Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

  • The intent of this guideline is to assist RNs and RPNs to focus on evidence-based best practices to prevent the use of restraints in healthcare settings (acute, long-term and home health-care) within the context of the nurse-client relationship and on strategies for:
    v assessment,
    v prevention, and
    v  the use of alternative practices (includes de-escalation and crisis management techniques).

  •  The move towards a restraint-free environment is demonstrated by the model and guiding principles used to guide the development of recommendations for Promoting Safety: Alternative Approaches to the Use of Restraints.
  • Please see Model 1  
  •  Guiding Principles that enhance nursing practice for Promoting Safety: Alternative Approaches to the Use of Restraints
     vClients – patient, resident, consumer, family, significant others, substitute decision-maker (SDM) – are active partners in care to the extent of their capacity and in collaboration with the interprofessional health-care team.
    vThe philosophy of individualized care is foundational to the therapeutic nurse patient relationship.
    vAll client behaviour has meaning that is contributing to the underlying cause.
    vPrevention of the use of restraints starts with assessment and use of alternative approaches.
    vDe-escalation techniques for crisis management can be used as a prevention strategy to avoid the use of restraints.
    vLeadership is required across all organizational and health care sector levels to create a move towards restraint free environments.
    vWhen restraint use is unavoidable, the least restrictive form of restraint is used for the shortest duration of time for avoidance of harm to self/others; restraint use is temporary and alternatives must continue to be considered

  • Nurses play a significant role in client safety through implementation of alternative strategies to prevent the use of restraints and to avoid the potential harmful outcomes associated with the use of restraints.

  • Restraints should be considered as a last resort, for the shortest duration of time when prevention, de-escalation and crisis management strategies have failed to keep the individual and/or others safe.
  • Effective health care depends on a coordinated interprofessional approach and ongoingcommunication between health-care professionals and clients/families and SDM.

  • As Nurses move towards the implementation of practices to support a restraint-free environment in any health care setting must be aware of the legislation that pertains to their:
    vgeographic location,
    vhealth care sector type, and
    vclient population.

  • Nurses must be aware of organization specific policies and procedures in order to identify what is:
    va restraint versus a Personal Assistance Service Device (PASD), and
    vthe required monitoring and observation practices that must be in place when restraints are used.

  • Nurses should review each recommendation and supporting discussion of evidence for applicability to the setting and population to ensure the promotion of safety within the context of that environment.