Restraints are measures used to restrict freedom, limit the activity, or control the behaviour of a person or a portion of their body. Restraints can be:
In situations where the safety of the client or others is a concern, the nurse’s responsibility to prevent harm while balancing the person’s right to autonomy can create an ethical conflict. This requires nurses to reflect on the situation and give serious consideration to their role and responsibilities in the use of seclusion and restraints.
Restraints are often overused and can be harmful. There is ongoing recognition that seclusion and restraints are not grounded in research and are not therapeutic (World Health Organization, 2017).
Harmful effects include loss of bone and muscle mass, falls, skin breakdown, urinary incontinence, urinary tract infection, pneumonia, cardiovascular stress, injury and death. Restraints may also lead to emotional distress such as increased agitation, anxiety, anger, delirium, confusion, depression and mistrust of health-care providers.
Nurses play an essential role in providing safe care to people in all care settings. This role requires that nurses provide effective, evidence-based care, including comprehensive assessment, prevention and management of behavioral emergencies.
Although restraints are ordered by the most responsible health-care practitioner, the assessment of need, application and removal are primarily the responsibility of nurses. As a result, nurses play a critical role in reducing restraints through:
Restraints should only be used as a last resort. The least restrictive restraint is used for the shortest time in an emergency or when other interventions have not worked.
Nurses should question using antipsychotic medicine to treat behavioural symptoms of dementia and limit their use to cases where non-pharmacologic measures have failed. Responsive behaviors are a form of communication and are often the last means of expression for unmet needs, pain, or fear. Responsive behaviours are often misinterpreted as agitation, aggression, disruption and resistance to care (Choosing Wisely Canada, 2017).
Alternatives to restraints can include a variety of physical, physiologic, psychological and environmental approaches. They are tailored to the needs of the individual client and the practice setting. Examples include:
Nurses can take responsibility for ongoing learning and professional development on reducing restraint use such as:
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