PREPARED AND PRESENTED BY: CLAIRE EDGE

AUBURN UNIVERSITY SCHOOL OF NURSING

Rethink Restraints

Learning Objectives

  Explain the different types or restraints   Identify appropriate uses of restraints   Identify alternatives to use before implementing

restraints   Discuss evidenced-based practice related to

restraints   Patient views on restraints

What is a Physical Restraint?

  “A physical restraint is a human, mechanical, and/or

physical device that is used with or without the

patient’s permission to restrict his or her freedom of

movement or normal access to a person’s body.”

Types of Restraints

  Non-violent, non-self destructive restraint   refers to restraints used on

inpatients or outpatients to prevent disruption of treatment or medical devices

  Violent, self-destructive restraint   refers to the use of restraints for

the purpose of controlling behaviors that pose an imminent risk of physical harm to the patient, staff, or others because of an emotional or behavioral disorder not related to a medical condition

  Chemical restraint   refers to the inappropriate use of

sedating, psychotropic drugs administered for the benefit of the caregiver, not the patient. Chemical restraints are not used at UAB Hospital.

When would you use restraints?

 Patients at high risk of fall- Non-Violent, Non-Self Destructive

 Patient pulling out tubes- Non-Violent, Non-Self Destructive

 Patients hitting staff- Violent, Self Destructive Restraints

 Patients that are combative- Violent, Self Destructive Restraints

Before applying restraints, have you tried implementing

alternatives?

Try these alternatives

for non-violent, non-

self-destructive

patients

  Orient patient   Provide a sitter   Offer diversionary activities   Place near nurse’s station   Verbally intervene   Promote relaxation   Ambulating   Toileting   Decrease stimuli   Food & Hydration

Try these alternatives for violent,

self-destructive

patients

  Verbally request cooperation   Redirection   Diversion   Separate the patient from others   Offer prescribed medication   Call for help; show of force

Other measure to take to avoid restraints

  Involve patients in their care

  Create a trusting relationship with the patient

  Be honest to the patient and explain everything

  Create a therapeutic relationship with your patients

Consider discontinuing the restraint if…

  The patient’s condition has improved.

  The time limit of the order has expired.

  Less restrictive measures have become available or effective.

  A trial release (a temporary removal of the restraint to see if the patient would be safe if the restraint was discontinued) is successful.

  You must document on the patient every 2 hours as if they are in are in restraints during the trial.

Patients see restraints as…

  Punishment for their actions

  Traumatizing

  Painful

  Embarrassing

  A way for nurses to hurt them legally

References

  Butterworth, R., & Harbison, I. (2011). Restraint and never events: an opportunity for change. Mental Health Practice, 15(1), 30-32.

  Carolyn Curry (2012). Restraint Utilization: First Do No Harm [PowerPoint slides].

  Lane, C., & Harrington, A. (2011). The factors that influence nurses' use of physical restraint: A thematic literature review. International Journal Of Nursing Practice, 17(2), 195-204. doi:10.1111/j.1440-172X.2011.01925.x

  Stubbs, B., Leadbetter, D., Paterson, B., Yorston, G., Knight, C., & Davis, S. (2009). Physical intervention: a review of the literature on its use, staff and patient views, and the impact of training. Journal Of Psychiatric & Mental Health Nursing, 16(1), 99-105. doi:10.1111/j.1365-2850.2008.01335.x

  Potter, P. A., & Perry, A. G. (2009). Fundamentals of Nursing (7th ed.). St. Louis, MO: Elsevier Inc.