Subject - Fundamental of Nursing Topic - Restraints Notes for ANM, GNM, B.Sc.Nursing,P.B.B.Sc.Nursing

1. RESTRAINTS
Prepared By: Mrs. Leena Sameep Sakpal.
Nursing Tutor

2. INTRODUCTION
SAFETY DEVICES
• Activities focusing on health propmotion and illness prevention also involve
promotion of the clients safety.
• Promotion od clients safety reduces the length and cost of treatment, the frequency of
treatment related accidents, the potential for law suits and number of work related
injuries to personnel.

3. RESTRAINTS
• These are protective devices employes
to prevent client from harming himself
or others, to immobilize a body part, to
restraint the activity and to promote a
feeling of security in a client who needs
control.

4. DEFINITION
“Restraint is defined as ‘the intentional restriction of a person’s voluntary
movement or behavior.”
OR
“Restraints are physical, chemical or environmental measures used to control
the physical or behavioral activity of person or a portion of his/ her body.”

5. PURPOSE
• To carry out the physical examination.
• To provide the safety to patients.
• To avoid clients from falling.
• To complete the diagnostic and therapeutic procedures.
• To maintain the prescribed position.
• To reduce the discomfort of patient during some tests and procedure like specimen collection.
• To reduce risk of injury to others.
• To prevent intteruption of therapy.
• To prevent confused or combative client from removing any life supportive equipments.

6. 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

7. ALTERNATIVES OF RESTRAINTS
• 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.

8. • 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)

9. GENERAL INSTRUCTIONS
• Explain the need for application and type of restraints.
• Need should be made to understand family and friends of clients.
• Restraints should be used with greatest care.
• Assistance should be given.
• Allow freedom to move.
• Circulation must no be occluded by restraint.
• Pad the bony prominences.

10. • While applying restraints, see that the normal body positions can be assumed.
• Untie the restraints should be visited at least every 30-60 mins.
• Do not apply linene restraint with a regular knot.
• Faten restraint to bed frame and not to side rails.
• Never use restraint iver an I/V site.
• While removing, remove one restraint at a time.
• Skin folds should be clean and dry prior to application of restraint.
• Ensure that there are no wrinkles in restraint.

11. HAZARDS OF RESTRAINTS
• Tissue damage under restraints due to constant friction.
• Damage to other parts of the body eg; dislocation.
• Development of pressure sores.
• Development of hypostatic pneumonia.
• Ischemia or nerve damage.
• Foot drop or wrist drop.
• Asphyxia or aspiration pneumonia.

12. • Development of other complications.
- Inability of client to escape injury or death.
- Inability of nursing staff to resuscitate a client
in time.
• Psychic injury - client feels that he/she is
punished.
• Strangling and death.

13. TYPES
• Physical restraints
• Chemical restraints
• Environmental restraints

14. PHYSICAL RESTRAINTS
• 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.

15. • Ankle and Wristlets
• Elbow amd Knee restraints
• Mitt restraints
• Body jacket
• Mummy restraints
• Safety belts
• Finger restraints
• Abdominal restraints
• Crib net restraints
• clove Hitch knot restraints
• Spilnts

16. ANKLETS AND WRISTLETS
• These are used to restrict the activity of limbs in a
client who are potentially harmful to himself or
others, to prevent the client from removing any
appliances used in treatment and to immobilize one
or more limbs during procedure.
• eg; Violent behavior of patient in hospital.
• The wrist and ankle restraint is padded to prevent
injury to the soft tissues of restrained limb.

17. ELBOW AND KNEE RESTRAINTS
• It is applied to prevent flexion of the ellow and
knee joints so, client not able to reach dressing or
tubings on his body.

18. MITT/ FINGER RESTRAINTS
• It is used for children or confused patients to prevent them using
their fingers or hands for removing tubes, dreding and other
appliances used in treatment.
• The mitten cover all fingers of a hand and restrict the movement of
finger.
• The hand can be wrapped by the gauze or hand can be put in a bag
like pouch and tie it properly at the wrist of child.
• Finger restraint is used in case of facial surgeries, burns,
intravenous infusion, any eczema of face and body part.
• Keep the mitten soft and it should not interfere with circulation

19. BODY JACKETS
• It is used for children for children and adults.
• The jacket us usually put on and tied at the back, the straps from the jacket are
then tied to the bed frame under mattress, thus preventing the client from sitting
on be.

20. MUMMY RESTRAINTS
• It is used to restraint the movements of
the limbs in a small child during a
procedure.

21. ABDOMINAL RESTRAINTS/ SAFETY BELTS
• It is made up of electrically non-conductive materials.
• There are frequently used on stretchers and operation tabes in
order to prevent the client from falling and prevents client from
leaving bed.
• restraint is used to hold the infant in a supine position on the bed.
• Abdominal restraint should not be too tight, so that it cannot
interfere with respiration and bowel movement.
• For this restraint use wide size wooden strips.
• Place the cotton pad appropriately to provide the proper comfort.

22. CRIB NET RESTRAINTS
• In this a net is used to cover the Childs cot net is attached to the cot
frame.
• This net restraint is used to prevent the children climbing over the
side rails of cot.
• In this net, when side rails are up the child can stand but cannot climb
over the side rails of cot.
• Inside the crib net, the child is totally free to move, no movement is
restricted.
• It mainly prevents the child to climb and fall from the side rails of
cot.

23. KNOVE HITCH KNOT RESTRAINT
To immobilize leg or arm.
Procedure
• Crepe bandage and 2inch wide gauze bandage.
• First apply the cotton pad over the wrist, ankle to provide comfort.
• Prepare a figure of eight by the bandage and place it in the wrist or on the ankle.
• Tie the bandage by knot.
• Knot should not be too tight or too loose.

24. ENVIRONMENTAL 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, quite rooms, side rails.

25. SECLUSIONS OR QUITE ROOMS
• These rooms are specially designed to be
hazard free and are commonly used for
psychiatric clients.

26. SIDE RAILS
• These are attached to the beds both sided to
prevent client from getting out or falling out of
the bed.
• Side rails must be kept raised on beds of all
clients who have altered level of consciousness.

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

28. NURSES RESBONSIBILITY
• 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 devices.

29. • 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.
• Consider the earliest possible discontinuation of restraint.

30. • 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.