Distinguishing Therapeutic Restraints from Abusive Practices in Healthcare

Physical restraints in healthcare must be carefully differentiated between therapeutic, evidence-based interventions and potentially abusive practices. The following outlines appropriate, non-abusive uses of physical assistance and restraint:

Appropriate Therapeutic Interventions

• Assistance with activities of daily living (ADLs): Helping patients with bathing, dressing, eating, and mobility when they lack capacity to perform these independently.
• Medication administration: Delivering prescribed medications, including injections, with patient consent or authorized surrogate decision-making.
• Medical procedures: Performing wound care, IV insertion, or other clinical interventions with proper informed consent.
• Safety restraints (last resort): Using the least restrictive restraints for the shortest duration necessary to prevent imminent harm to self or others, following strict protocols, physician orders, and continuous monitoring.

Potentially Abusive Practices to Avoid

• Using physical force to move a patient who is resisting care without exploring alternatives (de-escalation, communication, addressing underlying causes).
• Applying restraints for staff convenience, punishment, or as a substitute for adequate staffing.
• Failing to document rationale, obtain orders, or conduct regular reassessments.

Healthcare organizations must adhere to CMS, Joint Commission, and state regulations governing restraint use, prioritizing patient dignity, autonomy, and safety.