1. Promoting a Restraint-Free Environment
HEALTH SCIENCE
Promoting a Restraint-Free Environment

2. CONSIDERATIONS FOR CARE
OBRA:
Defines “physical restraints” as any method or equipment used on or near the resident’s body that the resident cannot remove easily and which restricts freedom of movement or normal access to one’s body
States that residents have the “right” to be free from restraints which are unnecessary, inappropriate or not required to treat the resident’s medical symptoms

3. CONSIDERATIONS FOR CARE
Drugs or drug dosages are restraints if they:
Control behavior or restrict movement
Are not standard treatment for the person’s condition

4. TERMS
Restraint is any manual method or physical or mechanical device, material, or equipment attached to or near the person’s body that he or she cannot remove easily and which restricts freedom of movement or normal access to one’s body.
Seclusion is involuntary confinement of a person alone in a room or area from which the person is physically prevented from leaving.
Freedom of movement is any change in place or position of the body or any part of the body that the person is physically able to control.
Remove easily means that the device, material, or equipment used to restrain the person can be removed intentionally by the person in the same manner it was applied by the staff.

5. REQUIRMENTS FOR RESTRAINT USE
Require written doctor’s order that specifies reason for restraint
May be used only to treat or protect resident-not for discipline or staff convenience
Least restrictive type of restraint must be used for least amount of time
Must be used only as last resort when all other methods have failed
Informed consent required

6. DANGERS OF RESTRAINT USE
Physical effects such as skin damage, circulatory impairment, incontinence, nerve/muscle injury, pneumonia, serious injury and death
Emotional effects such as depression, frustration, anger, agitation, disorientation and loss of self-esteem

7. ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTS
General Measures:
Keep environment calm, restful
Eliminate multiple stimuli
Speak in calm, gentle manner
Provide kind, respectful care
Treat residents as individuals
Meet residents’ needs, eg. Elimination, positioning, activity
Adjust staff and environment to resident’s needs-not vice versa

8. ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTS
Observations and Problem-Solving
Make careful observations of resident to identify what:
Causes problem behavior
Calms or distracts resident
Report your objective
observations to charge nurse
to assist nurse in
care-planning

9. ROLE OF CNA IN AVOIDING NEED FOR RESTRAINTS
provide care following instructions of charge nurse and care plan to:
Eliminate cause of behavior
Calm or distract resident
Continue to report
observations to
charge nurse to
assist nurse with
evaluating plan of
care

10. SAFETY GUIDELINES Observe for increased confusion and agitation.
Protect the person’s quality of life.
Restraints are used for as short a time as possible.
Follow the manufacturer’s instructions.
Apply restraints with enough help to protect the person and staff from injury.
Observe the person at least every 15 minutes or more often as required by the care plan.
Remove or release the restraint, reposition the person, and meet basic needs at least every 2 hours.
Follow the care plan.
Review the contents of Box 13-3 on pp in the textbook.
Review the Focus on Communication: Safety Guidelines Box on p. 188 in the textbook.
The care plan must show how to reduce restraint use.
You could be negligent if you do not apply or secure a restraint properly.
Restraints are dangerous. Injury and death can result from improper restraint use and poor observation.
Review the Teamwork and Time Management: Safety Guidelines Box on p. 188 in the textbook.

11. REPORT AND RECORD The type of restraint applied
The body part or parts restrained
The reason for the application
Safety measures taken
The time you applied the restraint
The time you removed or released the restraint and for how long
The person’s vital signs
The care given when the restraint was removed or released
Information about restraints is recorded in the person’s medical record.

12. REPORT AND RECORD Skin color and condition Condition of the limbs
The pulse felt in the restrained part
Changes in the person’s behavior
Complaints of discomfort, a tight restraint; difficulty breathing; and pain, numbness, or tingling in the restrained part (Report these at once.)

13. APPLYING RESTRAINTS Restraints are made of cloth or leather.
Leather restraints are applied to the wrists and ankles.
Wrist restraints (limb holders) limit arm movement.
Hands are placed in mitt restraints.
They prevent finger use.
The belt restraint is used:
When there is risk of injury from falls
For positioning during medical treatment
Leather restraints are used for extreme agitation and combativeness.
The person in a belt restraint cannot get out of bed or out of a chair. The person can turn from side to side or can sit up in bed.
The person can release the quick-release type belt restraint.

14. VEST AND JACKET RESTRAINTS
A jacket restraint is applied with the opening in the back.
The straps of vest and jacket restraints always cross in the front.
Vest and jacket restraints are never worn backward.
The restraint is always applied over a garment.
Vest and jacket restraints have life-threatening risks.
You are advised to only assist the nurse in applying them.
The nurse should assume full responsibility for applying a vest or jacket restraint.
Never use force to apply a restraint.
The person in a vest or jacket restraint cannot turn in bed or get out of a chair.
Review the Focus on Children and Older Persons: Applying Restraints Box on p. 193 in the textbook.
Review the Delegation Guidelines: Applying Restraints Box on p. 194 in the textbook.
Review the Promoting Safety and Comfort: Applying Restraints Box on p. 194 in the textbook.

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