Page 42 - UNC MC Assistive Personnel Orientation Manual 2020

Person-Focused Care and Restraint Use

In addition to unmet needs, other events, environmental factors, and staff behaviors all play a role in patient
behavior that may lead to the use of restraints.

Environmental
Events
Factors

Patient
Experiences Staff Behaviors
Patients'
Behaviors

Use of restraints should always be the last resort!
Alternatives are often really basic nursing care!
When restraints are used the least restrictive method, for the shortest amount of time possible must be used!

Intent is the Determining Factor
Some devices may serve multiple purposes
A device may be a restraint if the intent is to restrict movement and it cannot be removed by the patient.
Restraint Not a Restraint
 The patient cannot remove themselves  Quick Check Mitt (untied)
 Restricts movement or access to one’s body  Lap Belt secured in front
 Full side rails
Examples: o Stretchers
 Lap belt secured in back o Specialty ICU beds
 Lap belt & mitts together o Seizure precaution
 Geri chair with tray on if used to prevent o Per patient/family request
wandering DOCUMENT!
 Cribs – developmentally appropriate children
 Positioning or securing devices

Safety Considerations
The patient’s physical wellbeing and protection is paramount
• avoid undue physical discomfort, harm, or pain when applying/maintaining restraint
• articles that might be used to inflict injury must be removed from the environment
• patient’s airway must be unobstructed & lung expansion must not be compromised
• head of bed should be elevated to reduce risk of aspiration, if not contraindicated

Reference:
Restraint Application
Restraint and Seclusion
Nursing Practice and Professional Development / Assistive Personnel Orientation 2020 Page 39