TORONTO - The Registered Nurses' Association of Ontario has released new guidelines aimed at minimizing the use of patient restraints in such settings as psychiatric hospitals and long-term care homes.

The nurses organization was asked to formulate the guidelines as a result of the 2008 inquest into the death of psychiatric patient Jeffrey James.

The inquest was told that James, 34, was a violent patient with a disorder that led to sexually inappropriate behaviour. He died in 2005 of a blood clot that developed in his leg after he was restrained for five days at the Centre for Addiction and Mental Health in Toronto.

The RNAO guidelines focus on nurses and other care providers seeking alternatives to restraints, while still keeping patients and themselves safe from injury.

Co-author Laura Wagner says physical and medication-based restraints should be the last resort after exhausting the many alternatives that can be used to help keep patients safe.

Wagner, a nursing scientist at the Hartford Institute for Geriatric Nursing at New York University, said patients can be physically restrained using such devices as belts and side rails on beds, put in seclusion in a room or chemically restrained using drugs.

"There are primarily three reasons why a client is restrained," Wagner said from New York. "One is to prevent an interference with treatment, such as a breathing tube or feeding tube or an IV, some kind of therapy."

The others are to prevent falls that could cause injury to the patient and to minimize "behaviours of acting out."

Physical restraints that curtail movement can have serious adverse effects, she said, including on rare occasions deaths from strangulation when a patient tries to wriggle out of belts.

Restraints can also lead to reduced muscle strength and bedsores from not moving, she said.

"We actually know that sometimes when we restrain a patient they become more agitated, more stressed. And just think about having that and wanting to get out of the restraint and how that increases that person's risk for hurting themselves."