Restraints may be physical or chemical. Physical restraints involve the use of safety-oriented devices such as limb restraints, mittens, safety jackets, and wheelchair belts to prevent client injury. Chemical restraints, on the other hand, involve the use of medications such as sedatives and anxiolytics to control violent and disruptive behavior.
Due to the occurrence of numerous restraint-related injuries (e.g. skin tears, broken bones, pressure ulcers), psychological complications (e.g. loss of self esteem, depression, confusion, humiliation), and deaths (by asphyxiation and strangulation) due to the use and misuse of restraints, healthcare facilities generally adopt a restraints reduction policy. Meaning, a nurse or any qualified healthcare practitioner should use safety measures to protect the client from harm and injury and should only apply restraints to a client as a last resort.
Furthermore, since the application of restraints impedes a patient's ability to move freely, their use may pose legal problems for the nurse when done inappropriately. And so, in order to avoid client injury and resulting legal problems, here are a number of helpful guidelines in the use of restraints:
- Restraints are applied only when absolutely necessary and are used as a last resort.
- Restraints are applied to protect the client and others from injury. Restraints are never used as a form of punishment or used for the nurse's convenience.
- Before applying restraint to a client, know the healthcare facility's policy on restraints first.
- The use of restraints is ordered by a physician and the order should be signed, dated, and should specify the type of restraint used and for how long.
- In emergency situations, restraints may be applied by an authorized and qualified member of the healthcare unit. However, an order should be obtained from a physician within 24 hours. Ideally, a physician's order should be obtained within the first hour and a registered nurse should evaluate the need for continued restraint after the first four hours of use.
- When using restraints, the least restrictive methods should be used first.
- Always obtain consent from a competent client or from the guardian in the case of a legally incompetent client before the application of restraint to avoid legal complications (the nurse may be charged with false imprisonment, battery, and lack of informed consent).
- If an ordered restraint is refused by the client or the guardian, check the policy on restraints immediately. Most facilities require the client to sign a waiver releasing the agency from liability should injury result from the client's refusal.
- Choose a type of restraint appropriate for the client. A suitable restraint should be least restricting, least obvious, readily changeable, does not interfere with the client's treatment, fits properly, and is safe for the client.
- Restraints are applied securely and in such a way that it can be easily removed in cases of emergency.
- Restraints should support normal anatomic position of body parts to prevent complications.
- Ongoing assessments should be performed every 30 minutes. Watch out for cyanosis, pallor, broken skin, or coldness.
- Restraints should also be removed for 10 minutes every 2 hours to provide for ROM exercises, repositioning, ambulation, and skin care.
- When restraints are temporarily removed, the client is never left unattended or left with a family member. If necessary, responsibility should only be delegated to an authorized qualified personnel and never to the client's family member.
- Proper documentation should be accomplished. Documentation should include the rationale for restraining the client, type of restraint used, explanations given to client and significant others, client's consent, times restraint was applied and removed, alternative to restraints tried, protective care rendered, clients responses, and notification of the physician.
SOMETHING TO THINK ABOUT
Nearing the end of your shift during your clinical rotation in a mental health facility, you were talking to your 71-year-old male client when one of the staff nurses in the unit gave you four strips of cloth and instructed you to restrain your client before you leave the room to prevent him from leaving the bed and injuring himself and others. As a nursing student, what should you do?