Restraints

What are restraints?

A restraint is any device that limits a person's ability to move around or reach a part of his or her body. Restraints can be physical devices or medication.

Physical restraints include soft ties for arms, legs, or hands; hand mitts; vests tied to a bed or chair; lap boards attached to chairs; side rails on beds; and leather bands to tie a person's wrists and ankles to a bed.

Medication can also be used to slow or impair movement. Drugs are called chemical restraints when they are used for discipline or staff convenience or do not treat a medical problem.

Why might restraints be used?

The most common use of restraints has been to protect people in healthcare facilities from injury, such as preventing them from falling out of bed or a wheelchair. Also, healthcare workers in hospitals and nursing homes thought it took less time to care for a person who was restrained than to take other steps to keep people from injury. In addition, they feared the facilities would be sued if they did not keep patients or residents from falling.

However, researchers have found that restraints do not keep people from falling and injuring themselves. In fact, 60% of residents/patients who fall are restrained at the time. Also, restraints do not save nursing time. It takes more time and greater effort to care for someone who is restrained than to manage the reason for the restraints.

Although leather restraints are sometimes used to protect people with severe mental illnesses from hurting themselves and others, the use of such restraints in mental health situations will not be discussed here. All other restraints are considered "soft" or protective restraints.

In hospitals, sometimes restraints are the only way to keep patients from pulling out a tube or disrupting a lifesaving treatment. However, even in these situations, other options can often be successful. Restraints should be a last resort and applied only after discussion with the nurse, doctor, and family.

Federal and state regulations require nursing homes to find ways to give quality care without using restraints. Physical restraints can be used only in special circumstances, only with a physician's order, and only for specified times. If a physical restraint is used, it must restrict movement as little as possible. Chemical restraint (that is, medically unnecessary drug use) is also prohibited.

What are the bad effects of restraints?

Psychological trauma: People who have been restrained say they felt like a prisoner or as if they were being punished. They express fear of not being able to get help in an emergency. It is a humiliating experience.

Physical problems: When a person is restrained for any length of time, muscle strength and bone strength decrease. Pressure sores can develop from lying or sitting in one place too long. The skin around the restraint can be bruised or torn.

Injury: Most people struggle against the restraint. It is natural to try to work your way out, especially if you do not understand what is happening to you. Struggling can lead to even worse falls and fall-related injury.

Nutritional problems: People who are restrained do not eat as well and drink less. They can easily become undernourished or dehydrated.

Other diseases: By not moving around enough, the person who is restrained can get pneumonia.

Elimination problems: Limited movement can lead to constipation or incontinence (the person is unable to control his or her urine).

Death: People who have been restrained have strangled and died by asphyxiation (being unable to breathe).

Are there alternatives to restraints?

Yes, there are other options. First, the staff needs to realize that restraints will not prevent someone from falling. Falls that occur when someone is not restrained generally result in less injury than falls that happen when the person is restrained. If falling out of bed is the main concern, the mattress can be put directly on the floor or an alarm can be used that gives a signal when a person begins to get up.

If the reason for the restraint is to prevent someone from pulling out tubes, sometimes the tubes can be hidden or the therapy given in a different way. Family members can help stay with sick patients in the hospital and help protect tubes or IV lines so restraints can be avoided.

If the problem is wandering, disguising doors or involving the person in a different activity may be helpful.

These alternatives will not prevent all falls or injuries. Families can help by understanding when a fall occurs while a person who is confused or unsteady while walking about. Broken bones or other injuries sometimes happen, but this does not mean that the person should have been restrained.

What are a person's rights regarding restraints?

Federal and state regulations state that nursing home residents have the right to be free from restraint. Residents also have the right to the best level of health and well-being possible, given their medical condition. Nursing homes must work toward actively improving the condition of their residents. This means that they must protect the residents from getting worse, unless a resident's medical condition is such that this can not be prevented. Because restraints often make a person's condition worse, restraints should not be used.

For further information contact:

National Citizens' Coalition for Nursing Home Reform
1424 16th Street N.W., Suite 202
Washington, DC 20036
202-332-2275
Web site: http://www.nccnhr.org

You can also contact your local nursing home ombudsman. The phone number is posted in every nursing home.