This document defines restraint as the intentional restriction of a person's movement and discusses its purpose, indications, principles, types, risks, guidelines, orders, assessment, required behavior for release, and monitoring and documentation procedures for pediatric patients. The key points are that restraints should only be used to protect safety, reduce necessary movement, avoid injury, and allow medical procedures, following principles of least restriction, padding, and frequent monitoring for complications.

1. By-Kshirabdhi Tanaya
Tutor,Dept.of psychiatric
nursing
SUM Nursing college, S‘O’A
DTU Bhubaneswar

2. 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

3. 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 procedure like specimen collection

4. 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

5. GENERAL PRINCPILES 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

6. Principles Contd..
• 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

7. Principles Contd..
• Don’t give too much tight knot. Should be able
to quickly release the device
• Should be secure 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 properly

9. PHYSICAL RESTRAINT
Physical restraint is anything near or on the body
which limits a clients 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

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

12. 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

29. Physical:
•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
•Increased incontinence and urinary stasis
•Obstructed and restricted circulation
•Reduced appetite, Dehydration
•Impaired Circulation
•Death

30. RESTRAINT GUIDELINES
• Doctors order
• Informed consent
• Follow proper technique
• Least restrictive
• Pad boney prominence
• Maintain good body alignment

31. ORDER FOR RESTRAINT
• 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

32. ASSESSMENT
•Check for circulation, condition of limbs
•Attention should be given to patient’s
need including hydration, elimination
and nutrition
•Vital signs

33. BEHAVIOUR REQUIRED FOR RELEASE
• Follows instructions, directions
• Calm, in control
• Verbal contact
• Asks for assistance

35. Monitor a patient in restraint every 15 minutes for:
• Signs for injury
• Circulation and range of motion
• Comfort
• Readiness for discontinuation of restraint

36. 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

37. THANK YOU