Restraints should be used a very last resort. Instances where restraints are approved are during surgery, on a stretcher, for safety during transport, and if patient is removing tubes and lines necessary for life saving, as in breathing tubes. Also may be used temporarily if patient becomes violent and a danger to themselves or others. A doctor’s order must always be up to date in order to have a patient in restraints.
When a patient is in restraints, they must be able to use restroom and or bedpan when they need it. They should be able to call for help. They must have food and drink as needed. There must be vascular checks done every hour to prevent wounds where the restraints are applied and capillary refill to ensure adequate blood circulation to extremities. Vital signs and behavior monitoring is essential to addressing if restraints are still needed or not. There are many alternatives to restraints available. For example, using a bed alarm not only at night but twenty four hours a day. Placing the patient close to the nurse’s station. Having a sitter stay with this patient and if no resources are available for a sitter, ask the family if they have someone to stay.
Mr. J, was in restraints for no reason. This put him at risk for pressure ulcers and many other complications of immobility. He did not show signs of aggression or agitation. His level of consciousness was appropriate. He answered simple questions and recognized his daughter. Mr. J needs were not met. He needed to use the restroom and was not able to call for assistance. In this case Mr.J’s patient rights were violated. He did not have safety, freedom to move and respect was not given to him. When a red area on his back was noticed by the family member, the appropriate chain of command was not used. The CAN should have notified the primary nurse so that proper actions could have been done. The restraints certainly should not have been re-applied. This continued the skin breakdown for this patient. Mr.J should have been repositioned and turned every two hours at a minimum. The wound care nurse along with the hospitalist should have been notified by the primary nurse to start action on the prevention of pressure ulcers.
Nurses and the complete interdisciplinary team incorporate sensitive patient religious beliefs, patient rights and medical knowledge to deliver care. Encouraging Mr. J and his family to practice what they believe will impact recovery in a positive way. The importance that the medical team relate to families and patients that they respect and encourage their religion and spiritual practices, will recover from illness faster with experience fewer complications. “Health outcomes can be positively affected by attempts to address emotional, spiritual and psychosocial needs. Studies noted positive physiological responses resulting from the emotional comfort of…