Restraints and Restraint Alternatives

Clinical Definitions, Indications, and Fundamental Principles

In healthcare, a physical restraint is defined as any manual method, device, material, or equipment attached or adjacent to a client's body that the client cannot easily remove and that restricts their freedom of movement. In contrast, a chemical restraint is a medication used specifically to manage a client's behavior or restrict their freedom of movement that is not standard treatment for their condition. Restraints are never routine measures; they are considered a safety intervention of last resort and must never be used for staff convenience or as a form of punishment or discipline.

Restraints may be used as a last resort to prevent harm to the client or others or to prevent the client from disrupting medically necessary treatment; the treatment need not be life-sustaining. For example, when a client in an intensive care setting exhibits confusion and is at imminent risk of removing an endotracheal tube or another device essential to treatment, physical restraints may be considered if less restrictive measures have proven ineffective or are clinically inappropriate.

The definition of a restraint also extends to everyday hospital equipment when used to restrict mobility. Raising all four side rails on a hospital bed is legally considered a physical restraint if doing so prevents the client from exiting the bed voluntarily. Four raised side rails used for seizure precautions or transport are not automatically restraints, but their classification depends on whether they restrict the client's ability to exit the bed voluntarily, not solely on the caregiver's protective intent.