When and how to use restraints

Few things cause as much angst for a nurse as placing a patient in a restraint, who may feel his or her personal freedom is being taken away. But in certain situations, restraining a patient is the only option that ensures the safety of the patient and others.

As nurses, we’re ethically obligated to ensure the patient’s basic right not to be subjected to inappropriate restraint use. Restraints must not be used for coercion, punishment, discipline, or staff convenience. Improper restraint use can lead to serious sanctions by the state health department, The Joint Commission (TJC), or both. Use restraints only to help keep the patient, staff, other patients, and visitors safe—and only as a last resort.

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Enclosure bed: A protective and calming restraint

An enclosure bed can be used as part of a patient’s plan of care to prevent falls and provide a safer environment. This specialty bed has a mesh tent connected to a frame placed over a standard medical-surgical bed. Although it’s considered a restraint because it limits the patient’s ability to get out of bed, … Read more

Choosing the right restraint

Nurses at the bedside are experts in driving the safest, most effective patient care. In some cases, nursing assessment and clinical judgment suggest the need to apply restraints. A patient who is violent or self-destructive or whose behavior jeopardizes the immediate physical safety of him- or herself or another person may meet the behavioral health … Read more

Assessing and documenting patient restraint incidents

Restraining a patient is considered a high-risk intervention by the Centers for Medicare & Medicaid Services, The Joint Commission (TJC), and various state regulatory agencies, so healthcare pro­viders must carefully assess and document the patient’s condition. Assessing the patient’s medical condition Review the patient’s medical record for preexisting conditions that can cause behavioral changes—for instance, … Read more

Enclosure bed: A tool for calming agitated patients

By Dawn Walters, MS, RN, Vice-President of Behavioral Health and Rehabilitation Services Erie County Medical Center, Buffalo, New York As told to Janet Boivin, BSN, RN

At Erie County Medical Center, we’ve found enclosure beds to be an effective means to decrease stimulation for highly agitated patients with traumatic brain injury (TBI) who may injure themselves. The beds help calm patients with TBI or those who are cognitively impaired.   

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