RESTRAINTS

INTRODUCTION
• Restraint Children may need to be restrained
for some diagnostic procedures, GV
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.
 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
 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
 GENERAL PRINCIPLES FOR USE OF
RESTRAINT
• 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.
• 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
• Always maintain comfort to the child and maintain
body alignment.
• Should be changed when they become soiled or
damp.
• 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 properly.
• 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 .
• 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 .
 Types of Restraints
The different restraints to be considered are enumerated below:
• Physical restraint involves direct physical contact between persons
where force is positively applied against resistance, either to restrict
movement or mobility or to remove from harmful behavior displayed
by an individual.
• Chemical restraint involves the use of medication to restrain. It differs
from therapeutic sedation in that it does not have a direct
therapeutic purpose but is primarily employed to control undesirable
behavior.
• Mechanical restraint involves the use of equipment. Examples
include specially designed mittens in intensive care settings, everyday
equipment such as using a heavy table or belt to stop the person
getting out of their chair, or using bedrails to stop a person from
getting out of bed. Controls on freedom of movement-such as keys,
baffle locks, and keypads-can also be a form of mechanical restraint.
• Environmental restraint involves buildings designed to limit
people's freedom of movement, including locked doors, electronic
keypads, double door handles, and baffle locks. Seclusion is an
important subtype of environmental restraint. It is defined as
"placing of a person, at any time and for any duration, alone in an
area with the door(s) shut in such a way as to prevent free exit
from that area.
• Psychological restraint includes constantly telling a person not to
do something, or that doing what they want to do is not allowed,
or is too dangerous. It may include depriving a person of lifestyle
choices by, for example, telling them what time to go to bed or to
get up. It might also include depriving individuals of equipment or
property they consider necessary to do what they want to do, for
example, removal of walking aids, glasses, or outdoor clothing or
keeping the person in nightwear with the intention of preventing
them from leaving.
 On the Basis of Need
• Broadly speaking, the need to use restraint, particularly
physical restraint arises from two distinct circumstances: those
which are planned and those which are unplanned.
• Unplanned physical restraint refers to those incidents requiring
restrictive physical interventions which are unforeseen and
unexpected.
• Under these circumstances, does not allow time to plan. Staff is
guided by best practice guidelines and training.
• Planned physical restraint refers to restrictive physical
interventions which have been planned through risk
assessment and where there is an expectation that guess
circumstances are likely to occur.
• There is time for planning, and restraint plans are structured
and documented in healthcare records.
 Types of restraint devices
Types of restraint devices include:
• Manual restraint: A skilled, hands-on method of physical restraint used to
prevent patients from harming themselves or others. Its purpose is to
immobilize the patient safely. It includes the application of physical body
pressure by another person to the body of the patient in such a way as to
restrict the freedom of movement.
• Leather, nylon, or vinyl waist belt and wrist cuff: Used as a less restrictive
method than a four- or five-point restraint for patients who engage in
severe anxiety and primarily involves the hands or arms. A canvas
camisole may be used instead of a waist belt and wrist cuff to effectively
provide the same level of restraint.
• Leg restraint: A leather, nylon, or vinyl cuff with connecting strap, which
allows ambulation but limits the ability of the patient to run or engage in
aggressive kicking.
• Protective helmet: Used to protect the head of a patient who engages in
self-directed violence such as head banging.
Manual restraint
Leather, nylon, or vinyl waist belt and wrist
cuff
Leg restraint
Protective helmet
• Five-point restraint: A physical-restraint technique in which
a patient's wrists and ankles are secured to four points on a
bed with leather, nylon, or vinyl cuffs, and straps while the
patient is in a supine position on a plastic-covered mattress
with a waist belt to immobilize all movement. A five-point
restraint comprises the highest level of physical restraint,
and its use pre supposes a judgment by appropriate clinical
staff that lesser restrictive techniques of control, such as
verbal intervention, have not or would not be effective. If
head restraints are also used, it may amount to seven-point
restraint.
→ Restraint chair : A chair specifically designed to restrain a
patient who is in danger of hurting himself or others during
a severely agitated episode.
→ Leather, vinyl, or plastic cuffs : Used instead of metal
handcuffs to restrain a patient who is in danger of hurting
himself or others during a severely agitated episodes.
• Metal handcuffs, shackles, and chains: These
are abolished in the MHCA 2017 and strictly
forbidden. Physical restraint, the most
frequently used type, is a specific intervention
or device that prevents the patient from
moving freely or restricts normal access to the
patient's own body.
Physical restraint may involve:
• Applying a wrist, ankle, or waist restraint.
• Tucking in a sheet very tightly so the patient can't
move.
• Keeping all side rails up to prevent the patient from
getting out of bed.
• Using an enclosure bed.
• Typically, if the patient can easily remove the
device, it doesn't qualify as a physical restraint.
Also, holding a patient in a manner that restricts
movement (such as when giving an intramuscular
injection against the patient's will) is considered a
physical restraint. A physical restraint may be used
for either nonviolent, nonself-harmful behavior or
 Restraints for nonviolent, nonself-
destructive behavior:
Typically, these types of physical restraints are
nursing interventions to keep the patient from
pulling at tubes, drains, and lines or to prevent the
patient from ambulating when it's unsafe to do so-
in other words, to enhance patient care.

For example, a restraint used for nonviolent behavior

may be appropriate for a patient with an unsteady
gait, increasing confusion, agitation, restlessness,
and a known history of dementia, who now has a
urinary tract infection and keeps pulling out his IV
 Restraints for violent, self-destructive
behavior:
These restraints are devices or interventions for
patients who are violent or aggressive, threatening to
hit or striking staff, or banging their head on the wall,
who need to be stopped from causing further injury to
themselves or others. The goal of using such control,
self-discipline is to keep the patient and staff safe in
an emergency situation.

For example, a patient responding to hallucinations that

commands him or her to hurt staff and lunge
aggressively may need a physical restraint to protect
everyone involved.
 Chemical Restraint
• Chemical restraint involves use of a drug to restrict a
patient's movement or behavior, where the drug or dosage
used isn't an approved standard of treatment for the
patient's condition.
• For example, a provider may order haloperidol in a high
dosage for a postsurgical patient who won't go to sleep. (If
the drug is a standard treatment for the patient's condition,
such as an antipsychotic for a patient with psychosis or a
benzodiazepine for a patient with alcohol- withdrawal
delirium, and the ordered dosage is appropriate, it's not
considered a chemicalrestraint.)
• Many healthcare facilities prohibit use of medications for
chemical restraint.
 Seclusion
• With seclusion, a patient is held in a room involuntarily
and prevented from leaving. Many emergency
departments and psychiatric units have a seclusion
room. Typically, medical- surgical units don't have such
a room, so this restraint option isn't available.
• Seclusion is used only for patients who are behaving
violently. Use of a physical restraint together with
seclusion for a patient who's behaving in a violent or
self-destructive manner requires continuous
nursing monitoring.
 Restraint guidelines
• Doctors order
• Informed consent
• Follow proper technique
• Least restrictive
• Pad boney prominence
• Maintain Good body alignment
 NURSES ROLE
• Monitor a patient in restraint every 15 minutes for:
• Signs of injury
• Circulation and range of motion
• Comfort
• Readiness for discontinuation of restraint
DOCUMENTATION IN EVERY 2 HOURS FOR:
• Release the patient, turn and position
• Institute a trial of restraint release
• Hydration and nutrition needs
• Elimination needs
•
 RESPONSIBILITIES OF THE NURSE
• 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
• 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.
• 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.
THANK YOU