Description of Restraints

1. RESTRAINTS
KALPANA SHEE
Msc Tutor
S ‘O’A University

2. OUT LINE
 Definition
 Purpose
 Indication
 General Principles
 Types of restraint
 Risk and side-effect of restraint use
 Restraint guideline
 Role of Nurse

3. DEFINITIONS
• Restraint is defined as ‘the intentional restriction
of a person’s voluntary movement or behavior.
(Counsel and Care UK, 2002)
• Restraints are physical, chemical or
environmental measures used to control the
physical or behavioral activity of person or a
portion of his/ her body.

4. PURPOSE
• To carry out the physical examination.
• To provide safety.
• To protect from injury.
• To complete the diagnostic and therapeutic
procedures.
• To maintain the patient in prescribed position

5. INDICATIONS
• Displaying behavior that is putting themselves at risk
of harm
• Displaying behavior that is putting others at risk of
harm
• Requiring treatment by a legal order, for example ,
under the Mental Health Act 2007
• Requiring urgent life-saving treatment
• Needing to be maintained in secure settings

6. GENERAL PRINCPILES
• Should be selected to reduce client’s movement
only as much as necessary.
• Should carefully explain type of restraint and
reason for its use.
• Should not interfere with treatment.
• Bony prominences should be padded before
applying it.
• Always select the safe and appropriate restraint.

7. PRINCIPLES CONTD..
• Restraint should not be too tight; it should not
interfere with the normal circulation.
• Restraint should demonstrate to gain the
cooperation and reduce the anxiety.
• Always maintain comfort and maintain body
alignment.
• Should be changed when they become soiled or
damp.
• Should be secure away from a clients reach.

8. • Should be attached to bed frame not to side rails.
• Change the side to prevent pressure sore
• Observe the restraint every 20-30 minutes to prevent
any complications.
• Should be removed a minimum of every 2 hrs.
• Do the recording and reporting properly.
PRINCIPLES CONTD..

9. TYPES OF
RESTRAINT

10. PHYSICAL RESTRAINT
Physical restraint is anything near or on the body
which limits a client’s movement. This may be
attached to a person’s body or create physical
barriers.
E.g. table fixed to a chair or a bed rail that cannot
be opened by a client

11. ENVIORNMENTAL RESTRAINTS
Environmental restraints that change or modify a
person’s surroundings to restrict or control a client’s
mobility
E.g. A secure unit or garden, seclusion

13. CHEMICAL RESTRAINT
Chemical restraint are any form
of psychoactive medication used
not to treat illness, but to
intentionally inhibit a particular
behavior or movement.

14. TYPES OF PHYSICAL
RESTRAINT
1. Mummy restraint
2. Elbow and knee
restraint
3. Extremity restraint
4. Abdominal restraint
5. Jacket restraint
6. Mitten or finger
restraint
7. Crib net restraint
8. Safety belt
9. Slide rails and splints

26. POTENTIAL RISKS AND SIDE
EFFECTS OF RESTRAINT USE
Psychological /Emotional
• Increased agitation & hostility.
• Feelings of humiliation, loss of dignity.
• Increased confusion.
• Fear.

27. •Pressure ulcers, skin trauma.
•Decreased muscle tone, strength, endurance.
•Contractures, loss of balance & Dislocations/
fracture.
•Reduced heart and lung capacity.
•Physical discomfort, increased pain.
•Increased constipation, increased risk of fecal
impaction.
PHYSICAL:

28. •Increased constipation, increased risk of fecal
impaction.
•Increased incontinence and urinary stasis.
•Obstructed and restricted circulation.
•Reduced appetite, Dehydration.
•Impaired Circulation.
•Death.
Physical Continue:-

29. RESTRAINT GUIDELINES
• Use only after written order by the physician, unless emergency
situation occurs.
• Patient is reassessed every 24 hours for continued need for
restraint.
• New order is required after 24 hours.
• No standing order allowed.
• Physician and nurse must document in their notes the indication for
restraint.
• Type of restraint to be used.
• The projected time restraint is to be employed.

30. ROLE OF NURSE
• Check for circulation, condition of
limbs.
• Attention should be given to
patient’s need including hydration,
elimination and nutrition.
• Vital signs.
• Follows instructions, directions.
• Calm, in control.

31. • Asks for assistance.
• Monitor signs for injury.
• Maintain comfort of the patient.
• Readiness for discontinuation of restraint.
• Release the patient, turn and position frequently.
Role of nurse continue…

32. • Follow institute a trial of restraint release.
• Maintain hydration and nutritional need.
• Proper reporting and documentation.
Role of nurse continue…