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Scholarly Commons > HCA Healthcare Journal > Vol. 7 > Iss. 5 (2026)

 

Keywords

physical restraint; intensive care units; critical care; agitation; psychomotor agitation; evidence-based practice; patient safety

Disciplines

Nursing

Abstract

Background

Nurses and health care workers are dedicated to creating a therapeutic environment for healing. Sometimes, physical restraints may be used to ensure safety in patients exhibiting violence, confusion, or agitation, or in patients with life-saving medical devices. While the regulatory requirements for use of physical restraints are well developed, this is not the case with alternatives to using restraints, and many nurses may lack clarity on the best practice for identification and application of alternatives to physical restraint use.

Methods

Two trained reviewers searched PubMed, Google Scholar, and professional health care organizations’ websites guided by a search strategy and inclusion criteria to locate review articles and evidence-based guidelines on alternatives to restraints. All evidence located was reviewed independently by both reviewers for meeting inclusion criteria and quality assessment prior to selection. All evidence selected was placed into an evidence table allowing for the reviewers to identify themes.

Results

After screening 727 articles and guidelines for inclusion criteria and quality assessment, 24 review articles or evidence-based guidelines were identified. Reviewers identified 15 themes, which were synthesized into 3 core elements of restraint minimization and informed development of the Communicate and care, Assess contributing factors, Limit triggers and risks, and Modify environment and meet unmet needs, the CALM Bedside Restraint Alternatives Framework.

Conclusion

Restraint minimization requires a supportive organizational structure and culture, multicomponent restraint-reduction programs, and bedside strategies to identify, prevent, and address conditions associated with restraint use. Education, policy, appropriate staffing, audit and feedback, and bundled interventions are foundational to a least-restraint culture. The CALM Bedside Restraint Alternatives Framework organizes bedside strategies for practical use. More research is needed to evaluate individual restraint alternatives and implementation success.

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