The document discusses child restraints, including definitions, purposes, types, risks, and the nurse's role. It defines restraint as the intentional restriction of movement and describes physical, chemical, and environmental restraints. Common physical restraints for children include mummy restraints, elbow/knee restraints, extremity restraints, abdominal restraints, mittens, crib nets, and jackets. Risks of restraint use include psychological, physical, and in some cases death. Nurses must monitor restrained patients closely, document regularly, and follow policies and guidelines for safe and appropriate restraint.

1. welcome
By:
Mrs. Babitha K Devu
Asstt. Professor
SMVDCoN

2. “HEY!I THINK HEJUST MOVED!
ADD ONE MORE!”
Mrs. Babitha K Devu, Asstt. Professor 2

3. Restraints
&
Its Types

4. INTRODUCTION
• Children may need to be restrained for some
diagnostic procedures, therapeutic procedures
or during the physical examination and
sometimes to protect from an injury.
• An appropriate safe and comfortable restraint
should be selected. The restraint may be
provided manually with help of some device.
Mrs. Babitha K Devu, Asstt. Professor 4

5. Restraints- Definitions
Restraint is defined as ‘the intentional
restriction of a person’s voluntary movement
or behaviour. (Counsel and Care UK, 2002),
Mrs. Babitha K Devu, Asstt. Professor 5

6. • Restraints are physical, chemical or
environmental measures used to control the
physical or behavioural activity of a person or
a portion of his/her body.
Mrs. Babitha K Devu, Asstt. Professor 6

7. PURPOSE
• To carry out the physical examination
• To provide the safety to child
• To protect the child from injury
• To complete the diagnostic and therapeutic
procedures
• To maintain the child in prescribed position
• To reduce the discomfort of child during some
tests and procedures like specimen collection
Mrs. Babitha K Devu, Asstt. Professor 7

8. Indications
✦ Displaying behaviour that is
putting themselves at risk of harm
✦ Displaying behaviour 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
Mrs. Babitha K Devu, Asstt. Professor 8

9. GENERAL PRINCIPLES FOR USE 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
Mrs. Babitha K Devu, Asstt. Professor 9

10. Principles - Contin..
• Always select the safe and appropriate restraint
• Restraint should not be too tight; it should not
interfere with the normal circulation
• Restraint should demonstrate to the child, on the
child doll to gain the cooperation and reduce the
anxiety
• Always maintain comfort to the child and
maintain body alignment
• Should be changed when they become soiled or
damp
Mrs. Babitha K Devu, Asstt. Professor 10

11. •Do not give too much tight knot. Should be able to
quickly release the device
•Should be secured away from a clients reach
•Should be attached to bed frame not to side rails
•Change the side of child 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 properlyMrs. Babitha K Devu, Asstt. Professor 11
Principles - Contin..

12. All alternatives must be tried before restraining
• Offer bedpan or bathroom every 2 hours
• Offer fluids and nourishment frequently, keep water within
reach
• Provide divertional activity
• Decrease stimuli and noise
• Provide change of position, up to chair, ambulation
• Have patient wear glasses and/or hearing aides
• Activate bed alarm
Mrs. Babitha K Devu, Asstt. Professor 12

13. Alternatives – Contin..
• Increase observation
– Ask family to sit with patient
– Alert other staff to be observant
– Move patient to a room near the nurse’s station
• If the patient is interfering with his medical equipment
– Educate frequently not to touch the treatment device
– Place the device out of site if possible
– Cover the device (i.e. wrap I.V. site with Coban or Kerlex)
Mrs. Babitha K Devu, Asstt. Professor 13

14. TYPES OF
RESTRAINTS
Mrs. Babitha K Devu, Asstt. Professor 14

15. Physical restraints
Physical restraints is anything near or on the body
which limit a client’s movement. This may be
attached to a person’s body or create physical
barriers.
Eg: table fixed to a chair or a bed rail that
cannot be opened by the client.
Mrs. Babitha K Devu, Asstt. Professor 15

16. Environmental restraints
Environmental restraints that change or modify
a person’s surroundings to restrict or control
a client’s mobility.
Eg: A secure unit or garden, seclusion
Mrs. Babitha K Devu, Asstt. Professor 16

17. Chemical restraints
Chemical restraints are any form of
psychoactive medication used not to
treat illness, but to intentionally inhibit
a particular behaviour or movement.
Mrs. Babitha K Devu, Asstt. Professor 17

18. TYPES OF PHYSICAL RESTRAINTS
1. Mummy restraint
2. Elbow & Knee restraint
3. Extremity restraint
4. Abdominal restraint
5. Jacket restraint
6. Mitten or finger restraint
7. Crib net restraint
8. Safety Belt
9. Side rails and splints
Mrs. Babitha K Devu, Asstt. Professor 18

19. Mummy restraint
• It is a short-term type of restraint used on infants and
small children during examinations and treatment of
head neck and face. It is used to immobilize the arms
and legs of the child for a brief period of time.
• For example like scalp vein
puncture, ear examination, and
eye irrigation, gastric lavage.
Mrs. Babitha K Devu, Asstt. Professor 19

20. Elbow & Knee Restraint
• This restraint is used to prevent flexion of the elbow and to hold the
elbow in an extended position so that the infant cannot reach the
head and face. Knee joint also can be restraint like this so to control
the flexion of knee.
• plastic elbow restraint ,elbow cuff and well padded wooden splint
can also be used.
• This elbow restraint is used in case of face and head surgeries
Mrs. Babitha K Devu, Asstt. Professor 20

21. Extremity restraint
• It is used to immobilize one or more extremities. One type of
extremity restraint is clove-hitch restraint which is done with gauze
bandage strip (2 inches wide) making figure-of-eight.
• The end of the gauze to be tied to the frame of the crib/bed.
• This restraint should be used with padding of wrist or ankle.
• Precautions to be taken to prevent tightening of the bandage
Mrs. Babitha K Devu, Asstt. Professor 21

22. Abdominal restraint
• This restraint helps to hold the infant in a supine position on
the bed
• For this restraint, use wide size wooden strips
• Place the cotton pad appropriately to provide the proper
comfort
Mrs. Babitha K Devu, Asstt. Professor 22

23. Mitten or finger restraint
• Mittens 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.
Mrs. Babitha K Devu, Asstt. Professor 23

24. Crib-net restraint
• In this a net is used to cover the child cot
• Net is attached to the cot frame
• This net restraint is used to prevent the children climbing
over the side rails of cot
• Inside the crib net, the child is totally free to move, no
movement is restricted
Mrs. Babitha K Devu, Asstt. Professor 24

25. 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.
Mrs. Babitha K Devu, Asstt. Professor 25

26. Side Rails & Splints
Mrs. Babitha K Devu, Asstt. Professor 26

27. POTENTIAL RISKS AND SIDE EFFECTS OF RESTRAINT USE:
Psychological/Emotional:
 Increased agitation &hostility
 Feelings of humiliation, loss of dignity
 Increased confusion
 Fear
Mrs. Babitha K Devu, Asstt. Professor 27

28. Physical:
 Pressure ulcers, skin trauma
 Decreased muscle mass, tone, strength, endurance
 contractures, loss of balance & Dislocation/fracture.
 Reduced heart and lung capacity
 Physical discomfort, increased pain
 Increased constipation, increased risk of fecal impaction
 Increased incontinence and urinary stasis
 Obstructed and restricted circulation
 Reduced appetite, Dehydration
 Impaired Circulation
 Death Mrs. Babitha K Devu, Asstt. Professor 28
Risk - Contin..

29. Restraint guidelines:
• Doctors order
• Informed consent
• Follow proper technique
• Least restrictive
• Pad boney prominence
• Maintain Good body alignment
Mrs. Babitha K Devu, Asstt. Professor 29

30. Restraint Orders
Situational Medical Behavioral
* Initiation of
Restraints
(ALWAYS after
alternatives tried)
* Renewing
Order
-Obtain written or
verbal order within 12
hours of initiation,
physician exam within
24 hours.
- Every 24 hours
-May apply in emergency,
but get doctor order with in
1 hour. Dr must do face-to-
face assessment within 1
hour of restraint initiation.
- In accordance with
following limits up to a total
of 24 hours:
- 4 hrs for adults 18 and up.
-2 hrs for children
9-17 yrs of age.
-1 hr for children
nine and under.
Mrs. Babitha K Devu, Asstt. Professor 30

31. NURSES ROLE
Mrs. Babitha K Devu, Asstt. Professor 31

32. Monitor a patient in restraint every 15 minutes for:
• Signs of injury
• Circulation and range of motion
• Comfort
• Readiness for discontinuation of restraint
Mrs. Babitha K Devu, Asstt. Professor 32

33. DOCUMENTATION IN EVERY 2 HOURS FOR:
• Release the patient, turn and position
• Institute a trial of restraint release
• Hydration and nutrition needs
• Elimination needs
• Comfort and repositioning needs
Mrs. Babitha K Devu, Asstt. Professor 33

34. 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 devicesMrs. Babitha K Devu, Asstt. Professor 34

35. 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.Mrs. Babitha K Devu, Asstt. Professor 35
Responsibilities – contin..

36. Mrs. Babitha K Devu, Asstt. Professor 36
consider the earliest possible discontinuation of restraint.
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.
Responsibilities – contin..

37. Mrs. Babitha K Devu, Asstt. Professor 37

38. Mrs. Babitha K Devu, Asstt. Professor 38

39. Mrs. Babitha K Devu, Asstt. Professor 39

40. FACTS
“ Restraints may be used to protect a
patient from a greater risk of harm,
although evidence is lacking to support
the effectiveness of using physical
restraints to prevent treatment
interference.”
Mrs. Babitha K Devu, Asstt. Professor 40

41. FACTS
• Studies have repeatedly demonstrated that
there is no increase in serious injuries when
physical restraints are replaced with other less
restrictive safety measures based on the
individual’s specific needs.
• Studies have also demonstrated a dramatic
decrease in behavior problems when
restraints are removed.
Mrs. Babitha K Devu, Asstt. Professor 41

42. Mrs. Babitha K Devu, Asstt. Professor 42