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DFS Approved Curriculum-Unit 15 1
Unit 15Restraints
Nurse Aide I Course
DFS Approved Curriculum-Unit 15 2
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.
DFS Approved Curriculum-Unit 15 3
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.
DFS Approved Curriculum-Unit 15 4
DFS Approved Curriculum-Unit 15 5
15.0 Identify and discuss the safety precautions to be considered when using restraints.
DFS Approved Curriculum-Unit 15 6
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
DFS Approved Curriculum-Unit 15 7
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
DFS Approved Curriculum-Unit 15 8
Facts Regarding Restraints(continued)
• 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
DFS Approved Curriculum-Unit 15 9
Facts Regarding Restraints(continued)
• 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
DFS Approved Curriculum-Unit 15 10
Facts Regarding Restraints(continued)
• 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
DFS Approved Curriculum-Unit 15 11
Facts Regarding Restraints(continued)
DFS Approved Curriculum-Unit 15 12
15.1 List eight considerations that would be important when using restraints.
DFS Approved Curriculum-Unit 15 13
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)
DFS Approved Curriculum-Unit 15 14
Considerations When Using Restraints(continued)
• Staff must provide for the restrained resident’s basic needs, with special attention to elimination needs
DFS Approved Curriculum-Unit 15 15
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
DFS Approved Curriculum-Unit 15 16
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
DFS Approved Curriculum-Unit 15 17
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
DFS Approved Curriculum-Unit 15 18
Safety Measures For Restrained Residents(continued)
• Use slip knot to tie restraint for quick release
• Secure restraints to bed frame, not to side rails
DFS Approved Curriculum-Unit 15 19
Safety Measures For Restrained Residents(continued)
• 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
DFS Approved Curriculum-Unit 15 20
Safety Measures For Restrained Residents(continued)
• 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
DFS Approved Curriculum-Unit 15 21
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
DFS Approved Curriculum-Unit 15 22
Safety Measures For Restrained Residents(continued)
• Carry scissors in pocket to cut restraints in emergency situations
• Remove restraints for 10 minutes and reposition resident every two hours
DFS Approved Curriculum-Unit 15 23
Safety Measures For Restrained Residents(continued)
• Be sure resident needs are met when restrained
• Keep call signal within resident’s reach
DFS Approved Curriculum-Unit 15 24
Safety Measures For Restrained Residents(continued)
• Recording restraints should include:–The type of restraint
•wrist•ankle•waist belt
• mitt• vest
DFS Approved Curriculum-Unit 15 25
Safety Measures For Restrained Residents(continued)
• Recording restraints should include (continued):–Time restraint applied–Each time restraint loosened
and resident repositioned–Time restraint removed –Condition of resident
DFS Approved Curriculum-Unit 15 26
Safety Measures For Restrained Residents(continued)
• Observations and reporting should include:–Color and condition of skin under
restraint–Pulse rate, color and temperature of
skin in restrained extremity
DFS Approved Curriculum-Unit 15 27
Safety Measures For Restrained Residents(continued)
• 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
DFS Approved Curriculum-Unit 15 28
DFS Approved Curriculum-Unit 15 29
15.2 Demonstrate the application of restraints.
DFS Approved Curriculum-Unit 15 30
15.3 Demonstrate the application of a safety belt restraint.
DFS Approved Curriculum-Unit 15 31
DFS Approved Curriculum-Unit 15 32
15.4 Identify a sampling of alternatives to avoid the use restraints.
DFS Approved Curriculum-Unit 15 33
Alternatives To The Use Of Restraints
• Using friends, family, volunteers or sitters
• Diverting with interesting activities
• Answering call signal promptly
• Exercise and outdoor activities
DFS Approved Curriculum-Unit 15 34
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 15 35