A restraint is any method—physical, mechanical, or chemical—that restricts a person’s freedom of movement or access to their own body. While this definition applies in various settings, the most rigorous regulation occurs within healthcare and behavioral health facilities. Restraints are employed to manage behavior or movement, not to assist with a medical procedure. Their application is subject to strict protocols to ensure they are used only under specific, limited circumstances.
Differentiating Types of Restraints
Restraints in regulated environments fall into three main categories: physical, chemical, and environmental.
Physical or mechanical restraints involve devices like vests, belts, mitts, or limb holders attached to a bed or chair. These devices limit movement to prevent a patient from falling or disrupting essential medical treatments, such as pulling out intravenous lines or feeding tubes.
Chemical restraints use medication primarily to restrict behavior or movement, not as a standard treatment for a medical or psychiatric condition. Sedating an aggressive patient when no underlying medical necessity exists is considered a chemical restraint, as the drug’s purpose is behavior management.
Environmental restraints control mobility by limiting where a person can go. Seclusion is the most common form, defined as the involuntary confinement of a person alone in a room they are prevented from leaving. It is predominantly used in psychiatric or behavioral health settings to manage violent or self-destructive behavior.
Primary Justifications for Application
The use of any restraint is ethically and legally permitted only under narrow circumstances, centering on necessity and immediacy. Restraints are interventions of last resort, employed only when all less-restrictive alternatives have been attempted and failed.
The primary justification is to ensure the immediate physical safety of the patient or others. This immediate danger typically involves two scenarios: imminent physical harm to the patient (e.g., self-injury or removing a life-sustaining device) or imminent physical danger to others (e.g., aggression toward staff or other patients).
The method chosen must be the least restrictive intervention possible to ensure safety. Restraints must never be used for staff convenience, discipline, or retaliation, and they must be discontinued as soon as the immediate threat to safety is resolved.
Standards for Safe Use and Monitoring
Due to the significant physical and psychological risks, strict regulatory standards govern the application and maintenance of restraints. A physician or other licensed independent practitioner must order the restraint. In cases of violent or self-destructive behavior, a face-to-face evaluation is required within one hour of the restraint’s initiation.
These orders are time-limited, often requiring renewal every four hours for adults, and they cannot be standing or “as needed” orders. Continuous monitoring is mandatory, including regular checks of the patient’s circulation, skin integrity, and overall well-being. Staff must constantly reassess the patient’s condition to determine if the restraint can be reduced or removed.
Improper or prolonged restraint use can lead to serious physical complications, including injury, pressure sores, aspiration, and death, as well as psychological trauma. All steps—from the behavior leading to the restraint to de-escalation attempts and eventual removal—must be thoroughly documented in the patient’s medical record.
Alternatives to Restraint Use
Modern patient-centered care strategies focus on preventing the need for restraints, aiming for a restraint-free environment. Proactive strategies involve assessing and addressing underlying causes of distress, such as pain, hunger, discomfort, or confusion, before agitation escalates.
Environmental modifications can prevent falls and wandering without physical restriction. These include using bed alarms, placing patients closer to the nurses’ station for observation, or utilizing low beds.
Reactive interventions include verbal de-escalation techniques and therapeutic communication to help the patient regain control. Specialized staffing, such as assigning a dedicated sitter, offers continuous supervision that can prevent a behavioral crisis. Diversionary activities, like providing an activity apron or a soft item to hold, can redirect agitated energy and minimize the impulse to disrupt medical devices.