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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.