5.7 Restraints
Open Resources for Nursing (Open RN)
Definition of Restraints
Restraints are devices used in health care settings to prevent clients from causing harm to themselves or others when alternative interventions are not effective. A restraint is a device, method, or process that is used for the specific purpose of restricting a client’s freedom of movement without the permission of the person. See Figure 5.6[1] for an image of a simulated client with restraints applied.
Restraints include mechanical devices such as a tie wrist device, chemical restraints, or seclusion. The Joint Commission defines chemical restraint as a drug used to manage a client’s behavior, restrict the client’s freedom of movement, or impair the client’s ability to appropriately interact with their surroundings that is not standard treatment or dosage for the client’s condition. It is important to note that the definition states the medication “is not standard treatment or dosage for the client’s condition.”[2] Seclusion is defined as the confinement of a client in a locked room from which they cannot exit on their own. It is generally used as a method of discipline for behavior that can cause harm to themselves or others, or as a method of decreasing environmental stimulation. Seclusion limits freedom of movement because, although the client is not mechanically restrained, they cannot leave the area.
Although restraints are used with the intention to keep a client safe, they impact a client’s psychological safety and dignity and can cause additional safety issues and death. A restrained person has a natural tendency to struggle and try to remove the restraint and can fall or become fatally entangled in the restraint. Furthermore, immobility that results from the use of restraints can cause pressure injuries, contractures, and muscle loss. Restraints take a large emotional toll on the client’s self-esteem and may cause humiliation, fear, and anger.
Restraint Guidelines
The American Nurses Association (ANA) has established evidence-based guidelines that state a restraint-free environment is the standard of care. The ANA encourages the participation of nurses to reduce client restraints and seclusion in all health care settings. Restraining or secluding clients is viewed as contrary to the goals and ethical traditions of nursing because it violates the fundamental client rights of autonomy and dignity. However, the ANA also recognizes there are times when there is no viable option other than restraints to keep a client safe, such as during an acute psychotic episode when client and staff safety are in jeopardy due to aggression or assault. The ANA also states that restraints may be justified in some clients with severe dementia or delirium when they are at risk for serious injuries such as a hip fracture due to falling.
The ANA provides the following guidelines: “When restraint is necessary, documentation should be done by more than one witness. Once restrained, the c