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ayaat ahmed

on 8 April 2017

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Transcript of Restrains

Ehab Abirkith
What is Restrain?
What is Restraint?
General principles for use of restraint
Significance of the problem
Interventions and rationals
Process of program
Change theory.
What is different in our project ?
References pages.
Restraint is defined as ‘the intentional restriction of a person’s voluntary movement or behavior .
Ayat Ahmed
Amal Abdi
Asma Mahmoud
Ilham Elmi
Should be selected to reduce clients movement only as much as necessary.
Nurse should carefully explain type of restraint and reason for its use.
Should not interfere with treatment.
Bony prominences should be padded before applying it.
Should be removed a minimum of every 2 hrs
Frequent circulations checks should be performed when extremity are used
Should be changed when they become soiled or damp.
Should be secured away from a clients reach
Should be able to quickly release the device
Should be attached to bed frame not to side rails
Significant of the problem to patient's care:
The restrained person’s ability to stand and walk after the period of restraint is impaired.
Physical decline
Pressure ulcers
Immobilization often causes stress and has a negative impact on cognitive skills
To reduce the occurrence the use of restraint in the hospital.
More over if restraints are used it should be used ethically and in an effective way.
Improving patient safety by decrease restraint use for better patient out come.
Restraints are physical, chemical or environmental measures used to control the physical or behavior activity of a person or a portion of his/her body.
Interventions and rationals
According to Smith, Kruchowski, and Wannamaker, (2010) the only time hospitals are allowed to use restraints is when used to prevent a serious bodily harm to the patients and or others.
Stand for by the philosophy
that restraints are rarely used and are reserved for extreme circumstances.
Determine the triggers
for agitated behaviors in each resident, and learn how to prevent them. (Use of "personal assistance" devices such as hearing aids, visual aids and mobility device).
Design of the physical environment
to allow for close observation by staff.

Intervention and Rational
Learn what calms a resident
, and use that as an intervention to prevent and minimize restless behaviors.
There may be times when physical restraint is needed
to prevent a greater harm, but staff need to be fully aware of the risks and the required precautions. The risks must be considered in legal, ethical and professional contexts.

review with the service user involved must follow any incident of aggression or violence and/or restraint.
Care plans and risk management plans
must be reviewed by the care team following any incident of aggression or violence. The review must include evidence of the service user’s views regarding future prevention.
Care plans must have clearly recorded information
about contact with relatives. With the service user’s permission, relatives should be informed when adverse clinical events occur.
Behavioral problems such as agitation may even be reinforced by restraining measures, which can constitute a subjectively traumatic experience.
Therefore, each individual person who requires physical restraint should be allowed to retain as much freedom of movement as possible in the circumstances.
The use of FRM does not decrease the carers’ workload.
The restrained person must be closely monitored and cared for, and the administrative burden is high; every instance of FRM has to be painstakingly and clearly documented. Moreover, staff are required to attend training courses.
It was clearly shown in the articles that the use of restraints is not the appropriate intervention. All articles agreed that there should be reduction in the use of restraints. Although restraints are known to be used as the final solution in severe cases, however, the articles provided several interventions to avoid them at all times.
Some interventions that are effective in decreasing the use of restraints include; adopting policy changes, staff collaboration, changing the environment, staff education, staff to patient ratio.
A policy states that if all side rails are up, it is considered restrain. Thus, at least one side rail should always be down. Staff have to cooperate in close monitoring for patients, to avoid patient self-harm or the need of using restraints. Moreover, having an environment with as limited stimulants as possible, will reduce the risk of patients getting agitated or confused.
Increased staff education will help interpret patient's non-verbal communication, and intervene accordingly. Finally, increased staff to patient ratio will empower staff to properly monitor patients, as when patient ratio exceed staff ratio, the staff will be exhausted in monitoring patients leading to increase use of restraints.
Restraints create more harm than good. They cause more confusion, agitation, and disturbance to the patient. Staff education, collaboration, changing the environment, and good communication with the patient are known to be more effective and satisfying.
Use the least restrictive type of restraint.
An order of restraints can be ordered for a maximum of 24 consecutive hours.
The physician must evaluate the patient within 1 hour of the start of a restraint.

Process of program
Change theory
Lippitt’s change theory uses the similar language of the nursing process. And it consists of four main elements which are the
, which is the initial part of the nursing process that includes social details, medical observations. The
part follows the assessment and it focuses on determine the possible ways to address the needs of the patients. The planning phase is followed by the
phase, which id the phase that relates the nurse carrying out the action. The final phase is the
phase, which links to the assessment phase. It provides the chance to reassess the change and enhance it.
• Before initiating the change we have to identify the importance of minimizing the use of restraints, how the patient’s feel about the use of restraints. In addition to including the side effects that come along with restraining a patient in the hospital setting.
• After identifying the problem, the interventions that we made was the need to develop an educational workshop in order to educate the nurses about the use of restraints.
• In the meantime, before initiating the change and implementing it, it is important to provide the nurses with the sufficient information about why this change is needed:
- Literature review and evidence-based articles regarding restraints, minimizing its use and its effects will be provided to the nurses.
- Why the change is needed in the hospital setting and the aim of the change should be discussed in depth with the nurses.
- The nurses should be provided with sufficient time to answer their questions and concerns regarding the change.

• The interventions that we found suitable was to develop an educational workshop in order to educate the nurses about the use of restraints, the importance of monitoring the patient if they require a restraint, keeping the patients who require restraints close to the nursing station to monitor them and etcetera. The workshop will answer all of the questions regarding the change. In addition to that, it will focus on educating the nurses and engage them in the change process.



We can evaluate the change that we made and whether it was effective or not by receiving feedback from the nurses by the use of surveys.

It is important to get feedback whether it was positive or negative, in order to identify the areas that needs improvements and enhance the patient care further while working together with the health care providers as a team.
A nurse specialist will lecture the attendance (Head nurses, charge nurses) about restraints, adverse effect, and alternative interventions and policies regarding restraints.
The lecture will be twice a day divided into three days and each day will cost 1500 QR.
Handouts and brochures will be provided for the attendants, 120 Copies
360 QR
Increasing nursing stuff in the unit
Depend on the unit and the number of the new nurses’ stuff.
Break that includes soft drinks and snacks.
Booking a hall for the Workshop
5500 QR
Total cost is 10,360 QR
What is different in our project ?
Benson, R., Miller, G., Rogers, P., & Allen, J. (2012). Strategies to prevent restraint-related deaths. Mental Health Practice, 15(7), 32-35.
Huang, H. C., Huang, Y. T., Lin, K. C., & Kuo, Y. F. (2014). Risk factors associated with physical restraints in residential aged care facilities: a community-based epidemiological survey in Taiwan. Journal Of Advanced Nursing, 70(1), 130-143. doi:10.1111/jan.12176
Gaskin, C. J., Elsom, S. J., & Happell, B. (2007). Interventions for reducing the use of seclusion in psychiatric facilities. The British Journal of Psychiatry, 191(4), 298-303.
Smith, O., Kruchowski, J., & Wannamaker, K. (2010). Towards least restraint in the ICU: challenges and learnings in an inner city hospital. Dynamics, 21(2), 35.
Berzlanovich, A. M., Schöpfer, J., & Keil, W. (2012). Deaths Due to Physical Restraint. Deutsches Ärzteblatt International, 109(3), 27-31.
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management - UK, 20(1), 32-37.
Physical restraint promotes typical complications of such as:
Leg vein thrombosis .
Full transcript