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Times have changed from when physical restraints were common in nursing homes. Nowadays, it not only takes a physician’s order to have the restraint but all other methods must have failed. Even bedrails have been defined as restraints.
The term restraint actually includes both physical and chemical restraints. Physical ones are those, which are applied to the body and a stationery object. Chemical restraints are those, which come from medications of some type. It is the restriction of freedom that makes the restraint what it is, physical or chemical.
Since restraints have the potential for causing serious injury, there are safety guidelines in place for their use. The Omnibus Reconciliation Act (OBRA) adheres to the policy that restraints may only be used to treat someone’s medical conditions and not for convenience or to discipline. Symptoms can be emotional, physical or even behavioral and endanger the person themselves or other people, including staff members in a facility.
A variety of conditions can be considered harmful to people or the individual. Wandering is a serious hazard that elderly people with dementia often are faced with. When wandering they could become confused or agitated at their situation and lash out at other people. In this case, they are a threat to people around them. Individuals who have a tendency to crawl out of their bed are at risk of falling if climbing over bed rails. Pulling out IV tubing or catheters is another factor for people with various mental disorders. Since this interferes with their medical treatment they are at risk for injuring themselves and their health care. Combative behavior is common among people with various medical conditions, physical or mental, another good reason for restraining someone.
People, especially the elderly are often at risk for falling and restraints used to be applied in a regular manner to prevent these accidents that often lead to hip fractures. New research has shown the restraints can actually add to the risk of falling. Trying to free themselves from restraints, people end up injuring themselves more than if they had been free of the restraint. Their injuries are also more severe than if they had not been restrained in the first place.
The deteriorating mental states of many elderly and mentally handicapped individuals were also cause for using restraints for many years. Now, all other alternatives must be tried before considering physical or chemical restraints. Sometimes, just finding distractions for them or other activities to do can keep them from wandering or getting in harm’s way.
Restraints come in different sizes and forms and can be made of cloth or leather. Cloth restraints are also called soft restraints and include vest restraints, straps and belts. They are most commonly used on wrists, ankles, hands, elbows and forearms, waist and chest. Leather restraints are usually only used on wrists and ankles and for excessive irritation or agitation.
Wrist and ankle restraints come in two, three, or four point design. The number designates how many extremities are being restrained. For example, the two-point restraint would only restrict movement on the wrists. Two fingers should always fit between the restraint and the wrist to ensure circulation is not being hampered. These types of restraints are useful for someone who pulls out tubing like IV’s or catheters.
Mitt restraints cover an entire hand and fingers typically go in one of five inside pockets unless the individual’s hand could be grasping a towel inside the restraint. The goal is to keep the hand and fingers open to prevent permanent damage to the extremities. The goal with these restraints is also to keep someone from pulling out tubing and also to prevent scratching.
Vest and jacket restraints always cross in the back of a person and are applied to the chest. This confines a person to a bed or chair and prevents them from moving. These can also be useful when needing to give medical treatment to someone. These restraints also carry the greatest risk to life since if a person tries to get out of the position they are confined in, they can become strangulated and die.
Belt restraints are used in a similar fashion as a vest restraint, just not as restrictive in movement. The belt wraps around the waist and is secured to a chair or bed.
Elbow restraints restrict movement of the elbows and are most useful for children to keep them from bending their elbows. These kind wrap around the elbow and can be pinned to clothing.
All the various restraints need to be used in a safe manner to ensure the best possible outcome for the person. A physicians’ order must be in place before the restraint is used and the individual being restrained must be checked every 15 minutes and repositioned every two hours if they are confined to one particular position.
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