Rationale and Comments

Restraints cause more problems than they solve, including serious complications and even death. Physical restraints are most often applied when behavioral expressions of distress and/or a change in medical status occur. These situations require immediate assessment and attention, not restraint. Safe, quality care without restraints can be achieved when multidisciplinary teams and/or geriatric nurse experts help staff anticipate, identify, and address problems; family members or other caregivers are consulted about the patient’s usual routine, behavior, and care; systematic observation and assessment measures and early discontinuation of invasive treatment devices are implemented; staff are educated about restraints and the organizational culture and structure support restraint-free care.

Sponsoring Organizations

• American Academy of Nursing

Sources

• Expert consensus

Disciplines

• Geriatric Medicine

References

• Bourbonniere M, Strumpf NE, Evans LK, Maislin G. Organizational characteristics and restraint use of hospitalized nursing home residents. J Am Geriatr Soc. 2003 Aug;51(8):1079-84.
  
• Evans LK, Cotter VT. Avoiding restraints in patients with dementia: understanding, prevention, and management are the keys. Am J Nurs. 2008 Mar;108(3):40-9; quiz 50.
  
• Evans LK, Strumpf NE. Two decades of research on physical restraint: impact on practice and policy. In Hinshaw AS, Grady PA (Eds.), pp. 167-184. Shaping health policy through nursing research. New York (NY):Springer.
  
• Minnick AF, Mion LC, Johnson ME, Catrambone C, Leipzig R. Prevalence and variation of physical restraint use in acute care settings in the US. J Nurs Scholarsh. 2007;39(1):30-7.