Patient Restraints and Other Alternatives

What Family Members and Friends Need to Know

 

Caring for someone who is confused or combative can be hard to do.  These patients can fall and injure themselves.  They can wander to unknown areas and get lost.  Combative patients can strike out and injure staff or family members without meaning to.

 

While no one wants to see someone in danger of harm, the solutions are not simple.  Years ago, nurses and doctors quickly placed confused and combative patients in restraints.  They did this to assure safety.  Today, in our hospital, restraints are only used after other options have been tried without success.

 

Adopting “Restraint-Free” Approaches

Today, with the support of a federal mandate, nurses and doctors try many other options before placing restraints.  Many hospitals and nursing homes are adopting a restraint-free approach.  This promotes safety and allows the patient to be mobile.  Ways that can help to keep a patient restraint-free are:

• bring in objects that are well-known to the patient
• keep  the patient’s daily routine and rituals that they are used to
• help the patient maintain his or her ability to walk (when we are able to do this)
• keep a watchful eye on the patient when restraints are not in use

 

As much as we try, we are not always able to keep patients restraint-free.  At times, restraints are the best choice.  The rest of this handout helps to answer common questions that people often have about the use of restraints.  Please read the entire handout.  If you have any concerns, talk with your doctor or nurse.  

 

What are Restraints?

Restraints are devices used to restrict freedom of movement.  Their purpose is to prevent injury to the patient or others.  The most common types of restraints are belts and soft wrist restraints. These are used to tie a patient to a bed or chair.  An enclosure bed may also be used.  This is a box shaped tent-like structure that fits over the patient’s bed.  The sides are made of mesh and can be zipped open and closed by the nurse.  It provides a safe space in which the patient can freely move around in her bed.  This is used mainly for patients with impulsive behavior.  It may also be used for patients with seizures who are at risk for falls.

Why Use Restraints?

Restraints limit movement and prevent injury.  They can be helpful to nurses and doctors as they provide care.  Restraints can also be used to:

• keep the patient safe and prevent falls
• prevent injury to family members and staff
• prevent patients from pulling out tubes or taking off dressings

 

According to the 1992 federal guidelines, if patients have life-threatening symptoms, restraints may be used short-term to help with lifesaving treatments.  They may also be used if the patient’s behavior is posing a threat to the safety of others.

 

How Long Does a Patient Need Restraints?

The amount of time restraints are used depends on how well the patient is oriented and able to follow simple commands.  As the patient gets less confused, the staff will try many times a day to remove the restraints.  When they are off, family members or staff might need to be present.  The staff will teach you how you can be most supportive during those times.

 

Who Decides to Place Restraints?

Restraints are used as a last resort.  The decision to restrain a patient is made by one or more members of the patient’s treatment team.  This includes doctors and nurses.  If the patient cannot partake in the decision, a family member is consulted if possible. 

 

How Can I Be Assured that Someone is Safe While in Restraints?

Nurses and others will often check the patient’s safety and comfort.  At least every two hours, the restraints will be taken off for daily activities.  This may include eating, going to the bathroom, and exercise.  The hospital has policies on caring for patients in restraints.  Staff are trained to be sure all patients in restraints are closely checked.

 

What Measures Do We Take to Assure the Best Care?

When restraints are used, it’s important to let people know why they are being used.  Patients will sometimes fight against restraints and want them taken off.  This is when it’s useful to talk with the patient about what they can do to have the restraints removed.  Your nurse will talk with you about specific behaviors the patient needs to do in order to get out.  For example, they must follow simple commands and leave tubes, IVs, and other devices in place.  This helps us to know that the patient is less confused and is thinking more clearly.

 

What I Can Do to Help?

 

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What Does It Feel Like to Be Restrained?

This can vary.  Some patients are not aware of the restraints.  Other patients might feel lonely or isolated.  Still others feel angry, fearful, or humiliated.  You may hear your loved one ask, “What did I do wrong?”  They might feel like they are being punished.

 

How Can I Support the Patient While Restraints Are in Use?

 

• When you can, it is best to stop by the nurse’s station before you enter the patient’s room for the first time.  This will give the nurse a chance to briefly tell you about restraints and why they are being used.  This is a good time to ask questions.

 

• Often restraints are used because someone is confused.  Therefore, it’s best to try to do things that help the patient get reoriented and less confused.  It is helpful to tell them:
  • who you are
  • what day it is
  • where they are
  • why they are restrained

 

• Asking questions that require brief or one-word responses helps a patient to feel more in control.   Simple, short answers to questions also help a patient to understand your response.

 

• Placing calendars and clocks within sight can help to keep the patient oriented to date and time.  Reading current magazines or news articles to a patient helps to keep them oriented and current.

 

• Short frequent visits are best.  Having someone come in and out of the room gives the person a sense of support and safety.  It helps to conserve the patient’s energy while providing reassurance.

 

• You also need to be aware of your safety and the safety of the patient.  For instance, giving a glass of water rather than a hot drink can prevent spills and burns.  Using paper or plastic dishes and utensils are safer than glass ones.  Cigarettes and matches should never be given to a confused patient.  And certainly, no medicines or sharp objects that could be harmful should be left within reach.

The Spanish version of this Health Facts for You is #6698.

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 09/28/2009

Copyright © 01/30/2009 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. UWH #5055

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