Some method of physical restraint is a common nursing intervention in the care of children. It may be used to ensure the child's safety, facilitate therapeutic or diagnostic procedures, decrease the possibility of disrupting therapy, restrict movement, and immobilize a body part.
NURSING ALERT: Physical restraint should never be used as a substitute for good nursing care, for punishment, or as a convenience to the staff.
A study by Selekman and Snyder (1997) analyzed 18 institutional policies on the use of restraints on children. They found with a review of the literature, most of which focuses on the elderly, that there is almost no research concerning restraint use in children. While recognizing the need for research in this area, the authors of this study have made some recommendations based on their analysis of current practices.
Nurses need to assess whether or not restraints are needed. The nurse needs to take into account a child's development, mental status, potential threat to others or self, and safety. In some health care institutions the decision to apply restraint is a nursing decision, whereas in others a physician order is required before or within 1 to 2 hours of application. Creative approaches may make physical restraint unnecessary. For example, a young child might be brought to the nurses station for stimulation when the parents are not present.
NURSING ALERT: Alternative measures to using restraints should be a careful consideration of the nurse.
After the decision is made that some restraint is necessary, it must be determined what type of restraint should be applied.
NURSING ALERT: It is the nurses responsibility to select the most appropriate and least restrictive type of restraint.
For example, arm boards are less restrictive than 4 point extremity restraints. Less restrictive restraints are often possible by gaining the cooperation of the child and parents.
Selekman and Snyder (1997) recommend appropriate nursing interventions for the child who is restrained. These include but are not limited to the following:
Nurses play an important role in the practice of using physical restraints in children. Until more research is available, nurses need to carefully assess the children in their care and apply the nursing process in the use of restraints.
Selekman J and Snyder B: Institutional policies on the use of physical restraints on children, Pediatric Nursing 23(5):531-537, 1997.
See Chapter 27 in Nursing Care of Infants and Children, 5th and 6th editions.
See Chapter 22 in Essentials of Pediatric Nursing, 5th edition.
March 15, 2002
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