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; vests tied to a bed or chair; hand mitts; 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 limit movement. Drugs are called chemical restraints when they are used for discipline or staff convenience and not to treat a medical problem. Chemical restraint--that is, medically unnecessary drug use--is prohibited.

Why might restraints be used?

Restraints are used in 3 very different situations in healthcare facilities.

• Leather restraints are sometimes used to protect people with severe mental illness from hurting themselves and others. This situation happens most often in an emergency room or when someone is hospitalized for mental illness. There are strict policies and requirements for supervision when these restraints are used.
• Limited restraints may be used to keep someone from pulling at or damaging an IV line or other piece of medical equipment. This type of restraint may use mittens or a large bandage wrapped around an arm.
• Other types of restraints may be used to protect someone from injury—for example, to stop them from falling out of bed or from a wheelchair.

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 patients or residents are not protected from falling. However, researchers have found that restraints do not keep people from falling and hurting themselves. And restraints do not save nursing time. It often takes more time and greater effort to care for someone who is restrained than to manage the reason for the restraints.

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, with a physician's order, and for specified times. Restraints should be a last resort. They should be used only after discussion with the nurse, doctor, and family. If a restraint is used, it must restrict movement only as much as needed.

What are the bad effects of restraints?

Psychological trauma: People who have been restrained say they felt like they were being punished. They felt like a prisoner. They were afraid they would not be able to get help if there were an emergency. It is a humiliating experience.

Agitation and High Stress: Restraint is a significant stress. Blood pressure gets much higher when someone is placed in restraints. Stress hormones also increase.

Physical problems: When someone is restrained for a long time, their muscles and bones get weaker. Lying or sitting in one place too long can cause pressure sores. The restraint may bruise or tear the skin.

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 falls and injuries that are worse than they would be without restraint.

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 keep someone from falling. Falls that happen when someone is not restrained generally cause less injury than if they were 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 sounds when a person starts to get up from the bed.

If the reason for the restraint is to prevent someone from pulling out tubes, sometimes the tubes can be hidden or the treatment may be given in a different way. If family members can spend some time with a patient in the hospital, they can help protect tubes or IV lines.

If the problem is wandering, it may help to put alarms on doors or disguise them may help. Involving the person in an activity may distract them.

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?

According to federal and state regulations, nursing facility residents have the right to be free from restraint. Residents also have the right to the best 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 do what they can to keep the residents from getting worse. Because restraints often make a person's condition worse, this is another reason 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.