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Children's nurses should consider supportive holding and restraint as opposite ends of a continuum, but there is no policy that defines each procedure, says Karen Jeffery
Summary
The meaning of supportive holding versus restraint in children's nursing has been debated for some time. Supportive holding has been defined as a hold that supports the child through a therapeutic intervention, and restraint as a hold that overpowers the child who may be a danger to themselves or others. Both are conducted in the philosophy of best interest. The Royal College of Nursing (2010) guidance suggests adopting the terms therapeutic holding and restrictive physical intervention. This article was accepted before the new guidance was published.
However, with authors still using terms interchangeably, it is important to debate whether there is a clear demarcation in terminology and practice, or whether one is a continuation of the other, differentiated by the degree of force used.
Keywords
Anaesthetic nursing, clinical procedures, force, holding, restraint
THE PRACTICE OF supportive holding and restraint in children's nursing has been a subject of debate among academics as they examine the need to hold and the effect this has on the child (Robinson and Collier 1997, Stephens et al 1999).
There is justification of the practice and discussion of when it could be considered abusive (Jeffery 2002, Folkes 2005). There is also dialogue on the need for policies and guidance (Lambrenos and McArthur 2003, Royal College of Nursing (RCN) 2003, 2008, National Institute for Health and Clinical Excellence (NICE) 2005, British Institute of Learning Disabilities (BILD) 2006, Jeffery and Deaves 2007). Some authors have discussed benchmarking and the importance of education (Bland et al 2002, Valler-Jones and Shinnick 2005).
Research is evident but limited, and in some instances, dated (Robinson and Collier 1997, Stephens et al 1999, Morgan 2005, Demir 2007). Confusion persists as to what constitutes supportive holding and what constitutes restraint, with some authors using the terms synonymously (Pearch 2005, Brenner et al 2007).
Supportive holding
Supportive holding is distinguished from restraint by the degree of force used, and whether there is need to overpower the child (RCN 2003). The former requires consent whereas the latter does not. Supportive holding is used, for example, to sustain a child through a clinical...