When Should You Use Therapeutic Restraints in Behavioral Healthcare Facilities?

It may sound like "therapeutic" and "restraints" don't go well together, but medical and behavioral healthcare professionals sometimes have a real need for physical restraints to ensure the safety of the patient and those around them. However, it is important to remember that medical restraints are intended to be used only to keep the patient, staff, other patients, and visitors safe. They should only be used when it is necessary to do so, and they should not be used as a form of punishment, coercion, discipline, or simply to make things more convenient for staff members. Use of restraints in a healthcare environment should be restricted to situations in which lack of restraints would cause clear physical harm, and only to the extent that the restraints are necessary to prevent this harm.

Physical restraints like ankle and wrist cuffs are intended as a physical intervention or device that limits a patient's freedom of movement or restricts patients from access to their own body.  Manufacturers of speciality medical devices like Humane Restraint and Posey make cuffs that restrain the patient without hurting him or her. 

As a healthcare professional, you may be called upon to use physical restraints for both non-violent, non-self-destructive behavior or violent, self-destructive behavior depending on the needs of a patient. A patient may need to be restrained for non-violent behavior in situations where movement by the patient may be medically unsafe, due to physical incapacity or the possibility of accidentally or purposefully removing IV lines, tubes, or drains that are providing medical support.

On the other hand, a patient may need to be constrained for violent or self-destructive behavior if they are making clear threats of violence, are a clear and immediate physical danger to themselves or others, or when it can be reasonably assumed that delay in restraining them would cause a serious risk of harm to themselves or others, and preferably only after less restrictive solutions have been attempted or considered; restraints are intended to be used for emergency situations to keep the patient, staff, and others safe from harm.

Medical use of physical restraints is intended to use the least restrictive type of restraint possible to alleviate a clearly dangerous situation, used only as a last resort when the risk of harm to self or others is unacceptably high, and only for as long as the unsafe situation occurs. Nurses should receive hands-on training on safe and appropriate application of each type of physical restraint during orientation, and should reinforce this training periodically to ensure that they are familiar with the techniques required to safely apply restraints when they become necessary, and to provide appropriate care to ensure that their need and use is minimal.

Health care workers also need to know when not to use restraints; as a general rule, patient restraints are not to be used simply because of past behavior by the patient, but rather should be used in response to current behavior and risks, and only after exploring or attempting alternatives. There are increased risks of suffocation or pulmonary aspiration when using physical restraints for prolonged periods, and restraints may cause further psychological trauma or stimulate traumatic memories that may worsen the patient's overall condition. As such, there should be attempts to de-escalate situations before they reach the point where restraints become necessary by calming the patient down, redirecting or diverting their attention or emotions, or providing medications that are deemed appropriate for standard treatment. Only when other alternatives have been considered or attempted and it is clear that the patient is at risk of causing harm to themselves or others should restraints be utilized, and whenever restraints are used the patient should be carefully monitored, assessed, and given support so that their fear of the restraint is limited and the time the restraint is needed for can be reduced.

Medical professionals must assess the best form of treatment for the patients in their care, Having to physically restrain a patient against their will is one of the most difficult things many nurses have to do, both physically and emotionally. While the need to protect a patient and others from harm may mandate the use of physical restraint systems, you should not use this as a substitute for other forms of therapeutic care or treatment and should only use them when it is absolutely necessary.