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Unit 15

Restraints
Nurse Aide I Course

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Restraints
Introduction
Under OBRA, residents have a right
to be free from restraints.
As a member of the multidisciplinary
team, the nurse aide plays an integral
role in achieving a restraint free
environment.

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Restraints
Introduction
(continued)
When alternatives to restraints are
not effective, however, and the
physician orders restraints, it becomes
essential for the nurse aide to know the
risks involved in caring for these
residents.

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15.0 Identify and discuss the safety
precautions to be considered
when using restraints.

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Facts Regarding Restraints
• Ordered by the physician when
necessary to treat a medical
symptom or provide emergency
medical treatment
• Choice of restraint based on
multidisciplinary evaluation for the
least restrictive measure

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Facts Regarding Restraints
(continued)

• Types of acceptable restraints


– hand or mitts
– soft ties for wrists and ankles
– vests and safety belts
– lap cushions
– lap trays

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Facts Regarding Restraints
(continued)
• Types of unacceptable restraints
– using bed rails to keep resident
from voluntarily getting out of bed
– tucking in top sheet so tightly that
resident cannot move
– using wheel chair safety bars to
prevent resident from getting out
of chair
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Facts Regarding Restraints
(continued)
• Types of unacceptable restraints
(continued)
– placing resident in wheel chair so
close to a wall that the wall
prevents resident from getting out
of chair

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Facts Regarding Restraints
(continued)
• Reasons for use of acceptable
restraints
– Temporarily for life threatening
medical conditions
– Brief periods to allow medical
treatment to proceed if there is
documented evidence of resident
or legal approval of treatment
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Facts Regarding Restraints
(continued)

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15.1 List eight considerations that
would be important when using
restraints.

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Considerations When Using
Restraints
• Used to protect residents and not to
aid staff
• Restraints require physician’s order
• Need for restraint should be
apparent (unnecessary use is false
imprisonment)

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Considerations When Using
Restraints
(continued)
• Staff must provide for the restrained
resident’s basic needs, with special
attention to elimination needs

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Considerations When Using
Restraints
(continued)
• Secure enough help to apply
restraints quickly to prevent injury
• Use reassurance in an attempt to
calm agitated residents in restraints
• Apply according to manufacturer’s
directions

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Safety Measures For Restrained
Residents
• Check on resident frequently
• Apply restraint only after you have
received instructions in its use
• Protect bony areas and skin by
padding them prior to applying
restraint
• Adjust restraint so that it allows
some movement, but is secure
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Safety Measures For Restrained
Residents
(continued)
• Assure that resident can breathe
easily in a vest restraint
• Check pulse, color and temperature
of any restrained extremity and
breathing of resident in vest restraint
every 15 minutes

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Safety Measures For Restrained
Residents
(continued)

• Use slip knot to tie restraint for quick


release
• Secure restraints to bed frame, not
to side rails

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Safety Measures For Restrained
Residents
(continued)
• Loosen restraint, stay with resident,
and use call signal to notify
supervisor immediately:
– when unable to detect a pulse in
restrained extremity
– when fingers/toes are cold, pale or
blue in color
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Safety Measures For Restrained
Residents
(continued)
• Loosen restraint, stay with resident,
and use call signal to notify
supervisor immediately (continued):
– if resident complains of pain,
discomfort, numbness, or tingling in
restrained part

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Safety Measures For Restrained
Residents
(continued)
• Loosen restraint, stay with resident,
and use call signal to notify
supervisor immediately (continued):
– when skin appears red or
damaged under restraint
– when breathing is impaired with
vest or safety belt restraint
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Safety Measures For Restrained
Residents
(continued)
• Carry scissors in pocket to
cut restraints in emergency
situations
• Remove restraints for 10
minutes and reposition
resident every two hours

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Safety Measures For Restrained
Residents
(continued)

• Be sure resident needs are met when


restrained
• Keep call signal within resident’s
reach

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Safety Measures For Restrained
Residents
(continued)
• Recording restraints should include:
– The type of restraint
• wrist • mitt
• ankle • vest
• waist belt

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Safety Measures For Restrained
Residents
(continued)
• Recording restraints should
include (continued):
– Time restraint applied
– Each time restraint loosened
and resident repositioned
– Time restraint removed
– Condition of resident
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Safety Measures For Restrained
Residents
(continued)
• Observations and reporting should
include:
– Color and condition of skin under
restraint
– Pulse rate, color and temperature of
skin in restrained extremity

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Safety Measures For Restrained
Residents
(continued)
• Observations and reporting should
include (continued):
– Any complaints about restrained
part
– Red or injured skin areas under
restraint
– Respiratory rate and color of skin
with vest and safety belt restraints
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15.2 Demonstrate the application of
restraints.

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15.3 Demonstrate the application of a
safety belt restraint.

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15.4 Identify a sampling of alternatives
to avoid the use restraints.

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Alternatives To The Use Of
Restraints
• Using friends, family,
volunteers or sitters
• Diverting with interesting
activities
• Answering call signal
promptly
• Exercise and outdoor
activities
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Alternatives To The Use Of
Restraints
(continued)
• Electronic warning devices on
beds and doors
• Consistent reality orientation and
staff assignments
• Having room close to nurses’
station

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