NURSING FOUNDATION

Unit 10
DEFINE RESTRAINTS:

• A "restraint" is defined as any physical or chemical

means or device that restricts client's freedom to and
ability to move about and cannot be easily removed
or eliminated by the client.
• Restraints in a medical setting are devices that limit a
patient's movement. Restraints can help keep a
person from getting hurt or doing harm to others,
including their caregivers.
PURPOSE
• Restraints may be used to keep a person in proper position and
prevent movement or falling during surgery or while on a stretcher.
• Restraints can also be used to control or prevent harmful behavior.
• Sometimes hospital patients who are confused need restraints so
that they do not:
• Scratch their skin
• Remove catheters and tubes that give them medicine and fluids
• Get out of bed, fall, and hurt themselves
• Harm other people
•Physical restraint refers to means of
purposely limiting or obstructing the
freedom of a person's bodily movement.
PRINCIPLES OF RESTRAINTS:
• should be selected to reduce clients movement only as much as necessary
• Nurse should carefully explain type of restraint and reason for its use
• Should not interfere with treatment
• Bony prominences should be padded before applying it.
Should be changed when they become soiled or damp
•Should be secured away from a clients reach
•Should be able to quickly release the device
•Should be attached to bed frame not to side rails
•Should be removed a minimum of every 2 hrs
•Frequent circulations checks should be performed when extremity are used
Precautions of Restraint Application
• Before applying restraints it is important to try other
methods of promoting patient safety. Alternative
methods that might be effective are reorientation of the
patient to the physical surroundings, moving the patient’s
room near to the staff members, teaching relaxation
techniques in order to decrease anxiety and fear and
decrease overstimulation.
• Documentation of any alternative method used is
extremely important. Restraint application should be
documented thoroughly.
Situations that Requires Restraint Application
• Confused client tries to endanger him or herself
• Confused client attempts to remove supportive equipments
such as necessary tubes, IV lines or protective dressings.
• The client is at risk for falls.
• The client is suicidal.
• The client poses harm or threat of inflicting harm to health
care staff, other clients and/or visitors.
• A child is unable to remain still during a minor surgical
procedure.
Restraint Application Key Steps
• Make sure that the restraints are correct size for the patient’s build and weight.
• Explain the need for restraint to the patient. Assure him or her that they are used to
protect him from injury rather than to punish him. It is necessary to inform the
patient of the conditions necessary to release him or her from restraints.
• Restraints are ONLY used when all other methods have failed to keep the patient
from harming himself or others. Restraints used should be least restrictive to the
patient.
• Obtain adequate assistance to manually restrain the patient.
• After an hour of placing a restraint, the patient should be evaluated by a licensed
independent practitioner and an order must be written for restraints.
• The order must ne time limited: 4 hours for adults; 2 hours for patients ages 9 to 17
years old; 1 hour for patients younger than 9 years old.
• The original order expires in 24 hours. Thus, the same order cannot be used the
following day.
• To promote safety and ensure the patient is not harmed with restraint application,
the patient should be assessed every 2 hours or according to the facility policy.
• In cases where the client consented to have his family informed of his care, the family
should be notified of the use of restraints.
Types of Restraints
• Soft restraints. This type of physical restraint device is used to limit movement
of patients who are confused, disoriented or combative. The main goal of using
this restraint is to prevent the patient from injuring him or her self and/or
others.
• Vest and Belt Restraints. In using this device full movement of arms and legs are
permitted. This is used to prevent the patient from falling from bed or a chair.
• Limb Restraints. Patients who are removing supportive equipments such as I.V.
lines, indwelling catheters, NGTs and etc. are placed on limb restraints. This
device allows only slight limb motion.
• Mitts. This device prevents the patient from removing supportive equipment,
scratching rashes or sores and injuring him or herself and/or others.
• Body restraints. When patients become combative and hysterical they can be
controlled by applying body restraints. This immobilizes almost all of the body.
• Leather Restraints. This restraint is only used when soft restraints are not
sufficient to control the patient and when sedation is either dangerous to the
patient or ineffective.
Soft Extremities Restraints Vest restraints Mitt Restraints
Leather Restraint Mummy Restraint
Jacket Restraint
• ELBOW AND KNEE RESTRAINT
Elbow and knee restraint is used to control the flexion
of elbow and knee In this a readymade cloth with 6-10 pockets is used
Place the cotton on sides of elbow and knee and the knee the wooden or
plastic strips on pocket cloth.
• Place the cloth on elbow and knee and adjust it
with central location and tie the both side strips
properly.
• This elbow restraint is used in case of face and
head surgeries Cleft lip and cleft palate, scalp vein
infusion, heart injuries and sutures are good
examples of using this elbow restraint.
• ABDOMINAL RESTRAINT
This restraint is used to hold the infant in a
supine position on the bed Abdominal restraint
should not be too tight, so that it cannot interfere
with respiration and bowel movement .For this
restraint, use wide size wooden strips Place the
cotton pad appropriately to provide the proper
comfort .
• Extremity Restraint (Ankle & Wrist restraint)
This involve the extremity (one or
more) restraint to complete some procedures It is
used to immobilize the extremities
• CLOVE HITCH KNOT RESTRAINT
It used to immobilize the leg or arm.
The material for clove hitch can be soft cloth, crepe bandage and
inch wide gauze bandage.
First apply the cotton pad over the wrist, ankle to provide
comfort.
• Prepare a figure of “eight” by the bandage and place
it on the wrist or in the ankle and tie the bandage by
knot Knot should not be too tight, or too loose Child
can remove the knot, if it is too loose.
• To tight knot can interfere on blood circulation .
• The fingers and toes should be checked for
discoloration or any skin rashes .
• Jacket Restraint
In this method, a jacket made up of soft cloth and
leather is used .
This jacket has laces at the back and two long strips.
The laces are tied at back and long strips tie at the
side below the rails under the mattress.
Child can sit and sleep in supine position while
wearing jacket.
It can use on chair also.
•This restraint is used to avoid the child from
climbing over the side rails, climbing out from chair,
bed, cot, etc.
• It prevent the child from fall and injury Some other
types eg.
• Chest restraints are also used for children who are
sitting on a chair or wheel chair to maintain their
position and to prevent them from fall and injury.
• Side Rails
The rails are made up of iron or steel .
These can be raised when ever need arises and
can be decreased as per convenience .
The main purpose of side rails are to prevent
from fall and can be used for other restraints.
These are used for children with convulsive
disorders also.
• Splints
• these are prepared devices which are used to
restraint the movements of extremities.
• These are made up of plastic, card board, hard
paper, and cotton and gauze pieces.
• These can be applied where ever needed .
• Mummy restraint is used for the children to restrict the moment
of limbs It is used to the children for examination, procedure
and treatment of head, neck and face is required For example
like scalp vein puncture, ear examination, and eye irrigation,
gastric and gastric lavage
• PROCEDURE
• Take blanket or draw sheet and spread it our the bed or table One corner
of a small blanket is folded over.
• The infant is paced on the blanket with the neck at the edge of the
fold.Keep one hand of baby near the body and wrap the baby`s body by
holding the corner of the sheet and tuck it under the body in opposite
side.
• Now place another hand near the body and wrap the child`s body by
holding another corner of sheet and tuck it .
• Now take the rounded sheet at bottom near the leg and fold it towards the
chest and tuck it upper level of sheet or we can pin it at lower of sheet It
restrict all extremities.
 Mitt or finger restraint:
• Mitts are used for infants to prevent self-injury by hands in case of
burns, facial injury or operations, eczema of the face or body.
• Mitten can be made wrapping the child's hands in gauze or with a
little bag putting over the baby's hand and tie it on at the wrist.
• COMPLICATIONS OF RESTRAINTS
• If restraints are not used properly, it can cause various complications or
hazards .
• It can interfere the child muscular development due to lack movementIf
restraint is too tight, it cause obstruction in blood circulation tissue damage,
redness, scar formation, discoloration of the skin etc.
• Dislocation of the shoulder joint may occur if the child struggles during
application of arm restraints.
• Development of pressure sore, if the child is kept restricted for longer period of
time and does not have frequent change of position and skin care.
• Hypostatic pneumonia due to immobility
• Ischemia or nerve damage due to constrictive restraints.
• Psychic injury to the child, the child feels that, he/she is punished,
attention is self body image .
• Disturbance in psychosocial development.
• To avoid from these hazards, the care giver or nurse should follow the
safety precautions.
• Use proper amount of cotton pads, and do not use too tight restraint.
• Always follow continuous observation on child If any application occurs
release the restraint and consult with doctor.
• Maintain proper recording and reporting.
• RESPONSIBILITIES OF THE NURSE

• Assess the client’s behaviour and the need for restraint & applies as a last
resort.
• Get written order and obtain consent as per hospital policy
• Must communicates with the client and family members
• complies with institutional policies and guidelines for restraint
• Explain the client the reason for the restraint and cooperation
• Arrange adequate assistance from competent staff before carrying out the
restraint procedure
• Apply the least restrictive, reasonable and appropriate Devices.
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• Arrange the client under restraint in a place for easy,close and regular
observation
• particular attention to his/her safety, comfort, dignity, privacy and
physical and mental conditions.
• attend the client’s biological and psychosocial needs during restraint
at regular intervals.
• reviews the restraint regularly, or according to institutional policies.
• consider the earliest possible discontinuation of restraint.
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• document the use of restraint for record and
inspection purposes.
• Explore interventions, practices and alternatives to
minimize the use of restraint.
• Nurse must maintain his/her competence in the
appropriate and effective use of restraint through
continuous education.