Introduction

The use of physical restraints in the health care setting has been a controversial issue over the years.  There has been much questioning over whether the use of physical restraints is beneficial or not when providing care to patients.  The term physical restraint is defined by The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) as “any physical method of restraining a person’s freedom of movement, physical activity, or normal access to his or her body” (Smith, Timms, Parker, Reimels, & Hamlin, 2003).  Examples of physical restraints include beside rails, wrist restraints, lap belts, vests, mittens, and geriatric chairs with a table (Napierkowski, 2002).

There are many reasons that a patient may become restrained.  Some of them include managing disruptive behaviors, protecting the patient from falls, protecting the patient from injury, preventing patient disruption of medical treatment, and to maintain proper body position.  According to The Joint Commission, physical restraints can only be applied after all other interventions have been unsuccessful in controlling the patient’s behavior.  The physical restraint being used must be discontinued as soon as possible after application and the patient must continuously be monitored while the restraints are in use (Smith et al., 2003).  The maximum amount of time that a patient can be restrained per order is 24 hours.  After the 24 hours, a licensed practitioner must reassess the patient to determine if the restraints are still necessary.  Monitoring of the restrained patient is vital and documentation is essential for evidence of compliance (Kobs, 1997).

The issue of physical restraints is important to the field of nursing.  Nurses have a huge responsibility when caring for a restrained patient.  Nurses have to provide accurate documentation of why restraints are necessary for a patient as well as providing an explanation to the patient and/or family as to why they are being restrained.  The nurse also has to ensure that they attain a physicians order for the restraint and that they continuously assess and reassess if the restraints are necessary for the patient (Krapp, 2006).

Relevance of Issue to Nursing Practice

The use of physical restraints is relevant to nursing practice because restraints continue to be used in the majority of healthcare settings.  Nurses need to be educated on the use of restraints.  Nurses need to be aware of the benefits and the consequences that restraints can have on a patient.  With proper education regarding restraints, a nurse will be able to make an educated decision on whether the patient actually needs physical restraints or if alternative methods can be implemented.  “As the patient’s primary caregiver, a nurse is often the one to decide whether to request a restraint or to pursue alternatives” (Napierkowski, 2002).

Increased awareness through education can change staff perceptions, attitudes, and knowledge regarding restraint use (Smith et al., 2003).  “It is encouraging that nurses’ perceptions related to restraint use can be altered with education and mentoring.  Changes in attitudes always must occur before changes in practice can be effectively implemented” (Gilbert & Counsell, 1999).

It is important for nurses to understand and be aware of non-restraint interventions that can be used to help manage a patient.  “Education is the key to finding options to restraints.  A facility’s educational program must focus on creative solutions for alternatives to restraints.  Administration must provide support, including continuing education for all staff” (Napierkowski, 2002).  Increasing staff knowledge and awareness of non-restraint interventions to control disruptive behaviors can help to build a patient care environment that emphasizes early assessment and prevention of troublesome behaviors using optional measures that are appropriate for the patient (Smith et al., 2003).

Some examples of alternatives to physical restraints are environmental manipulation such as putting the mattress on the floor and encouraging family members to stay with the patient.  Also used are behavior techniques such as exercising and engaging in conversation with the patient and using orientation techniques such as a clock, television, radio, and using photographs of family and friends.  The nurse also needs to monitor the medications that the patient is taking to assess if any of the drugs could be causing changes in the patients behavior.  Using medication as an alternative to physical restraints is not appropriate or acceptable (Molasiotis, 1995).    Other alternatives include diversional therapy, music therapy, therapeutic touch, and personalization of the environment (Gallinagh, Nevin, McAleese, & Campbell, 2001).

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