Restraints

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.

Some common uses for restraints include preventing agitated or aggressive clients from harming themselves or others and preventing confused or disoriented clients from interrupting ongoing therapy, like removing medically necessary tubes or catheters from their bodies.

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 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.

Chemical restraints are used to help calm anxious, agitated, or physically combative clients to protect them and those around them from harm.

Now, there are a variety of types of physical restraints. 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.

Mitt restraints are applied to the hands to prevent finger use but still allow wrist and arm movement; these are often used to prevent clients from trying to scratch at wounds or remove medically necessary tubes.

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. 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 use

Restraints are never to be used as punishment or purely for the sake of staff convenience

And 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. 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. 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 lonely

Having volunteers or family members keep a client company