Restraints: Types, Concerns and Approaches - PDF

Restraints What are Restraints Mechanical restraints restrict or control movement or behaviour. They may be Examples include, soft limb restraints, Broda chairs, chair trays, side rails, pinels attached to a person's body or create physical barriers. Physical Restrain...

Restraints What are Restraints Mechanical restraints restrict or control movement or behaviour. They may be Examples include, soft limb restraints, Broda chairs, chair trays, side rails, pinels attached to a person's body or create physical barriers. Physical Restrains is the direct application Physical restraint is sometimes considered during personal care, such as holding a of physical holding techniques to a patient patient’s hands. The ideal is to hold one hand gently and/or distract the patient by that involuntarily restricts his or her talking or singing with them. Holding one hand gently while helping the person feel movement. safe is preferable to holding both hands more firmly – or multiple staff holding limbs. Chemical restraints are medications used to modify or restrict behaviour, for These can be used for pre-care example, tranquilizers and sedatives. Environmental restraints change or modify a person’s surroundings to restrict or What could go wrong? Injury from climbing, loneliness, misperception of “jail”, stress control movement, for example, a coded from fixation on the obstacle door, wanderguard, locked units  Restriction of freedom: Restraints can decrease a person’s physical activity level and ability to function independently. For example, a chemical restraint may leave a person sedated and inactive. A physical restraint, such as a tray on a geriatric chair, may prevent a person from moving freely, which can lead to frustration. The excessive or inappropriate use of some caregiving strategies may result in a person being restrained. These restrictions of freedom can also lead to a loss of confidence and self-esteem. Concerns Risk of harm or injury: Restraints can cause injuries. For example, where a bed Regarding rail is used, a person may try to climb over the rail during the night to get to the bathroom which could result in a fall. our Clients Loss of abilities: The restrictions created by restraints may result in the loss of cognitive and physical abilities. For example, a person who is sedated for long periods may possibly lose some abilities Do we them or not? Restraints are sometimes useful. Using restraints to manage For example, the temporary use of behavior is inappropriate and a lap belt can support a person to harmful. It can lead to loss of sit up and participate in a group skills, independence, and self- activity. The short-term use of a esteem, which may not recover. medication can decrease Restraints also prevent caregivers disturbing hallucinations. A from addressing the root cause of protected garden can allow for the person's distress safe wandering. Preferred Choice No restraints The preferred choice is to use no restraints. A physical, chemical or environmental restraint should not be used as a substitute for safe and well-designed environments or for the proper care of a person with dementia. Least Restraint Approach  The principle of least restraint emphasizes using the minimal level of restraint necessary to ensure safety while respecting the person's freedom, dignity, and independence. Restraints should always be a last resort. Key aspects include:  Last Resort: Restraints are used only when all other options have been exhausted and there is an immediate risk of harm. Multiple alternatives, such as de-escalation techniques or environmental adjustments, must be attempted first.  Least Restrictive: When restraints are necessary, use the smallest dose of a medication or the least restrictive physical or environmental measure to address the situation.  Shortest Time: Apply restraints for the shortest time possible and remove them as soon as the person is safe.  Consent and Communication: Involve the patient and/or their decision-maker in an informed consent discussion about the risks, benefits, and alternatives to restraint use whenever feasible.  Continuous Monitoring and Reassessment: Regularly evaluate the need for restraints, prioritize the person’s well-being, and aim to discontinue their use as soon as it is safe.   Restraint is used for “safety”  82% protect from FALLS  65% maintain therapeutic DEVICES (catheters, dressings, IVs, etc.)  67% PROTECT OTHERS from combativeness But the  65% CONFUSION reality…   22% prevent WANDERING 15% prevent from BOTHERING other patients  12% ENCOURAGE REST  These are inappropriate use of restraints which occurs when restraints are misused or used too often…which happens more often than you think ☹ Your role as the HCA HCAS ARE GENERALLY NOT AUTHORIZED TO THEIR INVOLVEMENT IS LIMITED TO ASSISTING HCAS MUST BE FAMILIAR WITH AND ADHERE INDEPENDENTLY APPLY OR REMOVE WITH RESTRAINT PROCEDURES UNDER THE TO THEIR EMPLOYER'S POLICIES AND RESTRAINTS. DIRECT SUPERVISION AND DIRECTION OF PROCEDURES REGARDING RESTRAINT USE. REGULATED HEALTH PROFESSIONALS, SUCH THESE POLICIES OUTLINE THE AS LICENSED PRACTICAL NURSES (LPNS), CIRCUMSTANCES UNDER WHICH RESTRAINTS REGISTERED PSYCHIATRIC NURSE (RPN) OR MAY BE USED, THE REQUIRED REGISTERED NURSES (RNS). DOCUMENTATION, AND THE ROLES OF VARIOUS HEALTHCARE TEAM MEMBERS. Monitoring & Observation HCAs are responsible for monitoring clients who are restrained and promptly reporting any concerns or changes in the client's condition to the supervising nurse. This includes observing for signs of distress, discomfort, or potential complications resulting from restraint use. Remember your ABCs Do your frequent checks per the care plan and agency policy Don’t forget to reposition! Ethical & Safety Considerations The use of restraints raises important ethical issues, including the client's right to autonomy and the potential for harm. HCAs should be aware of these considerations and advocate for the least restrictive interventions, prioritizing alternative measures to ensure client safety whenever possible. Consider safety always. Restraint use has associated risks, whether they are used to manage or support personal expressions, positioning needs, or behavioural symptoms related to mental health or substance use. It is important to ensure culturally safer practices when using restraints. Potential negative outcomes include; Increased risk Urinary and/or Cognitive Decreased Decreased Increased care of pressure Increased risk Respiratory Asphyxiation Death Depression Disorientation Falls Head trauma Muscle atrophy Poor sleep bowel decline mobility quality of life needs injury of stroke depression incontinence development