Question

client safety and actions for a client in restraints

Answer 1

There are three types of restraints: physical, chemical and environmental. Physical restraints limit a patient’s movement. Chemical restraints are any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behaviour or movement. Environmental restraints control a patient’s mobility.

Health care teams use restraints for a variety of reasons, such as protecting patients from harming themselves or others, after all other interventions have failed. Restraints should be used only for the shortest time when prevention, de-escalation and crisis management strategies have failed to keep the individual and others safe. In emergency situations, nurses may apply restraints without consent when a serious threat of harm to the patient or others exists and only after all alternative interventions were unsuccessful. Restraint use should be continually assessed by the health care team and reduced or discontinued as soon as possible. After the discontinuing restraints, interprofessional teams should debrief with the patient, patient’s family, or substitute decision maker to discuss intervention, previous interventions and alternatives to restraints.

With any intervention, such as restraint use, nurses need to ensure they actively involve the patient, patient’s family, substitute decision makers and the broader health care team. Nurses are also accountable for documenting nursing care provided, including assessment, planning, intervention and evaluation

There are many regulations and requirements that address restraints and restraint use including:

▪The initiation and evaluation of preventive measures that can prevent the use of restraints.
▪The use of the least restrictive restraint when a restraint is necessary.
▪Monitoring the client during the time that a restraint has been applied.
▪The provision of care to clients who are restrained.