The shift toward restricting the use of patient restraints in hospitals and care facilities is a direct response to a fundamental change in understanding patient safety and rights. For decades, these measures were common practice. However, a growing body of evidence has demonstrated that the perceived benefits often do not outweigh the significant risks to the patient’s physical and psychological well-being. This policy evolution was necessitated by findings that showed traditional restraints frequently caused more harm than the behaviors they were intended to prevent.
What Constitutes Patient Restraint
A patient restraint is defined as any manual method, physical device, or medication that limits a person’s freedom of movement or their ability to access their own body. Healthcare providers historically employed these methods, believing they were necessary to prevent immediate harm, such as a confused patient pulling out a life-saving tube or falling out of bed. Restraints were traditionally justified as a temporary measure of last resort for patient protection.
Restraints fall into two primary categories: physical and chemical. Physical restraints include mechanical devices that restrict movement, such as vests, belts, wrist cuffs, and the use of all four side rails on a hospital bed. The application of mitts to prevent patients from grasping objects like intravenous lines also qualifies as a physical restraint.
Chemical restraints involve psychoactive medication administered specifically to control a patient’s behavior or restrict movement, rather than for a recognized therapeutic purpose for their underlying medical condition. The medication’s primary intent is behavioral control, often leading to sedation or reduced responsiveness. Environmental restraints, like seclusion in a locked room, also limit a patient’s mobility within a given area.
Documented Patient Harm and Loss of Autonomy
The single most compelling reason for restricting restraints is the documented high rate of iatrogenic harm—harm caused by the medical intervention itself. Clinical studies and safety reports revealed that rather than guaranteeing safety, restraints introduced a new set of serious physical complications for the patient. Forced immobilization significantly increases the risk of pressure ulcers, which can develop rapidly and lead to severe infections.
Physical complications extend to the circulatory and musculoskeletal systems, causing nerve damage, reduced circulation, and accelerated muscle atrophy. Respiratory complications, such as pneumonia, are also associated with prolonged periods of restricted movement. Paradoxically, restraints were found to increase the risk of accidental injury and death, a finding that dramatically shifted clinical practice.
Patients attempting to free themselves have become entangled in vest or belt restraints, resulting in strangulation or positional asphyxia. Reports indicate that restrained patients have a higher mortality rate and longer hospital stays compared to non-restrained patients, even after adjusting for differences in their underlying conditions.
Beyond the physical toll, the psychological trauma is profound. Restraint use is associated with heightened agitation, fear, and delirium, especially in older or cognitively impaired patients. Patients who experience physical restraint are at a greater risk of developing post-traumatic stress disorder (PTSD) following their hospital stay. The experience strips the patient of personal control, violating the ethical and legal principle of patient autonomy.
Alternatives to Physical and Chemical Restraints
The recognition of adverse effects led to a paradigm shift from a reactive physical control model to a proactive, patient-centered approach. Modern care protocols emphasize non-restrictive interventions that address the root cause of agitation or confusion. Instead of physical devices, de-escalation techniques and behavioral management protocols are now the first line of intervention.
Environmental modifications and increased staff presence are employed to enhance safety without limiting movement. This includes:
- Using low beds and pressure-sensitive bed alarms.
- Optimizing lighting to reduce confusion and the risk of falls.
- Providing one-on-one supervision or frequent “intentional rounding” on patients.
- Proactively checking for pain, hunger, the need to use the toilet, or simple comfort.
The underlying cause of a patient’s behavior is always investigated, as confusion or agitation can be symptoms of reversible medical issues. Addressing factors like untreated pain, infection, dehydration, or medication side effects often resolves the behavior that might otherwise lead to restraint use. This focus on identifying and treating the underlying cause, combined with proactive monitoring, has proven to be a safer and more humane method of care.