The four A's of restraint reduction: attitude, assessment, anticipation, avoidance

The use of physical restraints in the nursing care of older persons is a controversial intervention. Consumer groups and regulatory bodies have issued statements and guidelines that call into question the use of restraints in all but the most extreme situations. This article reviews the changing perspectives on restraint use, including the growing body of research that documents the untoward effects of physical restraints. Alternatives to restraint use are discussed in relation to three broad areas: changing entrenched attitudes and beliefs, conducting thorough and frequent patients assessments, and planning interventions that anticipate events and behaviors and avoid problems that may lead to restraint use.