Defining Physical Restraint in Care
A physical restraint is any manual or mechanical method that restricts a person's freedom of movement or their normal access to their own body and cannot be easily removed by the individual. This differs from supportive touch or assistance, which aids a person without undue force.
Common examples of physical restraints
Physical restraints can include:
- Bed Rails (if the patient cannot lower them)
- Lap Trays and Belts
- Vests and Soft Ties
- Hand Mitts
- Tightly Tucked Sheets
- Manual Holds
The Serious Risks of Using Physical Restraints
Physical restraints carry significant risks and have been shown not to increase patient safety. Instead, they can cause physical and psychological harm.
Physical harms
Risks include increased severity of injuries from falls, decreased mobility, muscle atrophy, skin damage, pressure sores, circulation issues, blood clots, and respiratory distress.
Psychological and emotional harms
Restraints can lead to increased anxiety, agitation, loss of dignity and independence, depression, PTSD, and strained relationships with caregivers.
Ethical and Legal Frameworks for Restraint Use
Legal and regulatory bodies have strict rules regarding physical restraints.
Key principles
Restraints are for emergency last resort only, require a physician's order with medical justification, are prohibited for convenience or punishment, need informed consent, and demand ongoing monitoring and reassessment.
Promoting Safety Through Alternatives to Restraint
Modern senior care focuses on reducing restraints using person-centered strategies.
Effective alternatives include
These include environmental modifications, restorative care, meeting individual needs, de-escalation techniques, and assistive devices.
Comparative Approach: Restraints vs. Alternatives
| Aspect | Physical Restraint | Person-Centered Alternatives |
|---|---|---|
| Goal | Prevent injury, manage behavior | Enhance safety, address root cause |
| Method | Involuntary restriction of movement | Supportive assistance, environmental changes, de-escalation |
| Risks | High risk of physical injury, psychological harm, and decreased function | Very low risk, promotes well-being and independence |
| Impact on Dignity | Often leads to feelings of shame, helplessness, and loss of control | Upholds dignity, respects autonomy, and builds trust |
| Long-Term Outcome | Can cause rapid decline, dependency, and worsened behavior | Encourages independence, improved mobility, and better mental health |
A Restraint-Free Philosophy: Prioritizing Dignity
A restraint-free approach prioritizes person-centered care, dignity, and independence. Understanding the risks and implementing alternatives leads to safer, more humane, and higher-quality care.
For more information on the ethical guidelines for using restraints, see the American Medical Association's Code of Medical Ethics.
Conclusion
Understanding what is physical restraint in care is crucial for advocating for better senior care. Despite appearing as a quick fix, restraints pose significant risks. Embracing person-centered approaches and alternatives creates safer, more dignified care settings.
