Magazine article American Nurse Today

Choosing the Right Restraint: Keeping Patients and Others Safe Is Crucial, but Restraints Should Be Used Only as a Last Resort

Magazine article American Nurse Today

Choosing the Right Restraint: Keeping Patients and Others Safe Is Crucial, but Restraints Should Be Used Only as a Last Resort

Article excerpt

Nurses at the bedside are experts in driving the safest, most effective patient care. In some cases, nursing assessment and clinical judgment suggest the need to apply restraints. A patient who is violent or self-destructive or whose behavior jeopardizes the immediate physical safety of him- or herself or another person may meet the behavioral health requirements for restraints. Examples of such behaviors include:

* hitting, kicking, or pushing

* pulling on an I.V. line, tube, or other medical equipment or device needed to treat the patient's condition

* attempting to get out of a bed, chair, or hospital room before discharge, in patients who are confused or otherwise unable to follow safety directions.

Before using restraints, always explore alternatives for keeping the patient and others safe. When considering such options, discuss with the patient any conditions that may need to be addressed, such as pain, anxiety, fear, or depression. If distraction and other alternatives prove ineffective at calming the patient and he or she continues to pose a risk, consult with other healthcare team members. You may want to use an algorithm to help determine if your patient requires restraints. (To access the author's algorithm, visit www.American

Placing a patient in restraints requires a consult from the behavioral health team to consider behavioral restraint options--for instance, certain medications, distraction, seclusion, blanket wraps, or manual locked restraints. If such options don't apply to your patient, proceed with restraints applicable for nonviolent, nonself-destructive patients, such as mitts, soft wrist restraints, or a chest vest. (See Decision tree for nonviolent, nonself-destructive restraint.)

Restraint options

Which type of restraint to use depends on the patient's behavior and condition.

Hand mitts and freedom sleeves

If the patient is confused and impulsive and doesn't follow directions but can be redirected, consider hand mitts to decrease grabbing ability. Or consider "freedom sleeves" (also called soft splints). These are a good deterrent for patients trying to remove a medical device from the face or head (such as a nasogastric tube or drain). With freedom sleeves, patients have difficulty bending their arms. Be aware, though, that the sleeves don't necessarily prevent them from removing I.V. lines.

Hand mitts and freedom sleeves let the patient move the arms up and down but limit the ability to bend and grab tubes or drains. They can be removed by unstrapping the hook-and-loop closures and sliding them off the arms. Be sure to monitor patients closely because they may try to remove these restraints themselves.

Enclosure bed

An enclosure bed helps prevent patient injury by stopping the patient from getting out of bed unassisted. It may be a good option for patients who meet the criteria for this bed. (For more information, read "Enclosure bed: A protective and calming restraint" in this issue.)

Chest vests and lap belts

Chest vests and lap belts (also called waist belts) may be warranted for confused or impulsive patients who are continually trying to get out of bed or a chair after repeated redirection, when it's unsafe for them to get up unaided. Apply the vest or belt according to the manufacturer's instructions. …

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