1. DHSR Approved Curriculum-Unit 15
Unit 15 Restraints
Nurse Aide I Course
DHSR Approved Curriculum-Unit 15

2. Restraints Introduction
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.
DHSR Approved Curriculum-Unit 15

3. Restraints Introduction (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.
DHSR Approved Curriculum-Unit 15

4. DHSR Approved Curriculum-Unit 15
Facts
Regarding
Restraints
DHSR Approved Curriculum-Unit 15

5. DHSR Approved Curriculum-Unit 15
Objective
15.0 Identify and discuss the safety precautions to be considered when using restraints.
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
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11. Facts Regarding Restraints (continued)
May not be used
for convenience
or discipline
DHSR Approved Curriculum-Unit 15

12. DHSR Approved Curriculum-Unit 15
Objective
15.1 List eight considerations that would be important when using restraints.
DHSR 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)
DHSR 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
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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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
DHSR 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
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28. DHSR Approved Curriculum-Unit 15
Demonstration
and
Return Demonstration
DHSR Approved Curriculum-Unit 15

29. DHSR Approved Curriculum-Unit 15
Objective
15.2 Demonstrate the application of restraints.
DHSR Approved Curriculum-Unit 15

30. DHSR Approved Curriculum-Unit 15
Objective
15.3 Demonstrate the application of a safety belt restraint.
DHSR Approved Curriculum-Unit 15

31. DHSR Approved Curriculum-Unit 15
Alternatives
To The Use
Of Restraints
DHSR Approved Curriculum-Unit 15

32. DHSR Approved Curriculum-Unit 15
Objective
15.4 Identify a sampling of alternatives to avoid the use restraints.
DHSR 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 
DHSR 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
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35. DHSR Approved Curriculum-Unit 15
THE
END
DHSR Approved Curriculum-Unit 15