions in use of restraint are labour intensive and vulnerable to derailment by insufficient and poorly skilled staff. Implications for practice Restrictive practices are unlikely to be minimized unless wards are adequately staffed. Inadequate staffing is not independent of restrictive practices and reduces access to alternative interventions for reducing individuals' distress.

Implementation of a multicomponent intervention to prevent physical restraints in nursing homes (IMPRINT): A pragmatic cluster randomized controlled trial

BackgroundDespite clear evidence for the lack of effectiveness and safety, physical restraints are frequently applied in nursing homes. Multicomponent interventions addressing nurses’ attitudes and organizational culture have been effective in reducing physical restraints. ObjectiveTo evaluate the effectiveness of two versions of a guideline and theory-based multicomponent intervention to reduce physical restraints in nursing homes. DesignPragmatic cluster randomized controlled trial. SettingThe study was conducted in 120 nursing homes in four regions in Germany. ParticipantsAll residents living in the participating nursing home during follow-up, newly admitted residents were also included. A total of 12,245 residents included in the primary analysis (4126 and 3547 residents in intervention group 1 and 2 and 4572 residents in the control group). MethodsIntervention group 1 received an updated version of a successfully tested guideline-based multicomponent intervention (comprising brief education for the nursing staff, intensive training of nominated key nurses in each cluster, introduction of a least-restraint policy and supportive material), intervention group 2 received a concise version of the original program and the control group received optimized usual care (i.e. supportive materials only). Primary outcome was physical restraint prevalence at twelve months, assessed through direct observation by blinded investigators. Intervention and control groups were compared using baseline-adjusted linear regression on cluster level, Bonferroni-adjusted for double testing. Secondary outcomes included falls, fall-related fractures, and quality of life. We also described intervention costs and performed a comprehensive process analysis. ResultsAt baseline, mean physical restraint prevalence was 17.4% and 19.6% in intervention groups 1 and 2, and 18.8% in the control group. After twelve months, mean prevalence was 14.6%, 15.7%, and 17.6%. Baseline-adjusted differences between mean prevalences were 2.0% (97.5% CI, -5.8 to 1.9) lower in intervention group 1 and 2.5% (97.5% CI, -6.4 to 1.4) lower in intervention group 2 compared to controls. Physical restraint prevalence showed a pronounced variation between the different clusters in all study groups. We found no significant differences in the secondary outcomes. According to the process evaluation, the intervention was mainly implemented as planned, but the expected change towards a least restraint culture of care was not achieved in all clusters. ConclusionsNeither intervention showed a clear advantage compared to control. The pronounced center variation in physical restraint prevalence indicates that other approaches like governmental policies are needed to sustainably change physical restraint practice and reduce center variations in nursing homes. Trial registrationClinicalTrials.gov : NCT02341898.

Eliciting critical care nurses' beliefs regarding physical restraint use.

Despite the reported harms and ethical concerns about physical restraint use in the critical care settings, nurses' intention to apply them is unequal across countries. According to the theory of planned behaviour, eliciting nurses' beliefs regarding the use of physical restraints would provide additional social information about nurses' intention to perform this practice. To explore the salient behavioural, normative and control beliefs underlying the intention of critical care nurses to use physical restraints from the theory of planned behaviour. A belief elicitation study was conducted. Twenty-six critical care nurses were purposively sampled across gender, work-shift patterns and professional experience in five intensive care units of three hospitals in Spain. Data were obtained from a nine-item open-ended questionnaire and a focus group. Deductive content analysis was performed. Ethical approval was obtained from the hospital ethics committee. Participants were assured their participation was voluntary. Nurses framed the use of restraints as a way of prioritising patients' physical safety. They referred to contextual factors as the main reasons to justify their application. Nurses perceived that their decision is approved by other colleagues and the patients' relatives. Some nurses started advocating against their use, but felt powerless to change this unsafe practice within an unfavourable climate. Control beliefs were linked to patients' medical condition, availability of alternative solutions, analgo-sedation policies and work organisation. Safety arguments based on the surrounding work environment were discussed. Nurses' behavioural and control beliefs were related. Nurses should be trained in alternatives to physical restraint use. The impact of analgo-sedation protocols, relatives' involvement, leadership support and intensive care unit restraint policies on physical restraint practices need to be revised. Further research is required to explore why nurses do not act with moral courage to change this harmful practice.

Knowledge, attitude and practice of intensive care unit nurses about physical restraint.

Physical restraint is mainly used in intensive care units (ICUs) to prevent delirious or agitated patients from removing tubes and lines connected to them. However, inappropriate use of physical restraint could have many detrimental physical effects on the patient, such as nerve damage, asphyxiation or even death. The aim of the study is to investigate nurses' knowledge, attitude and practice of physical restraint in ICUs in Jordanian hospitals, about which little is known. A descriptive and cross-sectional design was used. A convenience sample of 400 nurses working in three public hospitals and one university-affiliated hospital from different geographical regions in Jordan was selected. An Arabic version of the Physical Restraint Questionnaire (PRQ) was used to collect the data. A total of 300 completed questionnaires were returned, with a response rate of 75%. Of the total sample, 51% were males, 65.7% were from public hospitals and 80.3% held a bachelor's degree. The mean score in the knowledge section was 9.7 (SD =1.7) out of 15; in the attitude section, it was 24.7 (SD = 4.8) out of 33; and in the practice section, it was 30.9 (SD = 3.5) out of 42. Nurses who reported previous related education scored higher on the knowledge section (mean = 10.7; SD = 1.4) than nurses who reported no previous related education (mean = 9.1; SD = 1.6; p < .001). However, no significant differences between these categories were found in relation to attitude and practice. The study demonstrated some lack of knowledge and unsafe practices regarding physical restraint in ICUs in Jordan. It suggests improving nurses' knowledge, attitude and practices through in-service education on best practice for physical restraint, developing policies/guidelines and providing adequate staff and equipment to maintain patient safety and prevent complications. Conducting education programmes on physical restraint for ICU nurses and providing other preventive strategies are important in improving nurses' knowledge, attitude and practice.

Nurses Practice to Physical Restraint Practices in ICU Units at Three Teaching Hospitals in Baghdad

Background: using physical restraints is a highly preferred practice in intensive care units. Most of the studies show that the main reasons for restraining patients is to prevent dislodgment of medical equipment’s and nurses have positive attitudes about restraining practices. Objectives: this research was conducted for the purpose of evaluating the use of physical restraints, and observing ongoing practices and perceptions about physical restraints among intensive care unit nurses. Methodology: A descriptive–cross sectional study done with 3 intensive care unit nurses in the 1st of Jan to end of May 2014. Nurses who agree to participate in the study were (63) filled out the questionnaire prepared by the researcher. The questionnaire consisted of three parts. The first part included questions related to nurses demographic variables; the second part included questions related to restraint practices of nurses; the third part included phrases to determine nurses perceptions for restraint use where nurses gave agree/ disagree answers. Results: the study indicated that the Prevalence of physical restraint use is high in all ICUs. Gauze is the mostly used but not a proper material for restraining patients in all intensive care units. Reasons for using restraints as described by nurses are to prevent equipment dislodgement and providing safe working environment for themselves. Conclusions: In this study, physical restraining practices of intensive care nurses and materials used for this practice are not appropriate for patient care. Perceptions and knowledge of nurses play an important role on the selection of the restraining method. Recommendation: The study recommended that in order to get a better nursing care it is very important to develop a restraint policy and educate nurses to provide awareness about this highly used practice in intensive care units in these hospitals

Knowledge and Practice Regarding Physical Retraining among Nurses Working in Selected Hospitals of Ludhiana, Punjab

A descriptive study on 60 nurses working in ICU's, Emergency and Neuro-Surgery ward of selected hospitals, Ludhiana was conducted. Convenience sampling technique was used. The study was aimed to assess the knowledge and practice of physical restraints among nurses working in various units of selected Hospitals, Ludhiana. Data was collected by using following 3 tools a) Socio-demographic profile of nurses b) Structured knowledge Questionnaire on physical restraints and c) Observational checklist to assess the practice of Physical Restraints. Majority (83.33%) of nurses belonged to ≤30 years, 91.66% were female, 83.33% of nurses were GNMs and only 16.67% were B.Sc.’s. Majority (61.66%) of the nurses were working in ICU's whereas only 38.3% were working in Neuro-Surgery and Emergency ward. 63.3% of nurses had work experience of >2 years and 36.7% of nurses had experience of ≤2 years. Mean knowledge score was found to be 14.2 ± 3.9. The result showed that majority (76.66%) of nurses had average knowledge regarding physical restraints. It was found that no physician written order were documented for all the patients, written consent were not taken from 43.33% of patients prior to the procedure. Clove hitch restraint with cotton and bandages were the most common type of physical restraints used.

Nurses' perceptions and practice of physical restraint in China.

There is controversy concerning the use of physical restraint. Despite this controversy, some nurses still consider the application of physical restraint unavoidable for some of their clients. Identify the perceptions and practice of physical restraint in China. This was a descriptive study that combined qualitative interviews with a quantitative cross-sectional survey. A total of 18 nurses were interviewed and 330 nurses were surveyed. Approval of the study was obtained from the hospital ethics committee. Permission to conduct the study was obtained from the director of nursing. Participants were assured that their participation is voluntary. Physical restraint was commonly used to protect patients' safety. Naturally, intensive care unit nurses used physical restraint much more frequently than general medical/surgical ward nurses (p < 0.01). In addition, night shift nurses tended to use physical restraint more frequently. Nursing managers should be aware of the role nurses play in the use of physical restraint. In-service training regarding the proper use of physical restraint should be strengthened and nurse staffing levels should be improved in order to minimize the use of physical restraint in China.

Survey and analysis of knowledge, attitude and practice of physical restraint on critical parents in secondary hospitals and tertiary hospitals in Hubei province

Objective To investigate the situation of knowledge,attitude and practice of physical restraint from nurses for critical parents in secondary hospitals and tertiary hospitals in Hubei province.Methods 300 nurses from four tertiary hospitals and four secondary hospitals were investigated for the situation of knowledge,attitude and practice of physical restraint by questionnaires.Results It showed that nurses had a good knowledge of physical restraint,(11.02±1.96),their attitude of physical restraint tended to be neutral,(34.99±3.52),the practice of physical restraint turned out to be at meddle-up level,(51.90±6.67).There was a statistically significant difference in the scores of physical restraint knowledge and practice between nurses who receive physical restraint train or not after they got a job,besides,there was also statistically significant difference in the scores of physical restraint knowledge between intensive department and non-intensive department,tertiary hospitals and secondary hospitals,however there was no statistically significant difference in the scores of physical restraint attitude and practice between them.Conclusions Compared with non-intensive department and secondary hospitals,the nurse managers of intensive department and tertiary hospitals should strengthen the training and education of physical restraint of clinical nurses,guide the nurses to build the positive attitude of physical restraint,to reduce the use of preventive physical restraint and then to promote their quality of practice on physical restraint. Key words: Secondary hospital; Tertiary hospitals; Critical illness patients; Restraint; Physical

Examination of Ethical Dilemmas Experienced by Adult Intensive Care Unit Nurses in Physical Restraint Practices

Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.

Predictors of physical restraint use in Canadian intensive care units

IntroductionPhysical restraint (PR) use in the intensive care unit (ICU) has been associated with higher rates of self-extubation and prolonged ICU length of stay. Our objectives were to describe patterns and predictors of PR use.MethodsWe conducted a secondary analysis of a prospective observational study of analgosedation, antipsychotic, neuromuscular blocker, and PR practices in 51 Canadian ICUs. Data were collected prospectively for all mechanically ventilated adults admitted during a two-week period. We tested for patient, treatment, and hospital characteristics that were associated with PR use and number of days of use, using logistic and Poisson regression respectively.ResultsPR was used on 374 out of 711 (53%) patients, for a mean number of 4.1 (standard deviation (SD) 4.0) days. Treatment characteristics associated with PR were higher daily benzodiazepine dose (odds ratio (OR) 1.05, 95% confidence interval (CI) 1.00 to 1.11), higher daily opioid dose (OR 1.04, 95% CI 1.01 to 1.06), antipsychotic drugs (OR 3.09, 95% CI 1.74 to 5.48), agitation (Sedation-Agitation Scale (SAS) >4) (OR 3.73, 95% CI 1.50 to 9.29), and sedation administration method (continuous and bolus versus bolus only) (OR 3.09, 95% CI 1.74 to 5.48). Hospital characteristics associated with PR indicated patients were less likely to be restrained in ICUs from university-affiliated hospitals (OR 0.32, 95% CI 0.17 to 0.61). Mainly treatment characteristics were associated with more days of PR, including: higher daily benzodiazepine dose (incidence rate ratio (IRR) 1.07, 95% CI 1.01 to 1.13), daily sedation interruption (IRR 3.44, 95% CI 1.48 to 8.10), antipsychotic drugs (IRR 15.67, 95% CI 6.62 to 37.12), SAS <3 (IRR 2.62, 95% CI 1.08 to 6.35), and any adverse event including accidental device removal (IRR 8.27, 95% CI 2.07 to 33.08). Patient characteristics (age, gender, Acute Physiology and Chronic Health Evaluation II score, admission category, prior substance abuse, prior psychotropic medication, pre-existing psychiatric condition or dementia) were not associated with PR use or number of days used.ConclusionsPR was used in half of the patients in these 51 ICUs. Treatment characteristics predominantly predicted PR use, as opposed to patient or hospital/ICU characteristics. Use of sedative, analgesic, and antipsychotic drugs, agitation, heavy sedation, and occurrence of an adverse event predicted PR use or number of days used.

Physical restraints practice in adult intensive care units in Egypt

Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El-Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a "physical restraint observation form" and a "structured questionnaire." The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.

Analysis of physical restraints practice and its influencing factors of ICU nurses

Objective To investigate ICU nurses' practice of physical restraints and to explore its influencing factors.Methods Questionnaires were used to investigate 150 ICU nurses from 5 third-grade hospitals in Hengyang City.Results The score of ICU nurses' knowledge of physical restraints was at middle-upper level, while the accuracy rate was 78.70%. The attitude toward physical restraints was neutral. Practice of physical restraints was relatively appropriate and the influencing factors were: age, nursing age, the indications of physical restraints, professional title, feeling of physical restraints, duration of working in ICU and education background of physical restraints.Conclusions The education of physical restraints should be improved, so as to set up the positive feeling of physical restraints, take pertinent measures and improve nursing quality. Key words: ICU nurses; Physical restraints practice; Influencing factors

Physical restraint use in intensive care units across Europe: The PRICE study

The use of physical restraint has been linked to delirium in ICU patients and a range of physical and psychological outcomes in non-ICU patients. However, the extent of restraint practice in ICUs is largely unknown. This study was designed to examine physical restraint practices across European ICUs. A prospective point prevalence survey was conducted in adult ICUs across European countries to examine: physical and chemical restraint use during the weekend and weekdays, reasons for physical restraint use, timing of restraint use, type of restraint used and availability of restraint policies. Thirty-four general (adult) ICUs in nine countries participated in the study providing information on 669 patients with details of physical and chemical restraint use in 566 patients. Prevalence of physical restraint use in individual units ranged from 0 to 100% of patients. Thirty-three per cent of patients were physically restrained; those that were restrained were more likely to be ventilated (χ(2)=87.56, p<0.001), sedated (χ(2)34.66, p<0.001), managed in a larger unit (χ(2)=10.741, p=.005) and managed in a unit with a lower daytime nurse:patient ratio (χ(2)=17.17, p=0.001). Larger units were more likely to use commercial wrist restraints and smaller units were more likely to have a restraint policy, although these results did not reach significance. As an initial exploration, this study provides evidence of the range of restraint practice across Units in Europe. Variation in the number of units per country limits generalization of findings. However, further examination is needed to determine whether there is a causal element to these relationships. Attention should be paid to developing evidence based guidelines to underpin restraint practices.

Physical Restraint in Critical Care Settings: Will They Go Away?

The critical care setting is perhaps the last major health care setting in which physical restraint remains a common, and oftentimes unquestioned, practice. This is despite the numerous regulations and accrediting standards that have limited or even eliminated practitioners' use of physical restraints in other health care settings. The decision to use physical restraint in the care of critically ill patients can be complex and is influenced by characteristics of the patient, the practitioner, and the environment. What do we know about physical restraint practice in critical care settings, and what steps must we take if we are, indeed, to become "restraint-free" environments?

The practice of physical restraint in the UK

World Psychiatric Association (WPA) Thematic Conference. Coercive Treatment in Psychiatry: A Comprehensive Review Thomas W Kallert, John Monahan, Juan E Mezzich Meeting abstracts – A single PDF containing all abstracts in this Supplement is available here . http://www.biomedcentral.com/content/pdf/1471-224X-7-S1-info.pdf

Role of substance abuse in requirement of physical restraint of psychiatric patients in emergency setting

Background The practice of physical restraint in psychiatric emergency practice is rather frequent. Patients with substance abuse more often present aggressive behavior requiring physical restraint in such settings. The legal frame for such practice in our country is defined in the Law for the protection of persons with mental disturbances. Patients admitted to a psychiatric emergency ward were analyzed prospectively according to their need of physical restraint.

Évaluation d'une intervention multiple pour implanter des recommandations nationales : le cas de la contention physique passive en gériatrie

Background There is a growing interest in developing guidelines. The French Agency for accreditation and Evaluation (Anaes) published in October 2000 guidelines on the use of restraint in geriatric care settings because in spite of the risks this practice remains widespread in that type of care setting. A multifaceted intervention was conducted in a Parisian geriatric hospital in order to improve the implementation of the published guidelines. An epidemiological study was conducted to assess the outcomes of this intervention. Methods The intervention consisted in distributing educational materials and a specific prescription sheet, and in staff training sessions. A time series study was used to assess outcomes. The three time points were: before the intervention, just after the end of the intervention and one year later. Two dimensions were studied: implementation of the guidelines using markers collected from patients' charts and restraining practices noted in an observational study of hospitalized patients. Results The results of the study suggest that five recommendations were followed better: restraint prescription (8.7 to 57.4%), writing in the patient chart the reasons for restraining (3.5 to 35.3%), follow-up prescription, assessment of potential benefits and risks for the patient and patient information (0% to 19–34%). Nevertheless, the prevalence of restraint and of devices employed (around 70%) remained unchanged after the intervention. The various outcomes of the intervention might be explained by the guidelines themselves, which were variably practical or precise. Moreover, the effect of certain factors directly related with the use of restraint, a routine practice strongly supported by myths about its efficacy, as well as factors related to intervention design may merely have prevented any decrease in the use of restraint practices. Conclusion Multifaceted intervention can favour implementation of certain national guidelines such as prescribing restraint, but can also fail in stimulating the implementation of others such as decreasing the prevalence of restraint in geriatric practice. Therefore the next intervention should emphasize alternatives to physical restraint practices.

Physical Restraint in School

The current emphasis on educating children in the least restrictive environment has resulted in the use of physical restraint procedures across all educational placement settings, including public schools. Since its initial use, restraint has been controversial. Professionals who use physical restraint claim that it is necessary to safely manage dangerous behaviors. Child advocates, however, argue that far too many children suffer injury and death from the very staff charged with helping them. The authors review research literature, legislation, and court decisions on topics related to the use of restraint in schools and identify position statements and recommended practices from nationally recognized professional organizations and advocacy groups. Recommendations are given for research, policy, and procedures for the use and practice of physical restraint in schools.

Pratique de la contention dans un service d’urgences psychiatriques

The practice of physical restraint is relatively frequent in medical emergency and geriatric units. Its use in psychiatry is controversial. Although distinct, it is often associated with seclusion, as a response to or prevention of agitated mentally ill patients'behavior. A detailed review of the literature shows the scarceness of work defining the exclusive use of restraint without seclusion. We report a naturalistic study over 6 Months, covering 76 cases having required restraint. The study of the international literature concerns nursing care, geriatric, child-adolescent psychiatric and adult psychiatric reviews. The restraint is a usual practice in general care like emergency, intensive care or geriatric units in order to prevent the patients from falling or to administrate certain care. Legal action has been reported as a consequence of lack of information or agreement of the family. The psychiatric use of restraint is conceived as an additional measure to seclusion, which is a controversial procedure from a therapeutic point of view as well as because of its long duration of application. The practice of restraint described in French literature, from Pinel (in to Daumézon and from French hospital regulations to "transparency forms", seems to be more easily accepted for its short duration and its careful prescription in order to maintain relations with the patients, including agitated children. We made a 6 Months retrospective study in a Parisian psychiatric emergency unit receiving an average of 30 patients a day. The rate of restraint is 1.4%. The objective was to describe the main clinical, epidemiological and situational characteristics and to define quality criteria concerning restraint regarding to the existing standards. We had at our disposal a restraint protocol in order to avoid its prescription as a punishment or for the comfort or the convenience of an insufficient staff. The decision of the restraint is directly prescribed by a physician or decided in emergency by the nurses and then rapidly confirmed by medical prescription. In short, most restrained patients are male, the average age is 32 Years old, and the diagnoses associated with restraint in order of frequency are schizophrenia, personality disorders, acute psychotic episodes, manic episodes and toxic abuses. The main early-warning signs are aggressiveness, delusions, opposition, paranoiac thoughts and distrust. The average duration is 2 hours with continuous clinical supervision and a relational contact maintained. Our study confirms the notion of cumulate restraint days. Actually, 43% of the restraints happen on the same day as others do. The high rate on those days could be as Fischer hypothesized the result of instinctive, aggressive and sexual release of the staff, as well as the consequence of an increase in anxiety and agitation of the other patients. The legal framework is more the duty of assistance to a person in danger than constrained hospitalization, which is not systematically pronounced. No injury or somatic complication occurred during restraint. Neither complaint from the patient or his family nor sick leave of staff was recorded. The specific use of restraint can be compared to the existing standards for using the seclusion room. Among those standards only 1 of 23 criteria was not verified. The others was applicable or without object. The therapeutic use of restraint requires the development of specific quality standards, and the existing criteria concerning seclusion represent a necessary but insufficient answer. We emphasize the need to take into account the early warning signs, a response to the cumulative restraint days, as well as a satisfaction study on patients and the feasibility of such a study in an emergency service.