Trauma-Informed Care and the Reformation of Restrictive Interventions: An Advanced Nursing Perspective

Abstract

Despite growing knowledge of their detrimental consequences, restrictive measures including physical restraint, isolation, and pharmaceutical restriction are still widely used in nursing practice in psychiatric, emergency, pediatric, and critical care settings.   While these measures are frequently justified as necessary to ensure the immediate safety of patients and healthcare workers, mounting evidence suggests that they can exacerbate psychological trauma, jeopardize therapeutic relationships, and violate professional nursing values such as dignity, autonomy, and advocacy.   Trauma-Informed Care (TIC), as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA), is a transformative framework that questions traditional approaches to behavioral management by framing challenging behaviors as adaptive responses to trauma rather than willful defiance. Despite growing knowledge of their detrimental consequences, restrictive measures such as physical restraint, isolation, and pharmaceutical restraint are still widely used in nursing practice in psychiatric, emergency, pediatric, and critical care units.   While these measures are frequently justified as necessary to ensure the immediate safety of patients and healthcare workers, growing evidence suggests that they can exacerbate psychological trauma, jeopardize therapeutic relationships, and contradict professional nursing values such as dignity, autonomy, and advocacy.   Trauma-Informed Care (TIC), as defined by the Substance Abuse and Mental Health Services Administration (SAMHSA), is a transformative framework that challenges traditional approaches to behavioral management by viewing challenging behaviors as adaptive responses to trauma rather than willful defiance. Reforming restrictive therapies based on trauma-informed principles is more than just a clinical adjustment; it is an ethical and professional necessity.  Nurses may move beyond coercion to a style of care that actually supports recovery, fosters trust, and preserves human dignity by incorporating safety, compassion, and respect for autonomy into their daily practices.