Every nurse will likely come across restrains at some point in their career, whether that be for confused patients, sedated patients, or combative patients. Because of this, it’s super important to know when and why restraints can be used and in what setting. Let’s go over what restraints are, the various types, and their proper use.
What are Restraints?
Restraints are anything we give to a patient that restrains their movement in any way. This can either be physically, environmentally, or chemically with various medications. In some situations, multiple types of restraints can be used at one time, for example a chemical restraint paired with mittens, a physical restraint, for an elderly confused and agitated patient.
Why Give Restraints?
Restraints are used for either the safety of the patient or the safety of the staff. If the patient is agitated, confused, or having a mental health crisis, then they may be a danger either to themselves or others, requiring restraints.
Types of Restraints
There are many different types of restraints because there are many different needs for restraints. These include:
- Vests
- Mittens
- Belts
- Jackets
- Straps
- Limb safety ties/straps
- Medications
- Individual safety rooms
When to Use Restraints
Restraints can only be used in two types of situations. When the patient is a danger to themselves and their own treatment, or when the patient is a danger to others, including staff.
When the Patient is a Danger to Themselves
An example of this is if a patient has an NG tube (aka nasogastric tube) that they keep pulling out. Another example is if the patient is itchy and is uncontrollably scratching at themselves potentially harming themselves and even accidentally pulling out IV’s. Additionally, if a patient is very young, elderly, or maybe has a developmental delay, then they may not realize that the care we are giving them, maybe a Foley Catheter and an IV, is for their own benefit and they may try to remove lines simply because they don’t understand.
Another reason is if the patient is a fall risk and they are bed-bound but have enough movement to inadvertently fall out of the bed. Lastly, if the patient is having a mental health crisis, they may be a danger to themselves if they are not wanting to live anymore and are on some sort of psychiatric hold that allows us to give them the care they need despite not wanting it.
When the Patient is a Danger to Staff/Others
An example of this is when patients are aggressive, whatever the cause may be. They may be verbally threatening or physically threatening which puts the staff in harm’s way. In this case, a physical or chemical restraint might be ordered along with a sitter to ensure the patients and staff’s safety.
In a situation where you may not feel comfortable due to threats by the patient, make sure you have alerted your breaker and/or other co-workers of the situation. If possible, have someone else come in the room with you when providing close contact patient care to better ensure your safety. Always have security’s phone number or extension easily accessible so you can quickly call them if need be. For me I have security’s number written on the back of my badge so it’s with me at all times.
For more information, be sure to visit How to Handle Aggressive Patients and How to Raise Awareness on Workplace Violence in the Nursing and Healthcare Field.
Restraint Rules
For different facilities and various locations, the rules for restraining patients are going to be slightly different, so be sure to know your facilities policy. In general, healthcare workers are only going to use restraints as a last resort. Education and/or de-escalation techniques are always going to be used first, whichever one is more appropriate for your specific patient.
Assessing Restraints
Restraints are constantly needing to be assessed and re-assessed for the patients’ own good. For example, does the patient need to still be restrained or have they calmed down? Has the patient been able to go to the bathroom or eat or drink water since they’ve been restrained? Are they comfortable or are the restraints physically causing them pain or discomfort? Is their skin still intact, are there any signs of redness or skin breakdown? Is their circulation good? Does the MD know that the patient is restrained and is there an active order for restraints? Does the order expire soon and need to be renewed? These are all questions to ask yourself when you have a patient on restraints.
Patient Education
Part of using and assessing restrains is patient education. Regardless of the state the patient is in that is requiring restraints, they need to be told why they are being put in restraints and how they can get out of them.
For example, let’s reference back to the patient that keeps pulling lines, like their NG tube or their IV’s. This patient needs to be educated on the importance of the line and the medical treatment they are receiving. Meaning why do they have the NG tube or IV in the first place? The patient then needs to be instructed on how they can get out of their restrains. For this patient, it may mean verbalizing back to you the reason they have the lines in the first place. Then after an hour of not attempting to touch their lines you can talk about safely removing the restraints.
Patient Safety and Dignity
Regardless of why the patient is in restraints, it is always important to remember patient safety and patient dignity. If a family member is at bedside and they are able to distract the patient from whatever the reason is they’re in the restraints, then it’s a good idea to try to take the restraints off and see how the patient does. Just remember that if for any reason you have to put the restraints back on, then you need a new restraint order from the doctor.
Do you use restraints at work? Comment below!
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