Restraints Then and Now: How Viewpoints and Policies Have Changed
The debate over restraints in patient care goes as far back as the 1840s, when British Parliament established a
commission to abolish restraint usage. Meanwhile, American mental health professionals used restraints as normal
protocol well into the 2000s, often to control or punish agitated patients.1
Types of Restraints
Several different interventions are considered restraints. Physical or mechanical restraints generally connect
the patient to a bed or chair, and may include belts, vests, jackets, mitts. Enclosure beds, siderails, and exit
alarms are also sometimes considered physical restraints. Chemical restraints are medications given with the
sole purpose of restricting movement—without treating an underlying medical condition.2
Establishing Facility Protocols
In recent years, The Joint Commission (TJC) and the Centers for Medicare and Medicaid Services (CMS) have
established guidelines for more limited use of restraints.3,4 Typical approaches include:
- Formal protocols and extensive staff training
- Restraints only if the patient is a threat to themselves or others (including those at risk of pulling out
tubes, catheters, ventilators, etc.)
- A physician must order the restraints and only for a short amount of time
- Patient must remain under continuous observation
TJC further clarified that use of siderails may be considered a restraint depending on intent.4 For
siderails are used to prevent a patient from exiting the bed (or attempting to), the siderails would be
considered a restraint. If they’re used to prevent a patient from falling out of bed, the siderails would not be
considered a restraint.
Within Long-Term Care facilities, CMS identifies siderails, concave mattresses, and position change alarms as
restraints. Use of any of these measures requires documentation, physician orders, and ongoing
APNA and Behavioral Health Restraints
The American Psychiatric Nurses Association revised its position statement about restraints in 2018, with new
guidelines to minimize the need for restraints among behavioral health patients. The group recognizes that all
patients “have the right to be treated with respect and dignity” and in a manner “that respects individual
choice and maximizes self-determination.”5
They recommend the eventual elimination of restraints altogether, focusing on “less intrusive, preventative, and
evidence-based interventions in behavioral emergencies that aid in minimizing aggression while promoting
Want more info?
The Sizewise Clinical Support Team is available to answer your questions or provide additional training.
Call 800-814-9389 or email firstname.lastname@example.org.