Introduction to Non-behavioral Restraints (Nursing)

by Samantha Rhea, MSN, RN

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    00:04 Hi guys, I want to take a moment, to talk about non-behavioral restraint application.

    00:09 So, that sounds like a lot of words, but let's break some of this down.

    00:13 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.

    00:20 Now, when you hear the word restraint, this should be one of the last interventions as a nurse that we have to use.

    00:27 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.

    00:37 Now, the other piece of this today I want to talk about, is we're talking about non-behavioral restraints, there's a difference.

    00:44 So there's a difference between behavioral restraints and non-behavioral.

    00:50 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.

    01:00 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.

    01:08 So let's talk about restraints and non-behavioral application.

    01:13 So before we kick off let's talk about the difference between a physical and a chemical restraint.

    01:19 So, you see here on this image on the physical, you see something around the patient's wrist.

    01:24 Now this is used anytime the patient may be trying to interfere with medical care.

    01:29 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.

    01:47 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.

    02:01 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.

    02:11 Again, this is not appropriate to be used as a nurse at our whim.

    02:16 There are specific guidelines that you need to consider, when doing either one of these types of restraints.

    02:22 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.

    02:37 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.

    02:46 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.

    02:55 So as a nurse, you need to assess your patient and use the least restrictive as possible.

    03:01 So before applying restraints, guys this is a big topic.

    03:05 So there's a lot of consideration to talk about before we even put those on.

    03:09 So first off can you try to attempt any alternative necessary to not place restraints on a patient.

    03:16 Again this should be a last stitch effort to keep the patient from interfering with medical treatment.

    03:23 So we talked about attempting all alternatives, now here's a great example, we can do things to maybe camouflage something.

    03:30 Something that will not restrict movement or we can try some preventive measures as well.

    03:35 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.

    03:45 A great example is an abdominal binder, so this is something around a gastric tube, that goes into the abdomen.

    03:52 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.

    04:03 So that's really helpful and this is not keeping the patient from moving around.

    04:09 Next let's talk about an arm board for an IV.

    04:11 Now this one's a little weird, so let's talk about this one.

    04:14 So sometimes, you have an IV in the patient's arm or their anti-cubital here.

    04:19 A lot of the times on movement, we may move it and pinch the IV off and sound the alarm of the IV.

    04:25 Now, that's impeding flow of the fluid, so that's an issue.

    04:30 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.

    04:43 So let's talk about some preventive measures, also really important.

    04:47 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.

    05:08 That was a great way to keep her out of restraints, because she was a really big fall risk.

    05:13 Another really common preventive measure you'll see in your hospital is called a "sitter".

    05:18 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.

    05:27 So that keeps the patient from interfering with treatment.

    05:32 Such as if they go to pull on a line, someone is immediately there to intervene.

    05:36 So sitters are widely used.

    05:39 Also reorientation of their cognitive status and also frequent monitoring or rounding definitely helps.

    05:47 So that was just one piece, I know we had a lot of conversation about attempting alternatives.

    05:52 That's so key because if you remember, restraint use is a last resort.

    05:59 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.

    06:11 Next, it's important as a nurse to understand what is considered a restraint.

    06:16 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.

    06:25 And next, make sure you are following your facility guidelines, I hate to say it but restraint definitely can come with some legal ramifications.

    06:33 We'll talk about that a little bit later, but it's really important for you to be up on your agency's policy.

    06:40 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.

    06:55 Okay, last half here.

    06:57 So know the difference between behavioral and non-behavioral, we talked a little bit about this, at the beginning of the presentation.

    07:04 Now, why this is important, is because the frequency of monitoring is different.

    07:10 So most the time in non-behavioral restraints in medical facilities, you have to document or assess about every hour, maybe two.

    07:19 Now, when we're talking about behavioral in mental health facilities, it's usually almost every 15 minutes, so see the difference there.

    07:28 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.

    07:40 And lastly, get a baseline assessment, so this is so very important, because a patient can be injured in restraint application.

    07:48 So make sure you assess your patient thoroughly, before applying, because if a patient has a deterioration we got to know that.

    About the Lecture

    The lecture Introduction to Non-behavioral Restraints (Nursing) by Samantha Rhea, MSN, RN is from the course Restraint Management and Application (Nursing).

    Included Quiz Questions

    1. To use the least restrictive restraint that allows the most movement without interfering with medical treatment
    2. To use the most restrictive restraint that allows the most movement without interfering with medical treatment
    3. To use the most restrictive restraint that allows the least movement without interfering with medical treatment
    4. To use the least restrictive restraint that allows the least movement without interfering with medical treatment
    1. Wrist restraints
    2. Lap restraint
    3. 5 mg Haloperidol
    4. Abdominal binder around a gastric tube
    1. Using wrist restraints on an intubated client
    2. Using a lap restraint on a client who is at high risk for falls
    3. Giving an ordered injection of Haloperidol to a client who has threatened to injure the nurse
    4. Having a sitter watch a client with suicidal ideation
    1. “The best way to ensure client safety is to apply a restraint that restricts as much movement as possible.”
    2. “I won’t have to monitor my client as much if I put them in wrist restraints.”
    3. “I’ve tried distracting my client and placing their arm in an arm board, but they’ve still taken out their IV three times.”
    4. “I know hospital policy dictates that having all four bed rails up at once is considered a restraint.”

    Author of lecture Introduction to Non-behavioral Restraints (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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