Restraints
Definitions & Key takeaways
Restraints refer to devices or methods used to physically restrict the movement of a person. They are used to restrict a client's freedom of movement or to prevent them from accessing certain parts of their body, and they are sometimes needed to keep patients as well as people around them safe. Restraints are of two types: physical and chemical.
Physical restraints are devices attached to or near a client's body that cannot be easily removed, such as attachments to chairs, side rails on a bed, or even tightly tucked sheets. Additionally, restricting access to other rooms or areas of a facility is also considered a type of physical restraint. On the other hand, chemical restraints include medications, like sedatives and tranquilizers, that are not a part of the standard treatment for a medical or psychological condition.
Laws, standards, and guidelines regulating the use of restraints require that restraints are used only as a last resort and that the minimum effective restraint must be used for the shortest period possible. It's important to not only take great care when working with restrained clients, but also to seek and exhaust all alternatives to restraints before resorting to their use.
Intro0:00–0:46
Restraints are sometimes needed to temporarily help keep clients and the people around them safe. The purpose of a restraint is to restrict a client’s freedom of movement or to prevent a client from reaching certain parts of their body.
Sometimes, restraints are used as a last resort to keep clients from falling and harming themselves. Now, there are two types of restraints: physical and chemical.
Physical vs Chemical Restraints0:46–1:56
Physical restraints are devices that are attached to or near a client’s body that restrict the client’s freedom of movement or their ability to access certain parts of their body; these cannot be easily removed by the client.
Physical restraints attached to a client’s body are commonly applied to the chest or waist or joints, such as the wrists, elbows, or ankles.
Physical restraints near a client’s body may be attachments to chairs, side rails on a bed, or even tightly tucked sheets.
Additionally, restricting access to other rooms or areas of a facility is also considered a type of physical restraint. Chemical restraints are medications, such as sedatives or tranquilizers, that are not a standard treatment for a medical or psychological condition.
These medications restrict a client’s freedom of movement or their ability to access certain parts of their body by altering a client’s mood or behavior.
Types of Physical Restraints and Examples of When They are Used1:56–3:18
Vest and jacket restraints are applied to the chest and help keep a client confined to a bed or chair. They can also be used to restrain physically combative clients.
Wrist restraints are attached to the wrists to limit arm movement and are commonly used to stop clients from reaching over to pull out medically necessary tubes, like IV lines or catheters; they can also function to restrict physically combative clients from using their arms to hit themselves or others.
When both wrists are restrained, it’s called 2 point restraint. 3 and 4 point restraints include restraining the wrists and also one or both legs with ankle restraints to better confine the client to the bed.
Belt restraints, also sometimes called lap restraints or lap belts, are applied around the waist and are used to confine a client to a bed or chair in order to prevent them from wandering away or falling.
Tray tables on chairs or lap buddies, which are cushions that can be attached across the frame of a wheelchair to remind a client to ask for help prior to getting up, can be considered restraints if a client cannot easily remove them.Remember that clients have the right to be free from restraints that are not medically necessary.
Laws, Standards, and Guidelines that Regulate the Use of Restraints3:18–4:38
The Omnibus Budget Reconciliation Act, or OBRA, The Joint Commission or TJC, the Food and Drug Administration, or FDA, the Centers for Medicare and Medicaid Services, or CMS, as well as the different U.S.
states all define laws, standards, and guidelines for using restraints. Some of the most important of these are: Restraints must be ordered by a healthcare provider, so clients are not unnecessarily restrained Informed consent is required, meaning the client or the client’s family needs to understand the reason for the restraint and the risks involved with their useRestraints are never to be used as punishment or purely for the sake of staff convenienceAnd the least restrictive restraint, or restraints, must be used for as minimal an amount of time as possible.
Failure to adhere to these guidelines can be considered holding a client against their will or false imprisonment. Therefore, all care facilities must keep restraint use to an absolute minimum.
As a nursing assistant, it is important that you are familiar with these laws, standards, and guidelines. You should also be familiar with your facility’s policies and your responsibilities regarding restraint use.Now, the use of restraints can be dangerous and can even result in death.
Risks Associated with the Use of Restraints4:38–5:36
This is true even when restraints are utilized appropriately, but the danger increases greatly if and when they are used improperly.
For example, an improperly applied vest restraint can strangle a client and prevent them from being able to breathe. Some restraints, if applied too tightly, can result in bruises or abrasions to the skin and can even cut off blood flow to certain body parts, causing permanent damage.If a restrained client tries hard to free themselves from restraint, they may seriously harm themselves.
Clients left immobile in a restraint for too long may develop pressure ulcers, blood clots, or pneumonia. Clients may also become incontinent if they are not able to use the bathroom regularly.
Additionally, restraints can take a mental toll on clients, making them feel embarrassed, humiliated, or even agitated or confused.Because the use of restraints is accompanied by so many dangerous risks, alternatives to restraints must be pursued, exhausted, and documented before considering and resorting to the use of restraints.
Alternatives to the Use of Restraints5:36–6:55
Some examples of alternatives to restraints include: Moving a client to an area where other people are located, such as the nurse’s station, as this can help clients feel safer and less lonelyHaving volunteers or family members keep a client companyUsing pressure-sensitive bed monitoring systems that sound an alarm when a client attempts to get out of a bed or a chairOr using wanderer monitoring systems, which are sensors on bracelets that can be applied to a client’s wrist or ankle that sound an alarm when a client attempts to leave the facility or enter restricted areas.
As a nursing assistant, you can help avoid the necessity for restraints by keeping clients company, which may help calm them and make them feel safe; answering call lights quickly; and providing clients ample opportunities to meet their physical needs with repositioning and snack or bathroom breaks as approved by the nurse and healthcare provider.
To prevent clients from removing medically necessary equipment, the healthcare team might employ strategies, such as concealing the IV site with sleeves or using special devices to secure the urinary catheter or nasogastric tube.
Before Application of Restraints6:55–7:38
Sometimes, alternatives to restraints will not be sufficient to keep the client and others around them safe, and restraints will need to be applied.
A healthcare provider will order the restraints, and you may be asked to assist with the application of restraints. Before assisting with the application of any restraint, wash your hands and observe standard precautions.
Then, gather the restraint in the proper size and read the warning labels and instructions in order to ensure you understand how the restraints should be applied.
Next, inspect the restraint to ensure it is not damaged or broken. Afterwards, greet the client, identify them, explain what will happen during the procedure, and ensure their privacy and safety prior to applying the restraint.The nursing assistant will be aiding in the application of the restraint.
During Application of Restraints7:38–8:26
The manufacturer’s instructions and your facility policy will dictate what type of restraints can be used and how they’re applied.The tasks you will perform can include assisting the nurses in positioning the client in a proper alignment for the specific restraint and padding any bony areas on the body where the restraints will be applied to prevent pressure ulcers or injury from the restraint.
Provide reassurance to the client by letting them know what’s being done during restraint application. Assist the nurse as directed to secure any buckles or straps to the movable part of the bed frame or wheelchair frame and out of the client’s reach.
You will also need to ensure the client’s privacy and safety throughout the duration of the application. After applying the restraint, ensure that it is snug but not too tight.
After Application of Restraints8:26–9:15
For vest or jacket restraints, make sure the client can breathe easily. Usually, if you can slide your flat hand between the restraint and the client’s body, that is an indicator that the restraint has been applied properly.
For wrist and mitt restraints, being able to slide one to two fingers between the restraint and the client’s body usually means the restraint is secured appropriately.
It’s also important to check for a pulse below wrist and mitt restraints to ensure the client’s circulation is not cut off.
Finally, check to ensure the skin is warm, normally colored, and not damaged and that the client is not experiencing any tingling, numbness, or pain in their restrained body part.
When you finish assisting the client, be sure to practice hand hygiene. Now, after a client has been safely restrained, as a nursing assistant, you will be responsible for the ongoing care of your restrained client.
Ongoing Care Considerations for a Client in Restraints9:15–9:56
You will have to check on the client at least every 15 minutes to ensure they are safe, comfortable, and injury-free. Additionally, check the client’s plan of care to see how frequently the restraints must be removed; for example, sometimes the restraints should be released every two hours for at least ten minutes.
During this time, assist them with repositioning; provide range of motion exercises; and help them meet their nutritional, elimination, and hygiene needs.
You will also observe the client’s circulation and skin condition.There are a few things you should immediately report to the nurse when caring for a restrained client.
Reporting and Documentation9:56–10:29
These include complaints from your client that they are having difficulty breathing or that they are experiencing pain, numbness, or tingling in a restrained body part.
This also includes any skin damage or color changes that you may notice. Finally, if your restrained client becomes confused or agitated, be sure to immediately inform the nurse.
Be sure to document the date and time of your observations and all the care you provide to your restrained client.Alright, as a quick recap… Restraints are used to restrict a client’s freedom of movement or to prevent them from accessing certain parts of their body, and they are sometimes needed to keep clients as well as people around them safe.
Recap10:29–12:01
Physical restraints are devices attached to or near a client’s body that cannot be easily removed, while chemical restraints are medications, like sedatives and tranquilizers, that are not a part of the standard treatment for a medical or psychological condition.
There are a variety of physical restraints that can be utilized in different circumstances. Laws, standards, and guidelines that regulate the use of restraints require that restraints are used only as a last resort and that the minimum effective restraint must be used for the shortest period of time possible.
Restraints are dangerous even when they are applied and used appropriately. So, it’s important to not only take great care when working with restrained clients but to seek and exhaust all alternatives to restraints before resorting to their use.
As a nursing assistant, you may help to apply restraints, and it is important to read and follow the manufacturer’s instructions and ensure client safety before, during, and after applying restraints.
When caring for a restrained client, follow the client’s plan of care, make sure to check on them at least every 15 minutes, and release the restraint at the specific intervals listed on the plan.
Document the care you provide and immediately report any unusual signs or symptoms to the nurse.
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