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Review of the Medical and Legal Literature on Restraint Chairs

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Möhler R, Nürnberger C, Abraham J, Köpke S, Meyer G. Interventions to prevent and reduce the use of physical restraints of the elderly in general hospital settings. 2016;2016(12):CD012476. Crutchfield P, Gibb TS, Redinger MJ, Ferman D, Livingstone J. The conditions for the ethical application of restrictions. Breast. 2019;155(3):617–25.

Whittemore R, Knafl K. The integrative review: updated methodology. J Adv nurses. 2005;52(5):546-53. One of the limitations of this study was our limited access to certain databases. In addition, this study only looked at studies published in English and Persian. Although all documents included in the study are of acceptable quality, the results of this study should be used with caution and generalized to other contexts. Gu T, Wang X, Deng N, Weng W. Investigation of factors influencing physical restraint in Chinese intensive care units: a prospective, cross-sectional study for observation. Aust Crit Care. 2019;32(3):193–8th

Mahmoud AS. Attitude and practice of psychiatric nurses towards physical restraint. Nurse Psychiatrists Arch. 2016;31(1):2–7th Leahy-warren P, Varghese V, Day MR, Curtin M. Physical restraint: perceptions of nurse managers, nurses, and health care assistants. 2018;65(3):327-35. Sharifi A, Arsalani N, Fallahi-Khoshknab M, Mohammadi-Shahbolaghi F, Ebadi A. Iranian nurses` perceptions of the use of physical restraint for hospitalized older adults: a cross-sectional descriptive-correlational study. BMC Geriatr. 2020;20(1):233rd

Cleary KK, Prescott K. The Use of Physical Chains in Acute and Long-Term Care: An Up-to-Date Review of Evidence, Regulation, Ethics and Legality. □ Acute Care 2015;6(1):8–15. The fifth major category of the study concerned the principles of public relations documentation. Documentation of therapeutic and nursing interventions in patients` medical records is the professional and legal responsibility of all health care providers, and patient medical records are a valuable source of safe, high-quality care [69]. However, there is evidence that over 70% of healthcare providers do not document the use of PR [58, 60, 66, 70]. One study showed that most physicians did not document PR assignments in patients` medical records. Therefore, nurses also avoid PR documentation for fear of the legal consequences of using PR [60]. The lack of documentation of PR in patients` medical records means that there is no evidence to assess the quality and complications of RP use.

Therefore, high-quality training and management supervision are needed to promote public relations documentation. Flaherty JH, Little MO. Adapting the environment for patients with delirium: lessons from the delirium room, a restraint environment for older hospitalized adults with delirium. J Am Geriatr Soc. 2011;59(s2):S295–300. Law enforcement`s use of restraint chairs for violent people has sparked controversy and litigation, as injuries and deaths of handcuffed people have been reported. The objective of this study is to review the available medical and legal literature and to enable the development of evidence-based best practice recommendations to support the development of guidelines for restraint chairs.

It is a structured literature review of four databases, two medical and two legal. The medical examination focused on the restraint chair with an additional examination of the materials compared to other methods and options of restraint. The legal review focused on disputes involving the president of restraint. The review of the medical literature revealed 21 peer-reviewed studies that examined the physiological or psychological effects of restraining chair use on humans or primates. Of these studies, 20 were conducted on primates. The only human study found no clinically significant effect of the restraint chair on the test subjects. The review of the legal literature revealed very few cases where the restraint chair was a major or secondary objective. The general problems associated with the restraint chair cases involved deviations from established protocols and rarely problems with the chair itself. The available medical literature shows that the restraint chair poses little or no medical risk. In addition, the restraint chair alone carries little legal responsibility when used correctly.

With proper supervision and adherence to established protocols, the restraint chair is a safe and appropriate device for restraining violent people. Saeidi S, Khatiban M, Khazaei A, Soltanian A, Rahimi-Bashar F. Evaluation of the knowledge, attitude and practice of physical restraint of nurses in intensive care. Sci J Hamadan Nurs Midwifery Fac. 2015;23(3):40–9. Dikiciyan J. Australian and New Zealand Society for Geriatric Medicine Summary of Position Statement: Physical restraint in the elderly. Australas J Aging. 2016;35(3):225. Mohler R, Meyer G. Nurses` attitudes towards the use of physical shackles in elderly care: a systematic review of qualitative and quantitative studies. Int J Nurses` Stud.

2014;51(2):274–88. Kalula SZ, Petros SG. Use of physical restraint in inpatients: a descriptive study in a tertiary hospital in South Africa. Curatonis. 2016;39(1):A1605. Bleijlevens MH, Wagner LM, Capezuti E, Hamers JP, IPR Working Group. Physical constraints: Consensus of a search definition using a modified Delphi technique. J Am Geriatr Soc. 2016;64(11):2307–10. All public relations care activities should be clearly documented in the patient`s chart [9,10,11,12, 35,36,37, 42].

Public relations documentation should include: Lach HW, Leach K, Butcher HK. Evidence-Based Practice Guideline. Change in the practice of physical restraint in acute care. J Nurses Gerontol. 2016;42(2):17-26. Cotter VT, Evans LK. Try the following: Avoid restrictions in hospitalized seniors with dementia. Hartford Inst Geriatr Nurses. 2018. Available from:

Said AA, Kautz DD. Reduce reluctance among acute care seniors. Breastfeeding. 2013;43(12):59–61. Guvercin CH, Samur M, Gurkan KP. The other side of the coin: nurses` views and behaviours on physical restraint.