Restraints

What are restraints?

A restraint is something that limits your ability to move around or reach a part of your body. Restraints can be physical devices or medicine.

• 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.
• Medicine can also be used to slow or impair movement. Drugs are called chemical restraints when they are used for discipline or staff convenience and not to 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. For example, restraints might be used to stop someone from falling out of bed or a wheelchair. Also, healthcare workers in hospitals and nursing facilities may think it takes less time to care for someone who is restrained. There may be fears that a facility will 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 hurting themselves. In fact, 60% of residents or 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.

Leather restraints are sometimes used to protect people with severe mental illnesses from hurting themselves and others. There are strict policies and requirements for supervision when these restraints are used. The use of such restraints in mental health situations is not discussed here. All other restraints are considered soft or protective restraints.

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

Federal and state regulations require nursing facilities to find ways to give good care without using restraints. Physical restraints can be used only in special cases, 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 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 were afraid they would not be able to get help in an emergency. It is a humiliating experience.

Physical problems: When you are restrained for some time, your muscles and bones get weaker. You can get pressure sores 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 injuries.

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

Other diseases: Because they are not able to move around enough, someone who is restrained can get pneumonia.

Elimination problems: Limited movement can lead to constipation or problems with controlling urination.

Death: Restraints can strangle someone and kill them because they cannot 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 happen when someone is not restrained generally cause less injury than falls by someone who is restrained. If falling out of bed is the main concern, the mattress can be put on the floor, or an alarm can be used that gives a signal when a person starts 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 may be given in a different way. If family members can spend some time with sick patients in the hospital, they can help protect tubes or IV lines so that restraints can be avoided.

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

These approaches will not prevent all falls or injuries. Broken bones or other injuries sometimes happen when someone is confused or unsteady, but this does not mean that they should have been restrained.

What are a person's rights regarding restraints?

Federal and state regulations state that nursing facility 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 facilities must work toward improving the health of their residents. This means that they must protect the residents from getting worse unless their medical condition is such that this is not possible. 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
Phone: 1-202-332-2275
Web site: http://www.nccnhr.org

You can also contact your local nursing facility ombuds (also called an ombudsman). The phone number is posted in every nursing facility.