Running head: ALTERNATIVE MEASURES TO RESTRAINTS

Alternative Measures to Restraints

Amanda Mathy
Ferris State University

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Abstract
This research paper gives a brief overview of physical restraint use and why it is concerning in
psychiatric care. Alternative measures are discussed in order to create a safer environment for the
patient and the nurse. Excessive restraint use tends to occur due to nurses lack of education on
alternate measures and safety precautions. If restraint use is not reduced, the patient is at risk for
physical injuries as well as death. Betty Newmans Nursing Theory correlates directly with the
use of alternative measures in order to maintain patient stability against environmental stressors.
These safety measures are required for optimum wellness.
Keywords: physical restraint, psychiatric, evidence-based practice, education

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Alternative Measures to Restraints
In hospitals and psychiatric facilities, patients who suffer from severe mental health
conditions have a higher tendency of acting in harmful and uncontrolled ways (Hellwig, 2000).
In order to create a safer and more stabilized environment, physical and chemical restraints are
used frequently by nurses. According to Walter Kulwers Health, physical restraints are defined
as any device applied on or near the body that interferes with some aspect of independent
movement, and chemical restraints are defined as medications to control behavior (Hellwig,
2000, 395). These devices can vary from vests and belts to sedatives and isolation rooms.
Restraints are meant to promote safety and comfort for the patient as well as the medical staff;
however, researchers have found that restraints lead to many significant physical and
psychological risks, including physical injuries, trauma, and even death (Haimowitz, Urff, &
Huckshorn, 2006).At the same time of researchers risk findings, alternative measures to
restraints were developed in order to create an effective and safe environment (Haimowitz, Urff,
& Huckshorn, 2006). Alternative measures to restraints are the safest method for patients to
receive that are in the least restrictive environment possible (Hellwig, 2000).
Purpose
The purpose of this research is to provide information to nurses about alternative
measures to restraints in order to reduce harmful risks to the patient. Clarification on any
misunderstandings about restraint use in medical facilities is important for staff members to
understand policies regarding safety (Fryback, 1998). Medical facilities and nurses need to know
the effects of restraints on patients and when they absolutely need to be used. Other than those
specific times, alternative measures should be implemented on patients in order to reduce risks
and costs. It will provide many examples of effective alternatives to restraints. This research is

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intended to give educational material on alternative measure to restraints, so nurses gain more
knowledge about patient care and can perform the most updated evidence-based practice.
Reasoning for Restraint Use
Physical and chemical restraints should only be used in specific situations regarding the
patients or nurses safety. Common causes for using restraints on the patient are due to violence
issues, including violence towards themselves, medical staff, or other patients . If the patient is
acting in a violent matter, such as biting or hitting, or is threating to harm themselves or another,
then nurses have no choice but to restrain them in order to maintain safety (Sailas, & Wahlbeck,
2007). Restraints are also necessary for fall risk patients. Especially in situations as Alzheimers
or dementia patients, confusion and amnesia frequently occurs, so patients are unaware of their
mobility levels and restrictions. In order to reduce injuries and deaths to fall occurrences,
restraints are implemented to restrict the patient from getting out of bed (Hellwig, 2000).
Factors of Nurses Decisions
Reasons for nurses placing numerous restrictions on psychiatric patients are due to many
factors that involve their own experience/education, time, and fears. When dealing with
psychiatric patients, many nurses feel that restraints are the only measure to promote safety. This
thought process deals with nurses lack of experience and education with alternative measures. If
nurses feel that they cannot implement alternative measures then they rely on restrictions as the
last resort. Time is also an issue when it comes to nurses decision to apply a restraint. Being
responsible for four or five patients can be a lot to handle when it comes to one nurse, so he or
she feels that restraining patients will allow them time to worry about other patients. The last
factor regarding restraint use is fear. Nurses, mostly being women, often fear going into a
patients room, which they cannot contain. For example, if the nurse is a bigger size male with

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confusion, the nurse might feel inferior to him and will restrain him in order to protect herself.
Overall, staff role perceptions and attitudes of hospital staff members have a greater influence on
restraint application than any other factors (Glassheim, 2008).
Alternative Measures
According to A Guide To Evidence-Based Practices for Psychiatric Patients, Restraints
are not evidence-based practices and their use is an indication of treatment failure (Glassheim,
2008). Restraints have no evidence to support proper therapeutic interventions for mentally ill
patients. Contrary to popular belief, restraints do not always protect patients and staff members,
but alternative measures insure safety.
Prior Assessment
Before any plan care or treatment of a patient, a documented assessment from the
patient and nurse is required. Nurses need to ask a series of questions to the patient in order to
gain medical history and any risk factors that could cause severe chronic illnesses. The
assessment of the patient needs to identify any violence risks, medical risks, or psychological
risks that could alter the patients health. Environmental stressors should also be looked at from
the nurse and patient so safety plans can be developed in order to eliminate conflict and lack of
control. Environmental stressors are identified differently between every individual, so the nurse
needs to listen to the patients thoughts and communicate in return with what he or she feels
(Glassheim, 2008).
Staff Education
Due to the lack of knowledge nurses had regarding alternative measures to restraints,
educational programs and seminars have been implemented. According to Glassheim, The first
step to incorporated alternative measures is to have the hospitals policies, procedures, and
practices to be based on principles of recovery and feature trauma-informed care (pg. 17).

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From gaining experience of different learning styles, nurses have learned to obtain interpersonal
relationships with their patients. Instead of restraining and isolating patients, nurses are utilizing
individualized care, which means communication with every patient (Gastmas, & Milisens,
2006). Nurses are now active listeners with their patients while showing the utmost courtesy and
respect. They also are now going into detail with explanations of therapeutic interventions, so the
patient understands what is going on at all time (Gastmas, & Milisens, 2006). The therapeutic
interventions include anger control, adaptive behaviors, and interpersonal self-awareness in order
to make the patient aware of his or her problems (Glassheim, 2008). Involvement is also a
priority in individualized care, so the nurse encourages family interactions/visits as well as
physical activities throughout the day (Gastmas, & Milisens, 2006).
Environmental Measures
Since most psychiatric patients have serious mental disabilities, they are most likely to
stay in their room for most of the day. With this being said, nurses need to ensure safe and
comfortable rooms for every individual to prevent injury and death. Specific measures, such as
lowered bed positioning, bed/chair alarms, and non-slip footwear, need to implemented at all
times in order to prevent falls (Gastmas, & Milisens, 2006). Minimization of sensory overload
also needs to be implemented because psychiatric patients often times get very distracted by light
and can have often thoughts about running out of the room (Gastmas, & Milisens, 2006). Nurses
should make sure there is proper lighting that eliminates glare as well as allowing patients to
wander if they choose to do so (Gastmas, & Milisens, 2006). Preventing fall factors are also a
very important issue is psychiatric facilities, so interventions should be used frequently; these
interventions include routine toileting, balance and gait training, strength exercises, and

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nutrition/hydration management, according to Gastmas & Milisens (pg. 17). Overall, the room
atmosphere should make the patient as comfortable as they would be in his or her home.
Nursing Theory
Identifying environmental stressors for psychiatric patients follows Betty Newmans
Theory of Nursing. The theorys central them is, Humans are in constant relationship with
stressors in the environment (Taylor, Lyllis, & Lynn, 2011, pg. 74). The central theme affects
most psychiatric patients because they have a hard time deal with environmental stressors along
with illnesses affecting their minds. With all of the confusion and amnesia, psychiatric patients
have difficulty understanding how to reduce or eliminate environmental stressors to promote
their own health. Nurses need to understand how to apply this theory to clinical practice, which
states, The major concern for nursing is keeping the client system stable through accurately
assessing the effects of environmental stressors and in assisting client adjustments required for
optimal wellness (Taylor, Lyllis, & Lynn, 2011, pg. 74). As said in prior information throughout
this paper, nurses implementing alternative measures to restraints, need to understand how to
utilize individualized care (Gastmas, & Milisens, 2006).Nurses should continue communicating
with the patient and actively listening to what he or she is saying (Gastmas, & Milisens,
2006).From patients thoughts, nurses can create care plans and interventions to eliminate the
distractions mentally-ill patients might obtain. The theory reinforces the idea that it is important
for nurses to reduce or eliminate distracting, uncomfortable, or unpleasant environmental
stressors in order to achieve optimal health.
Conclusion

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Physical and chemical restraints can be very beneficial when it comes to patient and
nurse safety; however, alternative measures are a less restrictive safety measure that is more
effective than restraint use. Alternative measures can start from listening and communication
with the patient to changing environmental views, such as lighting and bed positioning. Nurses
need to gain more knowledge regarding proper alternative measure techniques in order to reduce
the number and occurrences of restraints. If restraints are leading to higher rates of psychological
and physical risks leading to injuries and deaths of patients, then that is not the best evidencebased practice. Patient safety is a priority to the nursing staff, so nurses need to be informed of
the most updated information in order to perform the best practice.

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References
Fryback, J. (1998). Counting, using and reducing physical restraints. WISCONSIN
DEPARTMENT OF HEALTH SERVICES, Retrieved from
http://www.dhs.wisconsin.gov/rl_dsl/nhs/NH98-003.htm
Gastmans, C., & Milisen, K. (2006). Use of physical restraint in nursing homes: clinicalethical
considerations. Journal of Medical Ethics, 32(3), 148-152.
Glassheim , B. (2008). A guide to evidence-based practices for psychiatric hospitalization:
Adults with mental illnesses and co-occurring substance use disorders. Saginaw County
Community Mental Health Authority , 1-69.
Haimowitz, S., Urff, J., & Huckshorn, K. A. (2006). Restraint and seclusion a risk management
guide. 1-35. Retrieved from http://www.power2u.org/downloads/R-S Risk Manag Guide
Oct 06.pdf
Hellwig, K. (2000). Alternatives to restraints: What patients and caregivers should
know. Wolters Kluwer Health, 18(6), 395-402.
Sailas , E. A., & Wahlbeck , K. (2007). Who and how often?.Medscape NURSES, Retrieved
from http://www.medscape.org/viewarticle/518746_3
Taylor, C., Lillis, C., LeMone, P., & Lynn, P. (2011). Fundamentals of nursing: The art and
science of nursing care (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.

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