Restraints and Restraint Use
At the end of this class, you will be able to:
Doctors and some nurses have to make a very difficult decision to restrain a person. We do not want to use restraints, but sometimes it is necessary. We do not use a lot of restraints because restraints prevent a person from being able to move freely. They may also stop a person from being able to take care of themself. For example, if a person is restrained in bed with a vest they are not able to get out of bed and go to the bathroom whenever they want to. They will have to depend on the nursing assistant and others for this need and other basic needs. If a person has a restraint on their arm they may not be able to brush their teeth or even comb their own hair. Again, this kind of care has to be given by the nursing assistant or other members of the healthcare team.
All restraints have to be very necessary before they are used. Before they are used many other things have to be tried to keep the person safe. These things are called preventive or alternative measures. These measures prevent the use of restraints for many patients and residents. These measures are an alternative to restraints. Preventive and alternative measures that you can use are described below in this class.
When these preventive things do not work and the person is still in danger of hurting themselves or other people, a restraint is sometimes used. They are NEVER used to make our job easier. They are NOT for staff convenience. They are also NEVER used to punish a person. They are only used to protect a person from harm.
When restraints are used, nursing assistants and other members of the team must continue to maintain the person’s right to dignity and give the person the best possible care. It is also very important to make sure that the person is safe and not in danger of getting hurt while they have a restraint on.
A doctor’s order is necessary before a restraint is used. Some nurses can also order them. A nursing assistant can NEVER apply a restraint unless they are told to do so by the nurse.
Nursing assistants, and others, who put on restraints that are ordered by a doctor must be taught about the correct and safe way to put them on and take them off. If you have not been shown how to put a specific restraint on or take it off, do not do it. Ask the nurse to teach you. When the nurse tells you that you are competent to put on and take off a restraint, you can then do it without the nurse in the room with you.
If you forget how to do it after you are taught, tell the nurse so that you can be shown how to do it again. NEVER put a restraint on unless you are sure that you are doing it in the correct way. You can cause the person serious harm and even death if you do not do it in the correct way.
WHAT IS A RESTRAINT?
A restraint is anything that prevents a person from complete freedom to move about. Restraints can be physical and chemical. A chemical restraint is a medicine, or drug, that makes the person very sleepy and not able to move about with freedom.
A physical restraint is any device that is placed on or near a person that stops them from moving about freely.
Some examples of physical restraints are:
Special procedures, including observation of the person, must be done when a person is restrained except for certain situations when a device is NOT considered a restraint. The following are NOT considered a restraint needing special monitoring and care when the device is:
A RESTRAINT FREE ENVIRONMENT
The safety of our patients and residents is VERY important. We must make sure that all of our patients and residents are safe and free of harm. When a person is in danger of getting hurt or hurting others, we try to do special preventive things, other than using restraints right away, in order to keep them safe. We have a goal to keep people safe without restraints, but this is not always possible when the only way to keep a person safe is to use a restraint.
Yes, we try to have a restraint free hospital or nursing home but this is not always possible. We must balance the need for safety with the need of the person to be free and without a restraint whenever we can, however.
THE MOST COMMON REASONS FOR RESTRAINTS
Restraints are most often used in hospitals and nursing homes to:
THE ROLE OF NURSES AND NURSING ASSISTANTS
The registered nurse (RN):
THINGS THAT MAY PREVENT THE USE OF RESTRAINTS
We must all work together in order to prevent the use of restraints, unless they are absolutely necessary. Preventive actions can include such things as when the doctor changes an order and a person can now get oral feedings rather than a tube feeding when they are pulling on their feeding tube and able to eat by mouth.
Other things that we can do to keep the person safe without restraints include:
Closer Monitoring of the Patient or Resident
Making the Area Safer for the Patient or Resident
Other things that you may use to prevent falls and wandering are a bed and/or chair alarm. You may also care for a person that has a low bed and/or a gym mat in place. Low beds and mats next to the bed will lower the amount of injury when a person falls out of their bed.
Changing the Way We Give Care to the Patient or Resident
Reality Orientation and Other Interventions
Some of the things that you can do to prevent a person from the risk of violent injury to self and/or others without using a restraint include:
WHAT YOU MUST DO WHEN RESTRAINTS ARE USED
There are a large number of restraints that can be used. When restraints are needed, the LEAST restrictive of all must be used. The one that keeps the person safe and takes away the LEAST amount of freedom is the restraint that should be used and ordered by the doctor. A restraint that takes away more freedom of movement than needed to protect the person from harm should NEVER BE USED.
Restraints are started on a patient with an order from a doctor and also, in some very severe emergencies for a short time, by a nurse without the order from a doctor. For example, if a patient begins to hit and punch staff and other patients and nothing can stop it, a registered nurse can restrain the violent patient so that they do not bring serious injury to other people.
THE SAFE APPLICATION OF RESTRAINTS
You must follow your hospital or nursing home procedure on how to apply a restraint exactly! Do NOT do it in any other manner. You must follow the procedure without any changes.
Restraints should never be put on:
Restraints should never be tied to a part of a bed or chair that is moveable. For example, a vest restraint should NEVER be tied to a side rail or the bottom of the bed that moves when the head of the bed is moved up.
All nursing assistants, patient care technicians and other healthcare workers that put on a restraint and care for the patient in restraints must have education about the correct way to put a restraint on and the things that must be done for the patient or resident once they are restrained. If you have not been given this education or you are unsure of the way to put a restraint and care for the patient or resident, ask the charge nurse to teach you. Do NOT put a restraint on a patient or resident if you are unsure of the correct procedure. Do NOT care for a person with a restraint if you are unsure of the correct procedure.
When you put a restraint on a patient or resident:
Immediately report to the nurse if the patient, resident or family member says that they do not want a restraint to be used. If the person cannot be left alone without the restraint, put the nurse call light on so someone can get the nurse or stay with the person until you have had a chance to talk to the nurse about whether or not the restraint must still be used when a patient, resident or family member tells you that they do not want the restraint. Tell the person that you will be speaking to the nurse if they say that they do not want the restraint to be used. For example, you should say, “Mrs. Brown, let me speak to the nurse about this restraint.”
OBSERVING THE PATIENT OR RESIDENT THAT IS RESTRAINED
All patients or residents that are restrained must be observed very often. At times you may have to stay in the room with the patient or resident. Other times, you may be asked to look at the patient every 5, 10 or 15 minutes depending on the patient or resident and their condition. If the person is stable and safe you may be asked by the nurse to observe the person every hour or so.
When you monitor the patient or resident that is restrained, you must look at the person and observe their:
All monitoring of a person with a restraint must be documented. Some hospitals and nursing homes use a restraint flow sheet. Others may want you to write a note in the progress notes. Check your hospital or nursing home procedures for documentation during restraint or ask the nurse where this special monitoring is documented if you are not sure.
You must immediately report to the nurse if you have noticed that something is not normal or correct while you are monitoring the person in restraints. If the person is in danger, fix the problem if you can. If you cannot fix the problem, call for help. Do NOT leave the person that is in danger alone. Stay with the person and call for help.
TAKING CARE OF THE PATIENT OR RESIDENT THAT IS RESTRAINED
Patients and residents that have a restraint must be given the best care possible. They also need to be cared for more often than patients and residents without restraints. Care is given at LEAST every 2 hours and more often when the person needs it.
Some of the care that you will give to the person in restraints includes:
When a patient or resident is restrained, nursing assistants and all other healthcare workers must:
WHAT TO DO WHEN RESTRAINTS ARE STOPPED
Restraints are stopped when the doctor’s order expires and whenever the patient behavior gets better to the point that the restraint is no longer needed. Restraints to prevent a person from pulling out their medical tube, line, catheter or other treatment are stopped when the tube, line or catheter is taken out. A person that is no longer violent is not in need of a restraint. This restraint would then be stopped by the doctor or the nurse in charge.
At times you may be asked by the nurse to continue observing the patient or resident very closely even after the restraints have been stopped. This is sometimes done for a period of time just to make sure that the person stays safe and free from harm after the restraints are taken off.
SOME PROBLEMS THAT CAN OCCUR AS A RESULT OF RESTRAINTS
Restraints can cause problems, especially when:
Some of the problems that can happen with restraints are:
Nursing assistants and other healthcare providers, such a patient care technicians, rehabilitation aides, and restorative care aides, can prevent these problems by doing the following, as assigned by the charge nurse:
GETTING TRAINING AND EDUCATION ABOUT RESTRAINTS AND RESTRAINT USE
Your hospital or nursing home has given you education and training about restraints and restraint use when you began to work there. Your hospital or nursing home must also make sure that you get more education every once in a while to make sure that you still remember about how to put a restraint on and how to follow the procedures about restraints and restraint use. Some of the things that you will learn include the proper and safe way to apply restraints, patient monitoring, the patient care that must be given during restraint episodes, patient rights and patient dignity.
The use of restraints has both benefits and risks. Your hospital or nursing home collects data to make sure that restraints are used only when necessary and to make sure that they are used correctly when they are needed. The goal of this performance improvement activity is to find out how well your hospital or nursing home has been able to improve the quality of life and care for our patients and residents while insuring their safety and freedom from injury while under our care.
Performance measurement data is looked at for all restraint episodes. This data includes:
All hospitals and nursing homes try to stay restraint free, however, this is not always possible. There are times that restraints are needed to keep the patient or resident safe and free from harm.
Nursing assistants must know how to put a restraint on safely, and how to monitor and care for the person that is restrained.
Berman, Audrey, Shirlee Snyder, Barbara Kozier and
Glenora Erb. (2010). Kozier & Erb's Fundamentals of
Nursing: Concepts, Process, and Practice. 8th Edition.
Pearson Prentice Hall.
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