Restraints

Definition

Restraints are physical devices (soft wrist, vest, mittens) or chemical agents (medications used to control behavior) that restrict patient movement. They are used as a last resort when less-restrictive measures have failed and the patient poses a risk to self or others.

Types

• Physical: Wrist, ankle, vest, Posey jacket.
• Chemical: Antipsychotics, benzodiazepines, sedatives used for behavioral control (not therapeutic indication).
• Seclusion: Involuntary confinement alone in a room.

Requirements for Use

• Written provider order (face-to-face evaluation within 1 hour for violent/self-destructive behavior).
• Time-limited orders (maximum 4 hours for adults, 2 hours for age 9 to 17, 1 hour for children under 9).
• Never PRN.
• Least-restrictive option first.
• Clear documentation of indication, attempted alternatives, patient response.

Nursing Responsibilities

• Assess every 15 to 30 minutes (circulation, skin integrity, respiratory, needs).
• Offer toileting, fluids, and repositioning every 2 hours.
• Use quick-release knots tied to non-movable bed frame.
• Remove as soon as possible.
• Document attempts to use alternatives.
• Provide emotional support; explain reason.

Alternatives (Try First)

Reorientation, familiar objects, bed/chair alarms, sitters, adequate pain control, environmental modifications, family presence.

NCLEX Relevance

Restraints are a top safety and ethics topic. Know requirements, documentation, and alternatives. Restraints for staff convenience are never acceptable.