Although restraints are used to protect a patient, they compromise a patient`s psychological safety and dignity and can cause additional safety issues and death. An immobilized person has a natural tendency to fight and try to remove the chain and may fall or fatally be caught in the chain. In addition, immobility resulting from the use of chains can cause pressure injuries, contractures and muscle breakdown. Limitations weigh on the patient`s self-esteem and can cause humiliation, anxiety and anger. Nurses assess and determine the need for a client to be restrained or removed, and they also assess the appropriateness of the type of restraint or security device used based on the client`s current condition and behaviour; They assess and evaluate the client regularly and continuously to ensure that the client is safe and that their needs have been met when the use of restrictions or isolation cannot be avoided. Communication Susan communicated effectively with Jody and the family by discussing the care plan. Using the language Jody understood, Susan explained why she needed mittens. As noted in the Nurse-Client Therapeutic Relationship, revised in 2006, nurses use a wide range of effective communication strategies to meet patient needs. The standard outlines nurses` responsibilities in negotiating the roles of the nurse, patient and family, as well as loved ones, with the patient and negotiating the goals set out in the care plan. In some circumstances, a nurse may need to control patients even if she is unable to understand the need for intervention, as described in the Reducing Patient Constraints Act, 2001. The nurse should carefully consider these situations and, if possible, use minimal restraint methods. If chains affect the patient receiving medical treatment, the nurse, health care team and correctional officers must develop a care plan that considers how best to reduce reluctance to allow care. This includes discussing and planning alternative measures to implement while ensuring the safety of the patient and others.
The least restrictive restraint to correct the problem, such as dropping and loosening tubes, probes and catheters, is used when chains are needed. Restrictions, from least restrictive to most restrictive, include: The most common reasons for restrictions in health authorities are preventing falls, preventing injury to oneself and/or others, and protecting medically necessary tubes and catheters such as an intravenous line and tracheostomy tube. Handcuffs are a chain. In this scenario, it is the prison that makes the decision about the use of restraint, not the nurse. The patient is in the care of the correctional officer. As described in Professional Standards revised in 2002, nurses are expected to understand relevant legislation and ensure that their practice complies with the law. The nurse needs to think about how laws such as the Correctional Services Transformation Act, 2018, the Reducing Patient Constraints Act, 2001 and the Mental Health Act can be applied to this situation. For example, the Correctional Services Transformation Act, 2018 outlines the responsibilities of correctional officers. For the interpretation of the law, the nurse can contact her employer or a legal representative. In this scenario, the nurse must also consider the needs of the family and the impact of the request. Caregivers are expected to actively engage the patient as a partner by identifying their needs and wants and making this the foundation of the care plan.
The head nurse may work with the patient`s entire care team and family to explore other ways to meet the patient`s needs, including assessing the risk of falls and implementing fall prevention strategies as directed. The nurse can educate the family on the use of restraints. The nurse should explain that there are laws governing the use of restraint systems and that the facility`s policy of least restraint means that the health care team must first look for alternatives. Restraint is the last resort. If non-urgent restraints are indicated to ensure patient safety, the nurse takes appropriate steps to ensure that key expectations for the use of restraint systems are met: Consent Susan also received consent from Jody`s parents to use restraints. Nurses cannot use chains without the patient`s consent, except in emergency situations where there is a serious threat to the person or others. This is outlined in the Patient Restraint Reduction Act, 2001 and the Consent Practice Guideline. All healthcare environments embrace the philosophy and goal of a safe environment; However, it is often not possible to prevent the use of chains and isolation. There are rare cases where the use of channels is inevitable because chains have become the last resort to protect the customer and others from serious injury. Once restraint is applied, initial monitoring is performed as needed, but at least every 15 minutes for the first hour by a licensed independent physician (LIP) or qualified nurse (RN).
If the patient or resident is stable and without significant changes, monitoring and correlation documentation is performed at least every 4 hours for adults, every 2 hours for children 9 to 17 years of age, and at least every hour for children under 9 years of age. Many alternatives to the use of chains in long-term care homes have been developed. Most interventions focus on individualizing patient care and eliminating medications with side effects that cause aggression and the need for restrictions. Common interventions used as alternatives to chains include routine daily schedules, regular feeding hours, facilitating activities of daily living, and pain relief.  Distraction techniques such as watching TV, music, playing games, or looking out the window can also be used to calm an agitated patient. Encouraging agitated patients to spend time in a supervised area, such as a dining room, living room or near the nurse`s station, helps prevent their desire to get up and move. If these techniques are not successful, bed and chair alarms or the use of a bedside guard are also considered an alternative to restraints. The nurse must also effectively convey the need for chains to patients and their families. As outlined in the Nurse-Client Therapeutic Relationship standard of practice, revised in 2006, nurses use a wide range of effective communication strategies to meet patients` needs and discuss their expectations. The standard describes nurses` responsibilities in negotiating with the patient the roles of the nurse, patient, family and significant other, as well as the goals set out in the care plan.
Discourage a patient from walking alone if they need help with their safety After assessing the patient and determining that no emergency restrictions are required for patient safety, the nurse and healthcare team are responsible for obtaining consent. Chain releases and attempts to control behavior with appropriate alternatives to restraint provide the registered nurse and/or licensed independent physician (LIP) with reassessment data that guides the decision-making process regarding: Restrictions are devices used in healthcare facilities to prevent patients from injuring themselves or others when alternative interventions are not effective. A restraint device is a device, method or process used specifically for the purpose of restricting a patient`s freedom of movement without their permission. See Figure 5.6 for an image of a patient simulated with chains. For more information on the use of restraint assemblies, alternatives to restraint, documentation and consent, see the Patient Restraint Reduction Act, RNAO`s Best Practice Guideline: Promoting Safety: Alternative Approaches to the Use of Restraints, and CNO`s Documentation Standard and Consent Guideline. A full medical prescription is required to begin the use of restraints, except in situations of extreme urgency where a registered nurse may initiate emergency use of chains using an established protocol until the doctor`s prescription is obtained and/or the unsafe behaviors no longer exist.