Hi guys, I want to take a moment,
to talk about non-behavioral
So, that sounds like a lot of words,
but let's break some of this down.
When we talk about restraints,
that's something sometimes as a nurse
you are going to have to use
in the safety of your patient.
Now, when you hear the word restraint,
this should be one of the last interventions
as a nurse that we have to use.
However sometimes a patient may be interfering
with medical treatment for example
and they do need restraint application,
so that we can continue our care.
Now, the other piece of this
today I want to talk about,
is we're talking about non-behavioral restraints,
there's a difference.
So there's a difference
between behavioral restraints
Now, today we're going to focus on non-behavioral,
so this is going to be used more
likely in your acute care facilities,
like Med-Surg, or intensive care for example.
Now, when we're talking
about behavioral restraints,
typically going to be used in
the mental health facilities
and that's not what we're talking about today.
So let's talk about restraints
and non-behavioral application.
So before we kick off let's
talk about the difference
between a physical and a chemical restraint.
So, you see here on this image on the physical,
you see something around the patient's wrist.
Now this is used anytime the patient may
be trying to interfere with medical care.
So this is going to help
restrict that body movement
and again you can imagine as
a patient that may be ill,
confused, not feeling well,
restraints are not fun,
it's not fun for the nurse,
it's not fun for the patient,
so this is something we really got to consider,
when we're choosing restraints and applying those.
So again, physical restraint is something that's
going to be used to restrict
movement of the person
and specifically anytime someone's interfering
with medical treatment that must be continued,
that's when restraints are used.
Now on the other side you
see, a chemical restraint,
now when we're talking about chemical,
we're talking about giving a medication,
to sedate or relax the patient.
Again, this is not appropriate to
be used as a nurse at our whim.
There are specific guidelines
that you need to consider,
when doing either one of
these types of restraints.
So one important note, is, anytime
you're talking about restraints,
you want to use the least restrictive,
what I mean by that is what's
going to allow that patient
to have the most movement during the care
and while they're being restrained.
Here's an example,
maybe your patient's trying to
pull out their IV out of their arm,
now obviously this is restricting care
or interfering with their care.
However, if we're going to restrain the patient,
we don't need to tie down and restrain both arms
and both legs, right, that's a little excessive.
So as a nurse, you need to assess your patient
and use the least restrictive as possible.
So before applying restraints,
guys this is a big topic.
So there's a lot of consideration to talk about
before we even put those on.
So first off can you try to attempt
any alternative necessary to not
place restraints on a patient.
Again this should be a last stitch effort
to keep the patient from
interfering with medical treatment.
So we talked about attempting all alternatives,
now here's a great example,
we can do things to maybe camouflage something.
Something that will not restrict movement
or we can try some preventive measures as well.
So we're talking about not restricting movement,
here's a great thing such
as camouflaging something
or camouflaging a tube or an IV to
keep the patient from pulling it out.
A great example is an abdominal binder,
so this is something around a gastric tube,
that goes into the abdomen.
We simply just place this
around the patient's abdomen
and most of the time that
camouflaging of the tube,
may make the patient forget that it's there
or it's not in the way for the
patient to grab it and pull it.
So that's really helpful and this is not
keeping the patient from moving around.
Next let's talk about an arm board for an IV.
Now this one's a little weird,
so let's talk about this one.
So sometimes, you have an IV in the patient's arm
or their anti-cubital here.
A lot of the times on movement,
we may move it and pinch the IV off
and sound the alarm of the IV.
Now, that's impeding flow of the fluid,
so that's an issue.
We can put an arm board
underneath here, so if we do that,
okay, you're thinking,
"Well that is going to
restrict some movement", right,
however we are free to move that limb still
and to use our hands, so that's the difference.
So let's talk about some preventive measures,
also really important.
So distraction is great, here's a great example,
I had a patient that kept
trying to get out of bed,
so to keep her busy, I
honestly just gave her a lot of
towels and washcloths and
had conversations with her
and had her set there, and
she folded all those for me,
so she was able to do something
and have conversation, we had frequent monitoring.
That was a great way to
keep her out of restraints,
because she was a really big fall risk.
Another really common preventive measure
you'll see in your hospital is called a "sitter".
It is exactly that, it is a person
or a staff that is designated
to set at the patient's bedside
and monitor that patient
the whole time.
So that keeps the patient from
interfering with treatment.
Such as if they go to pull on a line,
someone is immediately there to intervene.
So sitters are widely used.
Also reorientation of their cognitive status
and also frequent monitoring
or rounding definitely helps.
So that was just one piece,
I know we had a lot of conversation
about attempting alternatives.
That's so key because if you remember,
restraint use is a last resort.
Also don't forget to communicate
with your interdisciplinary team,
because there may be something that tips them off,
that says, you know, something
else medically may be going on,
so make sure you have that communication.
Next, it's important as a nurse to understand
what is considered a restraint.
We talked about that a little bit earlier,
some things are not a restraint,
they could be used as camouflage,
but some things are, so you need to
be familiar with the difference.
And next, make sure you are
following your facility guidelines,
I hate to say it but restraint definitely
can come with some legal ramifications.
We'll talk about that a little bit later,
but it's really important for you
to be up on your agency's policy.
Okay guys, so that was only about four points,
I've got a few more points to make
before we talk about restraints,
because as you know, it's
so important to make sure
that restraints are a last-ditch effort
and we try to avoid this at all possible.
Okay, last half here.
So know the difference between
behavioral and non-behavioral,
we talked a little bit about this,
at the beginning of the presentation.
Now, why this is important,
is because the frequency
of monitoring is different.
So most the time in non-behavioral restraints
in medical facilities, you have to document
or assess about every hour, maybe two.
Now, when we're talking about
behavioral in mental health facilities,
it's usually almost every 15
minutes, so see the difference there.
Next, don't forget to get a
specific order from the physician,
so there are some variations
on when this has to happen
but let your agency know and
follow your facility guidelines.
And lastly, get a baseline assessment,
so this is so very important,
because a patient can be injured
in restraint application.
So make sure you assess your
patient thoroughly, before applying,
because if a patient has a deterioration
we got to know that.