The advanced practice nurse and changing perspectives on physical restraint

Regulatory changes concerning the use of physical restraints in nursing homes have stimulated an examination of restraint use practices in other care settings. Caregivers are receiving mixed messages about appropriate restraint use in the hospital. Legal decisions are ambiguous in terms of the nurse's liability for restraint decisions, and the use of restraints may create a conflict between respecting patient autonomy and acting in the patient's best interest. Recent research does not support the belief that restraint use prevents patient injuries, but continues to document the untoward effects of restraints. Restraint reduction efforts have been successful in nursing homes, and many strategies can be adapted in acute care. As the movement to integrated systems of care places increased emphasis on continuity of services across settings and improved client outcomes, restraint practice is one area where interinstitutional collaboration and coordination must occur. The advanced practice nurse is in a key role to facilitate continuity of restraint reduction efforts.