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HomeHealth articlesactivity restrictionWhat Are the Implications of Restraint Therapy?

Restraint Therapy and Its Implications

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Restraints restrict a person's movement to provide uninterrupted treatment and protect the patient from harming themselves and others. Read the article to know.

Medically reviewed by

Dr. Vedprakash Verma

Published At January 9, 2023
Reviewed AtJanuary 9, 2023

Introduction:

Restraint is non-psychiatric-based healthcare which is deprivation of freedom of movement or action. Restrain includes mechanical devices, chemicals, or physical force to immobilize a person. Healthcare professionals do patient restraint initiation, monitoring, and documentation for safe handling. Restraint is helpful in patients with mental illness who may possess critical illness to others and themselves. Restraint has both advantages and disadvantages. Proper application and management of restraint should be followed to avoid complications affecting the patient's life.

What Is Restraint?

Restraint in the medical field is done using devices that limit the movement of patients. Restraints can help keep a person away from getting hurt or doing harm to others. However, it is used in unmanageable children and mentally ill or disabled patients.

Restraints can be used in different forms, such as:

  • Belts, jackets, vests, and milts for the patient's hand.

  • Devices that prevent the movement of their elbow, wrist, knees, and ankles.

  • Medicines can also be used to restrict a person's movement.

  • Place an individual into a room alone from where the person is not allowed to move.

When Are Restraints Used?

Restraint keeps the person in the desired position and prevents falling or movement during surgery. They help to prevent or control harmful behavior. Restraints are used in hospitals for patients who are not allowed to scratch their skin, remove catheters that contain fluid, harm other patients and hurt themselves. In addition, they are used to prevent interruption during surgery.

What Is the Purpose of Restraint?

Healthcare service providers intervene when a person is at risk to others or themselves. However, restraint should be the last option when escalation and prevention have not worked. It should be done in such a way that it does not cause any pain, stress, or fear.

What Are Different Types of Restraint?

There are three different types of restraints, namely:

  • Physical Restraint: It is used to limit a patient's movement during treatment procedures. It includes devices that limit specific body parts such as legs or arms, for example, belts, vests, trays, and bed rails.

  • Chemical Restraint: It is any psychoactive medication used to inhibit a particular movement and behavior. It includes sedatives and antipsychotics, usually given as pills or injections.

  • Environmental Restraint: This is used to control a patient's mobility. It includes isolation and seclusion. Patients are monitored all time by healthcare providers.

  • Seclusion: This should only be used if one is detained under the mental health act unless it is an emergency. There are procedures in the mental health act code of practice on seclusion, including how it is reviewed and ended.

Who Can Use Restraint Techniques?

Restraint should not cause any type of harm or be used as punishment. Instead, health providers should always try the other methods first to control patients and ensure safety. Hospital care providers can only use restraint in emergencies or when it is necessary for medical care. The doctors should check the patient's blood flow to ensure that the blood flow is not cut off by using a restraint.

How Will Healthcare Providers Monitor the Patient While Under Restraints?

The healthcare providers monitor the following-

  • Vital signs such as breathing rate, blood pressure, and heart rate are checked to ensure they are in the normal range.

  • Physical comfort is monitored closely to check the patient's skin for any external injury or blood flow issues under the restraints.

  • The patient's behavior is also monitored. Healthcare providers allow the patient to leave seclusion or remove physical restraint as soon as the patient is cooperative and calm.

What Are Factors Associated With Fatality During Restraint?

Factors associated with fatality during restraint are :

  • Heart disease.

  • Obstruction of nose or mouth.

  • Obesity (accumulation of excessive body fat).

  • Exhaustion.

  • Sedation without supervision.

  • Hyperflexion (flexion of muscle beyond its normal limit).

What Are the Advantages of Restraint?

  • Restraints help in controlling patient agitation and violent behavior.

  • Allow examination and performance of radiographic imaging.

  • Reduce treatment time.

  • Helpful in patients who have mental and physical disabilities.

  • Maintaining proper movement and position of the patient during surgery.

What Are the Disadvantages of Restraint?

Restraints should be used for the shortest time and carefully with management strategies. The various problems with restraints are :

  • Chemical restraints can produce more sedation and leave a person too sedated to act.

  • Physical restraint, like a wheelchair, may keep the person from moving freely around.

  • Restraint can lead to a loss of self-esteem and self-confidence.

  • It can create stress inside the patient.

  • Restraints can sometimes cause injury, such as an attempt to climb a bed rail can result in a fall.

  • Confusion and disorientation of patients.

  • Prolonged sedation under restraints often leads to loss of cognitive or physical abilities.

  • The patient may get angry or violent while in seclusion or under restraints.

  • The patient may struggle with physical restraint that can cause blocked blood flow or skin wounds.

  • Chemical restraint can cause drooling, heart rhythm problems, slow or shallow breathing, and low blood pressure.

  • Increased agitation and frustration.

  • Loss of appetite, development of an ulcer, and urinary retention.

  • Nosocomial infections like pneumonia result from immobility.

  • Decrease stiffness, strength, and muscle tone.

What Are Precautions Taken Before Using Restraint?

  • The patient’s consent is to be taken before the application of restraint.

  • Always select appropriate and safe restraint techniques.

  • Restraint should not be too tight and should not interfere with average circulation.

  • Use appropriate cotton pads to maintain the comfort of the patient.

  • Explain the restraint to the patients so that they understand.

  • Restraint should be demonstrated to gain cooperation and reduce anxiety.

  • Restraint should be observed every 20 to 30 minutes to prevent complications.

  • Circulation must not be occluded.

  • Restraint should be untied after every four hours.

  • Bony prominence should be padded before the application of restraint.

Conclusion:

Restraining is one of the methods of delivering treatment using devices, chemicals, or isolation to maintain the patient's position. It is done on a patient with mental illness who cannot comply with the treatment. National and state agencies regulate restraint use. Restraint should always be considered the last option for managing the patient; special care must be taken for performing restraint techniques on the patient. Patient consent is always required before a restraint application.

Frequently Asked Questions

1.

What Are the Functions of Restraints in Nursing?

Restraints are done using devices or other methods by the healthcare provider to prevent causing harm to the patient or the doctor. Its role is to limit the patient’s movement to provide the best patient care.

2.

What Are Restraints Used For?

The various uses of restraints in medical treatment are: 
- It can limit unwanted or unexpected movements of the patient’s body.
- Help control harmful behavior by mentally challenged people.
- Prevent patients from scratching their skin, which may exacerbate the condition.
- Abstain the patient from removing the catheters or fluid bag from being removed.

3.

How Can One Apply the Restraints?

Physical restraints can be done in many ways: 
- Using ankle or wrist cuffs.
- Using a tightly fitted sheet around the patient.
- Placing barriers around the bed to prevent patient falls.

4.

What Are the Ethical Concerns Regarding the Use of Restraints?

Ethical concerns regarding restraint use arise as it may harm the individual’s dignity and personal autonomy. It may also cause psychological or physical trauma. Following a strict consent policy and informing the caretaker or patient is one way to overcome this ethical challenge.

5.

When Are Restraints Indicated?

- When the patient appears to cause harm to oneself or others around.
- When the patient is physically challenged.
- When the patient is unable to restrict movements, causing a delay in the treatment.
- When less restrictive alternatives do not help in performing the treatment.

6.

What Are the Types of Patient Restraint?

Depending on the patient's condition and circumstances, it can be physical, chemical, or mechanical.
- Physical Restraint: By physically holding the individual or by using devices like hand or foot cuffs.
- Mechanical Restraint: Using mechanical devices such as belts or straps.
- Chemical Restraint: Involving medications to calm the patients- like sedatives.

7.

What Is the Restraint Used Over Chest?

It is a type of restraint used to limit or restrict patient movement by placing straps or belts over the chest region. It provides stability over the upper body, including the head, to perform treatment.

8.

How Frequently Should the Individual Be Relieved From Restraints?

The healthcare provider must check at least every 15 minutes to ensure no irritation or scratches are being formed at the site of placement. Restraints should be removed every two hours as well. This is necessary to prevent discomfort faced by the individual and also to ensure further compliance.

9.

When Is Restraint Indicated in Children?

Restraints in children are indicated for therapeutic and safety purposes. It can be advised if the child might harm themselves or anyone around them. It is used to assist in providing the necessary medical care. However, it should only be used as a last resort.

10.

What Is the Recommended or Acceptable Clearance or Space Under a Restraint?

It is recommended to have at least two adult fingers between the restraint and the patient’s body. This is to ensure or prevent patient discomfort or injury that can be formed under the restraints if kept very tight. It is necessary to follow the guidelines to ensure patient safety and complaints.

11.

What Are the Five Possible Risks That Can Be Formed Due to Restraint?

Five possible risks due to restraint application are:
- Physical harm can cause injuries like bruising and fractures.
- Psychological distress.
- Life-threatening risks like difficulty breathing.
- Pressure sore due to prolonged restraint application.
- It may affect the patient’s dignity.

12.

What Can Be Used as an Alternative to Restraints?

- Verbal de-escalation technique by avoiding tense situations through communication.
- Environmental modification ensures a safe environment.
- Behavioral interventions form a personalized treatment plan based on the patient’s mental or physical condition to avoid.
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Dr. Vedprakash Verma
Dr. Vedprakash Verma

General Practitioner

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