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Safe Use Of Restraints For Medical Management
What is a restraint?
A restraint is any method that limits your ability to move around freely or reach normal body parts. There are two different types of restraints.
- Physical restraints are when you are forced to stay in a chair or bed. This is done with special kinds of restraints placed on or near your body. These restraints cannot be easily removed by you. Following are some of the different kinds of physical restraints.
- Belts placed around your waist and connected to a bed or chair.
- Cloth bands placed around your wrists or ankles.
- Cloth vests or "posey's" placed around your chest.
- Lapboards hooked to chairs that limit your ability to move.
- Mittens placed on your hands.
- Chemical restraints are medicine used to help you calm down and relax when you may hurt yourself or others. This medicine is not the regular medicines you may take every day for your medical or emotional problems.
What are the reasons for using restraints for medical management?
Medical restraints are used to protect you or limit your movement during or after a procedure or surgery. Restraints should never be used to punish you. And, restraints should not be used to make it easier for the caregivers to take care of you. Following are some of the reasons medical restraints may be used.
- To keep you from pulling out tubes.
- To keep you from moving during a procedure.
- To keep your arms or legs from moving after surgery.
- To keep you from walking around by yourself and getting hurt.
- To keep you from sliding out of a chair.
- To keep you from having bad falls.
What are the ways to keep from needing restraints?
Caregivers will work with you and your family to keep you safe so restraints may not be needed. Talk to your caregiver so they understand your special needs. Following are some things that can be done to keep you safe and lessen your need for restraints.
- Caregivers may put you in a room near the nurses' station. This allows caregivers to watch you closely and answer quickly when you call for help
- Your call button should be placed in easy reach of the bed and the toilet. Call a caregiver before getting up especially after lying or sitting for a long time. Getting up quickly can make you feel weak, dizzy, or lightheaded.
- Keep tissues, the phone, and other needed things close to you so you can easily reach them.
- Have someone stay with you whenever possible. You may be less anxious when someone familiar is with you, such as a family member. Caregivers called "sitters" may be used to stay with you all the time to keep you safe. This person can remind you where you are and what is happening.
- Your family can help you do things that keep you relaxed and calm. These may be listening to TV, music, holding a favorite item, or reading to you.
- Have your family bring in pictures and things that help make your room feel more like your home.
- Use your eyeglasses or hearing aids as needed. This helps to keep you from getting confused.
- Tell caregivers when you are in pain. They can help control your pain with medicine. Caregivers may also suggest non-medical ways to lessen pain, like music therapy or a backrub.
- Ask caregivers about physical (fizz-ih-kull) therapy if you feel you need to be stronger. Physical therapy may be used to help make muscles stronger. This may make it possible for you to move about on your own safely.
- Ask caregivers to tell you about your medicines you are on and their side effects. Some medicine may cause confusion, dizziness, or weakness.
Following are some things that can be done to make your room safe so you do not fall.
- Chairs and the bed should be kept at the lowest height for you.
- Using a night light at bedtime may help you know where you are.
- Keep a clear path or area in your room so you do not trip.
- Caregivers may put a commode chair beside your bed. Or, a raised seat may be put on the bathroom toilet.
- Wear non-skid shoes or slippers that fit well.
- Some hospitals have bed sensors that alarm at the nurses' station. The bed sensor alarms when weight is taken off the bed, such as when you try to get out of bed. Ask caregivers for more information on bed sensors.
- Your mattress may be put right on the floor if falling out of bed is a problem.
What are the risks of using restraints?
- Elimination problems: You may become constipated (unable to have a BM.) because you could not drink enough liquids or move around enough. Or, you can become incontinent (in-kon-tih-nent) which means loosing bowel and bladder control if you are in restraints. This may happen because the restraints did not allow you to get up to use the toilet when needed. Always call your caregiver if you have to go to the bathroom.
- Injury problems: Severe injuries have been caused by restraints when they are not used correctly. You could get caught in the restraint, choke and die if the restraint is put on wrong. You may become more upset or out of control than before the restraints were used. You may also fight against the restraints. Fighting to get out of the restraints can cause very bad falls and injuries. Always call your caregiver if you need help or if you are afraid.
- Lung problems: You may be more likely to get pneumonia (lung infection). This is caused by not moving around enough and not breathing deeply. Swallowing your secretions (spit) into your lungs or choking on food or liquids can also cause lung problems.
- Mental problems: Restraints may cause you to feel you are being punished. You may be afraid that you will not be able to get help in an emergency. You can become depressed. Restraints can bring back bad feelings of being abused if you have been abused in the past. Being restrained can also be embarrassing. You may become more confused and need more help to do things you use to do on your own.
- Nutritional problems: You may not feel like eating or drinking as much if you are in restraints You may need someone to help you eat or drink. You may become weak and low on body fluids in your body if you do not eat or drink enough
- Physical problems:
- Bone strength may decrease because of less activity if you are in a restraint for a long time. This can lead to bone fractures.
- Muscles can contract (tighten) and shrink if you cannot move freely. This can make you weak and have pain when you move.
- Skin can break down and cause sores if you do not move enough. These sores may happen under the restraints and on other parts of the body.
- Blood flow can decrease to the area under the restraints if they are too tight. This can cause long-term damage to muscles and nerves if blood flow is cut off by the restraint.
- Blood clots can form and cause blood flow problems to important body parts, like your lungs or brain.
What are the safety issues when using restraints?
Restraints can be very dangerous if not used correctly. So, caregivers will try other ways to make sure you are safe before using restraints. Talk to your caregivers if you have questions about your care and the need for restraints. These following safety things will be done if you need restraints.
- Doctor's order: Your doctor must order restraints. The written order will tell the caregivers what type of restraint to use. The order also says how long they will be used and when they can be removed. Restraints should only be used for a short time. And, restraints are used only after other things have been tried to keep you safe
- Family: Your family will be called, around the time you are put into restraints. This is done only if you and your family had both agreed to have your family called.
- Safety checks: Caregivers are specially trained in how to care for patients in restraints. Caregivers will check on you often to make sure you are safe and all your needs are met.
- You have the right to be free any time from restraints unless medically needed. You also have the right to safe care and to be treated with respect when restraints are used. Restraints should not cause you pain or harm.
- You have the right to help plan the care for yourself. To help with this plan, you and your family must learn about your illness and when you need restraints. Ask if you or your family can come to the caregiver team meeting to discuss your care and need for restraints. You can then discuss the treatment options with caregivers. You can work with them to decide what care will be used to treat you.