What guidelines should nurses follow when considering whether or not a client requires restraints?

Restraints in a medical setting are devices that limit a patient's movement. Restraints can help keep a person from getting hurt or doing harm to others, including their caregivers. They are used as a last resort.

There are many types of restraints. They can include:

• Belts, vests, jackets, and mitts for the patient's hands
• Devices that prevent people from being able to move their elbows, knees, wrists, and ankles

Other ways to restrain a patient include:

• A caregiver holding a patient in a way that restricts the person's movement
• Patients being given medicines against their will to restrict their movement
• Placing a patient in a room alone, from which the person is not free to leave

Restraints may be used to keep a person in proper position and prevent movement or falling during surgery or while on a stretcher.

Restraints can also be used to control or prevent harmful behavior.

Sometimes hospital patients who are confused need restraints so that they do not:

• Scratch their skin
• Remove catheters and tubes that give them medicine and fluids
• Get out of bed, fall, and hurt themselves
• Harm other people

Restraints should not cause harm or be used as punishment. Health care providers should first try other methods to control a patient and ensure safety. Restraints should be used only as a last resort.

Caregivers in a hospital can use restraints in emergencies or when they are needed for medical care. When restraints are used, they must:

• Limit only the movements that may cause harm to the patient or caregiver
• Be removed as soon as the patient and the caregiver are safe

A nurse who has special training in using restraints can begin to use them. A doctor or another provider must also be told restraints are being used. The doctor or other provider must then sign a form to allow the continued use of restraints.

Patients who are restrained need special care to make sure they:

• Can have a bowel movement or urinate when they need to, using either a bedpan or toilet
• Are kept clean
• Get the food and fluids they need
• Are as comfortable as possible
• Do not injure themselves

Patients who are restrained also need to have their blood flow checked to make sure the restraints are not cutting off their blood flow. They also need to be watched carefully so that the restraints can be removed as soon as the situation is safe.

If you are not happy with how a loved one is being restrained, talk with someone on the medical team.

Restraint use is regulated by national and state agencies. If you want to find out more about restraints, contact The Joint Commission at www.jointcommission.org. This agency oversees how hospitals are run in the United States.

Heiner JD, Moore GP. The combative and difficult patient. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 189.

Kowalski JM. Physical and chemical restraint. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 69.

Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M. Body Safe client environment and restraints. In: Smith SF, Duell DJ, Martin BC, Gonzalez L, Aebersold M, eds. Clinical Nursing Skills: Basic to Advanced Skills. 9th ed. New York, NY: Pearson; 2017:chap 7.

The Joint Commission website. The comprehensive accreditation manual for hospitals. www.jointcommission.org/accreditation/hospitals.aspx. Accessed October 24, 2021.

Updated by: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

The CCTC Standard of Care for restraint use has been developed to comply with the LHSC Standard of Nursing Care for Restraint Use.  

Definition:

Restraints are any mechanical, chemical or environmental means which are intended to prevent injury or bring under control behaviours or physical movements which could cause bodily harm to patients or others.

Ensure that patient and health care provider safety standards are met during this procedure including:

• Risk assessment and appropriate PPE
• 4 Moments of Hand Hygiene
• Procedural Safety Pause is performed
• Two patient identification
• Safe patient handling practices
• Biomedical waste disposal policies

References:

College of Nurses Of Ontario (2000). A Guide on the Use of Restraints. “Communique” January.

Deprospero, R.P., & Bocchino, N. (1999). Restraint Free Care – Is It Possible? American Journal of Nursing 99(10) 27-34.

Fletcher, K. (1996). Use of Restraints in the Elderly. AACN Clinical Issues, 7(4), 611-620.

Gilbert, M., & Counsell, C. (1999). Planned Change to Implement a Restraint Reduction Program. Journal of Nursing Care Quality, 13(5), 57-64.

Knapp, M.B. (1996). Physical Restraint Use in Critical Care: Legal Issues. AACN Clinical Issues, 7(4), 579-584.

Leith, B. (1998). The Use of Restraints in Critical Care. Official Journal of the Canadian Association of Critical Care Nurses, 9(3), 24-28.

Leith, B. (1998). Do Physical Restraints Prevent Patients form Removing Invasive Therapeutic Devices? Official Journal of the Canadian Association of Critical Care Nurses, 9(3), 31-34.

London Health Sciences Centre (2001; February).Revised February  1, 2010.Policy on the Use of Restraints, PCC020.

Maccioli, G., Mazuski, J., Kuszaj, J., Devlin, J. & Peruzzi, W. (2003). Clinical Practice Guidelines for the Maintenance of Patient Physical Safety in the Intensive Care Unit: Use of Restraining Therapies: American College of Critical Care Medicine Task Force 2001-2002, Critical Care Medicine, 31(11), 2665-2676.

Mion, L. (1996). Establishing Alternatives to Physical Restraint in the Acute Care Setting: A Conceptual Framework to Assist Nurses’ Decision Making, AACN Clinical Issues, 7(4), 592-602.

Reigle, J. (1996). The Ethics of Physical Restraints in Critical Care, AACN Clinical Issues, 7(4), 585-591.

Which statement is true regarding the use of patient restraints?

Which reason would support the use of patient restraints?

What are some nursing interventions the nurse should use to facilitate mourning?

Which refers to the professional obligation of the nurse to assume responsibility for actions?