Restraints

							        Unit 15
  Restraints
Nurse Aide I Course




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              Restraints
             Introduction
    Under OBRA, residents have a right
to be free from restraints.
    As a member of the multidisciplinary
team, the nurse aide plays an integral
role in achieving a restraint free
environment.


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              Restraints
             Introduction
                 (continued)
     When alternatives to restraints are
not effective, however, and the
physician orders restraints, it becomes
essential for the nurse aide to know the
risks involved in caring for these
residents.

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15.0 Identify and discuss the safety
     precautions to be considered
     when using restraints.




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     Facts Regarding Restraints
• Ordered by the physician when
  necessary to treat a medical
  symptom or provide emergency
  medical treatment
• Choice of restraint based on
  multidisciplinary evaluation for the
  least restrictive measure


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     Facts Regarding Restraints
                 (continued)

• Types of acceptable restraints
  –hand or mitts
  –soft ties for wrists and ankles
  –vests and safety belts
  –lap cushions
  –lap trays


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     Facts Regarding Restraints
                 (continued)
• Types of unacceptable restraints
  – using bed rails to keep resident
    from voluntarily getting out of bed
  – tucking in top sheet so tightly that
    resident cannot move
  – using wheel chair safety bars to
    prevent resident from getting out
    of chair
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     Facts Regarding Restraints
                (continued)
• Types of unacceptable restraints
  (continued)
  – placing resident in wheel chair so
    close to a wall that the wall
    prevents resident from getting out
    of chair



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    Facts Regarding Restraints
                (continued)
• Reasons for use of acceptable
  restraints
  – Temporarily for life threatening
    medical conditions
  – Brief periods to allow medical
    treatment to proceed if there is
    documented evidence of resident
    or legal approval of treatment
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Facts Regarding Restraints
          (continued)




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15.1 List eight considerations that
     would be important when using
     restraints.




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    Considerations When Using
            Restraints
• Used to protect residents and not to
  aid staff
• Restraints require physician’s order
• Need for restraint should be
  apparent (unnecessary use is false
  imprisonment)


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    Considerations When Using
            Restraints
                 (continued)

• Staff must provide for the restrained
  resident’s basic needs, with special
  attention to elimination needs




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     Considerations When Using
             Restraints
                 (continued)
• Secure enough help to apply
  restraints quickly to prevent injury
• Use reassurance in an attempt to
  calm agitated residents in restraints
• Apply according to manufacturer’s
  directions

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  Safety Measures For Restrained
            Residents
• Check on resident frequently
• Apply restraint only after you have
  received instructions in its use
• Protect bony areas and skin by
  padding them prior to applying
  restraint
• Adjust restraint so that it allows
  some movement, but is secure
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  Safety Measures For Restrained
            Residents
                 (continued)
• Assure that resident can breathe
  easily in a vest restraint
• Check pulse, color and temperature
  of any restrained extremity and
  breathing of resident in vest restraint
  every 15 minutes

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  Safety Measures For Restrained
            Residents
                  (continued)

• Use slip knot to tie restraint for quick
  release
• Secure restraints to bed frame, not
  to side rails



              DHSR Approved Curriculum-Unit 15   18
  Safety Measures For Restrained
            Residents
                 (continued)
• Loosen restraint, stay with resident,
  and use call signal to notify
  supervisor immediately:
   –when unable to detect a pulse in
    restrained extremity
   –when fingers/toes are cold, pale or
    blue in color
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  Safety Measures For Restrained
            Residents
                 (continued)
• Loosen restraint, stay with resident,
  and use call signal to notify
  supervisor immediately (continued):
   –if resident complains of pain,
    discomfort, numbness, or tingling in
    restrained part

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  Safety Measures For Restrained
            Residents
                 (continued)
• Loosen restraint, stay with resident,
  and use call signal to notify
  supervisor immediately (continued):
   –when skin appears red or
    damaged under restraint
   –when breathing is impaired with
    vest or safety belt restraint
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  Safety Measures For Restrained
            Residents
                 (continued)
• Carry scissors in pocket to
  cut restraints in emergency
  situations
• Remove restraints for 10
  minutes and reposition
  resident every two hours

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  Safety Measures For Restrained
            Residents
                (continued)

• Be sure resident needs are met when
  restrained
• Keep call signal within resident’s
  reach



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  Safety Measures For Restrained
            Residents
                 (continued)
• Recording restraints should include:
  –The type of restraint
    • wrist     • mitt
    • ankle     • vest
    • waist belt

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  Safety Measures For Restrained
            Residents
                (continued)
• Recording restraints should
  include (continued):
   –Time restraint applied
   –Each time restraint loosened
    and resident repositioned
   –Time restraint removed
   –Condition of resident
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  Safety Measures For Restrained
            Residents
                 (continued)
• Observations and reporting should
  include:
   –Color and condition of skin under
    restraint
   –Pulse rate, color and temperature of
    skin in restrained extremity

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  Safety Measures For Restrained
            Residents
                 (continued)
• Observations and reporting should
  include (continued):
   –Any complaints about restrained
    part
   –Red or injured skin areas under
    restraint
   –Respiratory rate and color of skin
    with vest and safety belt restraints
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15.2 Demonstrate the application of
     restraints.




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15.3 Demonstrate the application of a
     safety belt restraint.




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15.4 Identify a sampling of alternatives
     to avoid the use restraints.




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        Alternatives To The Use Of
                 Restraints
•   Using friends, family,
    volunteers or sitters
•   Diverting with interesting
    activities
•   Answering call signal
    promptly
•   Exercise and outdoor
    activities
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     Alternatives To The Use Of
              Restraints
                 (continued)
• Electronic warning devices on
  beds and doors
• Consistent reality orientation and
  staff assignments
• Having room close to nurses’
  station


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