dfs approved curriculum-unit 151 unit 15 restraints nurse aide i course

DFS Approved Curriculum-Unit 15 1

Unit 15Restraints

Nurse Aide I Course


RestraintsIntroduction

Under OBRA, residents have a right to be free from restraints.

As a member of the multidisciplinary team, the nurse aide plays an integral role in achieving a restraint free environment.


RestraintsIntroduction

(continued)

When alternatives to restraints are not effective, however, and the physician orders restraints, it becomes essential for the nurse aide to know the risks involved in caring for these residents.


15.0 Identify and discuss the safety precautions to be considered when using restraints.


Facts Regarding Restraints

• Ordered by the physician when necessary to treat a medical symptom or provide emergency medical treatment

• Choice of restraint based on multidisciplinary evaluation for the least restrictive measure


Facts Regarding Restraints(continued)

• Types of acceptable restraints –hand or mitts–soft ties for wrists and ankles–vests and safety belts– lap cushions– lap trays



• Types of unacceptable restraints– using bed rails to keep resident

from voluntarily getting out of bed– tucking in top sheet so tightly that

resident cannot move– using wheel chair safety bars to

prevent resident from getting out of chair



• Types of unacceptable restraints (continued)– placing resident in wheel chair so

close to a wall that the wall prevents resident from getting out of chair



• Reasons for use of acceptable restraints – Temporarily for life threatening

medical conditions– Brief periods to allow medical

treatment to proceed if there is documented evidence of resident or legal approval of treatment


15.1 List eight considerations that would be important when using restraints.


Considerations When Using

Restraints • Used to protect residents and not to

aid staff• Restraints require physician’s order• Need for restraint should be

apparent (unnecessary use is false imprisonment)


Considerations When Using Restraints(continued)

• Staff must provide for the restrained resident’s basic needs, with special attention to elimination needs


Considerations When Using Restraints(continued)

• Secure enough help to apply restraints quickly to prevent injury

• Use reassurance in an attempt to calm agitated residents in restraints

• Apply according to manufacturer’s directions


Safety Measures For Restrained Residents

• Check on resident frequently• Apply restraint only after you have

received instructions in its use• Protect bony areas and skin by

padding them prior to applying restraint

• Adjust restraint so that it allows some movement, but is secure


Safety Measures For Restrained Residents(continued)

• Assure that resident can breathe easily in a vest restraint

• Check pulse, color and temperature of any restrained extremity and breathing of resident in vest restraint every 15 minutes



• Use slip knot to tie restraint for quick release

• Secure restraints to bed frame, not to side rails



• Loosen restraint, stay with resident, and use call signal to notify supervisor immediately:–when unable to detect a pulse in

restrained extremity –when fingers/toes are cold, pale or

blue in color



• Loosen restraint, stay with resident, and use call signal to notify supervisor immediately (continued):– if resident complains of pain,

discomfort, numbness, or tingling in restrained part


Safety Measures For Restrained Residents

(continued) • Loosen restraint, stay with resident,

and use call signal to notify supervisor immediately (continued):–when skin appears red or

damaged under restraint–when breathing is impaired with

vest or safety belt restraint



• Carry scissors in pocket to cut restraints in emergency situations

• Remove restraints for 10 minutes and reposition resident every two hours



• Be sure resident needs are met when restrained

• Keep call signal within resident’s reach



• Recording restraints should include:–The type of restraint

•wrist•ankle•waist belt

• mitt• vest



• Recording restraints should include (continued):–Time restraint applied–Each time restraint loosened

and resident repositioned–Time restraint removed –Condition of resident



• Observations and reporting should include:–Color and condition of skin under

restraint–Pulse rate, color and temperature of

skin in restrained extremity



• Observations and reporting should include (continued):–Any complaints about restrained

part–Red or injured skin areas under

restraint–Respiratory rate and color of skin

with vest and safety belt restraints


15.2 Demonstrate the application of restraints.


15.3 Demonstrate the application of a safety belt restraint.


15.4 Identify a sampling of alternatives to avoid the use restraints.


Alternatives To The Use Of Restraints

• Using friends, family, volunteers or sitters

• Diverting with interesting activities

• Answering call signal promptly

• Exercise and outdoor activities


Alternatives To The Use Of Restraints(continued)

• Electronic warning devices on beds and doors

• Consistent reality orientation and staff assignments

• Having room close to nurses’ station

dfs approved curriculum-unit 151 unit 15 restraints nurse aide i course

Documents

dfs approved curriculumunit

restraints introduction

staff restraints

use of acceptable restraints

restraints nurse aide

chair slide

physician orders restraints

false imprisonment slide