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Avoiding Restraints in Patients with Dementia: Understanding, prevention, and management are the keys.

Evans, Lois K. PhD, RN, FAAN; Cotter, Valerie T. MSN, CRNP, FAANP

AJN The American Journal of Nursing: March 2008 - Volume 108 - Issue 3 - p 40–49
doi: 10.1097/01.NAJ.0000311827.75816.8b
FEATURE: How To try this

Older adults with dementia are at higher risk than other patients for being placed in restraints, despite numerous negative physical and psychological outcomes associated with their use. Many nurses continue to believe that restraints are necessary to control behavioral symptoms and prevent falls or the disruption of life-sustaining therapies in patients with dementia. Reducing the use of restraints depends on interpreting patient behavior to identify unmet needs; regular assessment for changes in mental or physical status; individualized care focused on communication, consistency, surveillance, and appropriate environments; and a flexible team approach based on dialogue among staff members and respect for patients' needs and rights. For a free online video demonstrating the use of the practice guide, go to

When nurses turn to restraints out of worry that patients with dementia will harm themselves, the situation could get worse. This article reveals the hidden dangers of restraints and explains how to keep patients safe without them.

Lois K. Evans is the van Ameringen Professor in Nursing Excellence and director of the Psychiatric Mental Health Advanced Practice Program at the University of Pennsylvania School of Nursing in Philadelphia, where Valerie T. Cotter is an advanced senior lecturer and program director in the Adult Health Nurse Practitioner Program.

Contact author: Lois K. Evans, Avoiding Restraints in Older Adults with Dementia is reproduced with permission of the Alzheimer's Association, Chicago.

How to Try This is a three-year project funded by a grant from the John A. Hartford Foundation to the Hartford Institute for Geriatric Nursing at New York University's College of Nursing in collaboration with AJN. This initiative promotes the Hartford Institute's geriatric assessment tools, Try This: Best Practices in Nursing Care to Older Adults: The series will include articles and corresponding videos, all of which will be available for free online at Nancy A. Stotts, EdD, RN, FAAN (, and Sherry A. Greenberg, MSN, APRN, BC, GNP (, are coeditors of the print series. The articles and videos are to be used for educational purposes only.

Routine use of Try This approaches or tools may require formal review and approval by your employer.

© 2008 Lippincott Williams & Wilkins, Inc.