Purpose
The purpose of this position statement is to address the role of registered nurses in reducing patient restraint and seclusion. Restraints have been employed with the belief that such actions promote patient safety. It was frequently thought that without effective restraint and seclusion practices, patients were in danger of injuring themselves or others, including nursing staff, patients, and visitors. The use of restraints has been demonstrated to be problematic. Additional research is needed to explore safe, appropriate, and effective nursing responses to patient behaviors that continue to place patients at risk, and to the safety factors related to restraint and seclusion.
Statement of ANA Position
The American Nurses Association (ANA) strongly supports registered nurse participation in reducing patient restraint and seclusion in health care settings. Restraining or secluding patients/residents either directly or indirectly is viewed as contrary to the fundamental goals and ethical traditions of the nursing profession, which upholds the autonomy and inherent dignity of each patient or resident.
ANA is concerned that lack of personnel to provide adequate monitoring of patients and less restrictive approaches to behavior management may increase the violation of patients’ rights and place them at greater risk of harm caused by being placed in seclusion and/or restraints.
Dilemmas in patient care are an inevitable consequence of nursing accountability. Nurses struggle to balance their responsibility to protect patients' rights of freedom with their obligation to prevent harm to patients and staff. They may face pressure from family and peers to use restraints. ANA believes restraint should be employed only when no other viable option is available. An acute psychotic episode in which patient or staff safety is jeopardized by aggression or assault would justify temporary restraint. Restraint may also be justified in a case of dementia or delirium where an elderly person is likely to fall and fracture hips or other bones.
When restraint is necessary, documentation should be done by more than one witness. Once restrained, the patient should be treated with humane care that preserves human dignity. In those instances where restraint, seclusion, or therapeutic holding is determined to be clinically appropriate and adequately justified, registered nurses who possess the necessary knowledge and skills to effectively manage the situation must be actively involved in the assessment, implementation, and evaluation of the selected emergency measure, adhering to federal regulations and the standards of The Joint Commission (2009) regarding appropriate use of restraints and seclusion.