RESTRAINTSLesson 16

OBJECTIVES Student will be able to explain the NA role in

protecting resident’s rights to be free of physical and chemical restraints

Student will be able to explain the NA responsibilities related to monitoring and releasing resident’s in restraints

Student will be able to explain the difference between devices that are restrictive and enabling and give examples

Student will be able to describe the potential negative outcomes of side rails

PHYSICAL RESTRAINT-Manual method which restricts freedom of movement or normal access to one’s body 8 times more likely to be injured Many facilities Restraint Free Often causes anger, agitation,

embarrassment, humiliation and mistrust Doctors order to treat medical conditions Not allowed for purposes of discipline or

convenience

BILL OF RESIDENT RIGHTS Includes free of verbal, mental, sexual,

physical, corporal punishment, and seclusion NA must report any suspected abuse to

the nurse immediately NA must ask for help if resident becomes

aggressive or uncooperative NA must Never use a protective device

without the nurse’s permission

MONITORING & RELEASE Must be checked by nursing staff at

least HOURLY and more frequently if warranted

Released at least every 2 hours for 10 minutes

Check skin, security of device, comfort, toileting needs, ROM, position changes, ambulate if able

TYPES OF PHYSICAL RESTRAINTS Limb (arm or leg)- prevents free

movement of arms and/or legs Mitts/Mittens- prevents finger movement Soft tie belt- prevents getting out of bed

or chair Vest Restraints- prevents getting out of

chair or bed Lap cushions/trays- prevents getting up or

out of chair (ones not easily removable)

ACTIONS CONSIDERED RESTRAINTS Side Rails Tucking in sheets, fabric, clothing so

movement is restricted Using trays, tables, bars, or belts to prevent

resident from rising or getting up from chair Using a chair that prevents resident from

rising Placing chair or bed too close to a wall that

prevents resident from rising our of chair or being able to get up

RESTRAINTS Self-releasing devices: not considered a

restraint if resident can easily release on his/her own without assistance

Enclosed, framed, wheeled walker- if resident not able to release self from frame= restraint

REASONS FOR A RESTRAINT Prevention of injuries from falls Allowing necessary medical treatment without

interruption (IV infusions, feeding tubes, etc.) Protecting staff, resident, or others from harm

Can only be applied by individuals properly trained to do so (know facility policy and the manufacturers

instructions)• Never tie to side rail or the fixed frame of the bed• Requires quick release ties to easily be released

in case of emergency

RESTRAINT ALTERNATIVES Diversional activities Pillows or positioning devices Meeting basic needs Encourage more frequent visits from family & friends Companions/Sitters Increased staff contact Allow for wandering in safe area Exercise programs and outside activities Electronic warning devices Moving resident closer to nursing station Reality orientation Consistent staff assignments

SIDE RAILS Required doctors order May or may not be considered a

restraints, depends on the individual circumstances

Entrapment Zones

REVIEW QUESTIONS1. Under what conditions can a physical

restraint be applied?2. How often must a resident with

physical restraints be checked?3. How often must a resident be released

from physical restraints? For how long?4. True or False? Under certain

conditions, side rails are considered to be a restraint.

1. Which of the following is an example of physically restraining a resident? (A) Asking the resident to stay in his bed (B) Telling the resident’s roommate to press the call button if the resident gets up (C) Leaving the resident’s door ajar (D) Putting both side rails up on the bed

2. Restraints can be applied (A) As punishment from staff when a resident is not behaving properly (B) Only with a doctor’s order (C) When a staff member does not have time to watch a resident closely (D) When a nursing assistant judges a resident is a danger to himself or others

3. A serious problem that has been associated with restraint use is (A) Jaundice (B) Headache (C) Increased activity (D) Pressure ulcers

4. Which of the following statements is true of restraint usage? (A) People tend to respond better to restraint alternatives than to restraints. (B) Laws allow the use of restraints when a facility is short-staffed. (C) Using restraints does not cause negative effects. (D) Restraint-free care means a facility uses restraints only for disciplining residents.

5. An example of a restraint alternative is (A) Tying the resident to the bed (B) Removing the resident’s call light (C) Leaving the resident alone for long periods of time (D) Giving the resident a repetitive task

6. If a restraint is applied, a nursing assistant must (A) Tie the restraint to the side rails (B) Leave the area so she won’t hear the resident complain (C) Withhold fluids (D) Check the skin around the restraint for signs of skin breakdown and security of the device

7. If a resident is in a restraint or seclusion the resident must be checked on every _________? (A) 15 minutes (B) 30 minutes (C) 1 hour (D) 2 hours 8. If a resident is in a restraint or seclusion the resident must be released for 10 minutes at least every ___________? (A) 15 minutes (B) 30 minutes (C) 1 hour (D) 2 hours 9. Which of the following is NOT a reason in which a restraint might be applied? (A) Prevention of injuries from frequent falls (B) The resident is getting out of bed in the middle of the night (C) Preventing a resident from pulling out IV’s, catheters and/or feeding tubes (D) Protecting staff and others from harm caused by the resident

10. Which of the following facility practices would NOT be considered a restraint? (A) Using side rails to prevent a resident from getting out of bed (B) Tucking in bedding tightly so movement is restricted (C) Using a tray, table, or belt while the resident is sitting in a chair to prevent a resident from rising (D) An enclosed, wheeled walker that the resident can easily open 11. Which of the following is NOT a physical restraint? (A) Mittens to prevent the fingers from moving (B) Vest to prevent the resident from getting out of a chair (C) Self-releasing device to prevent the resident from getting up without assistance (D) Lap cushion or tray that cannot be removed easily 12. What is meant by corporal punishment? (A) A form of discipline that involves the body and causes purposeful physical harm (B) A from of accidental physical harm (C) A form of discipline that involves verbal slander (D) A form of discipline that involves taking away belongings