NSE 12A/B Lecture 13: NSE12 Winter Semester lec 13
NSE12 Winter Semester: Week 2
Objectives:
Discuss the role of the therapeutic nurse-client relationship in the prevention of abuse;
Discuss nurses’ role and responsibilities when observing abusive behavior by a nursing colleague towards
a client;
Discuss the legal, ethical, nursing and medical issues involved in the use of restraints;
Apply the use of restraints in accordance with the standards set by the CNO.
Practice Standard - Restraints
Restraint is “a controversial measure used to restrict the movement or control the behaviour of a client.”
CNO (2017), Practice Standard: Restraints, p.3
• No longer on the CNO website but it’s still testable material -- posted on d2l
• Pt with behaviour that is a bit diff to care that bnefits the pt -- may implement restraints -- not the
first option to do so
• Restraints: Not covered in CCSW
True or false?
1. Restrait use is part of a pt’s long term care plan - false
2. Sedation is a type of restraint - true
3. Decisiions about restraints are made by the pt’s doctor - false
4. Use of restraints can contribute to constipation - true
5. Use of restraints can increase the risk of falls - true
Restraints may be:
Physical
• Ie: crib = not a restraint , bc babies cannot make the decision to roll out of bed
• Putting up side rails for adults= restraint
Environmental
Chemical
What is considered a restraint in one setting may not be in another
CNO (2017)
Physical Restraints
items which restrict or control movement
may be attached physically to a person or create a physical barrier
• Something that is physically attached to you or surounding you
• Ie: bed rails, side table, extremity restraints, belt restraint, elbow restraint, mitten restraint
• Ie table fixed to chair -- however this is controversial practice -- replaced by using bedside table
and roll it in front of bed
CNO (2017)
Chemical Restraints
Use of a psychoactive medication to purposely inhibit a specific behaviour and not to treat illness
it’s to inhibit a certain behaviour that we want to diminish
• Ie: sedatives ( ie:lorazepan ) - prsecribed by physicians for procedures
• Ie: Tranquilizers
• Often given in preparation for a procedure to reduce a behaviour
CNO (2017)
Environmental Restraints
modification of an individual’s surroundings
used to control a client’s mobility
confine the client to a specific geographic area or location
• Locked unit - pts that are at risk of wandering
• Seclusion- lock them in their own room if appropriate
• Isolation room could be cnosidered- but they are in the isoluation room due to their condition and
not based on behaviour necessarily
CNO (2017)
Least Restraint Philosophy
2001: Patient Restraints Minimization Act
• As a result to observations that restraints were not the most beneficial so the 2001 restraints was
placed -- every institution has a diff form of this protocol so do find out what the philosophy is in
their guidelines
Supported by CNO
Clients have right to make decisions about their care
Nurses must respect client wishes
All alternative interventions will be exhausted before using a restraint
• Have to get client consent for restraint
CNO (2017)
Least Restraint Philosophy
Use of restraints is an intervention of last resort & is based on meeting the needs of the client, not
the needs of the staff.
• Don’t choose to use restraints to help nurses,,, it’s for the client -- it should benefit the client
CNO (2017)
Use of Restraints Associated with:
Pneumonia
• When lying on the same position for a prolonged period of time
increased skin breakdown
• Need to be checked every 1-2 hours
Impaired circulation
• If on restraints for long period of time, too tight -- need to monitor that the pt is given rest from
restraints if possible -- always check on pt
• Constipation
o Peristalsis is slowing down - esp among elderly pts
• Incontinence
o If toilet needs are not met, challenge in being regular when restrained to bed
• Emotional distress
o Loss of autonomy, cant eat or go to the bathroom when they want to
o If the pt is demonstrating aggressive behaviour -- there may be some needs that haven’t
been met and thus be sure thye are met before doing restraints
• Loss of self esteem
o Going hand in hand with emotional distress
Restraints and Falls
Restraint use has not been proven to prevent falls
Document Summary
Discuss the role of the therapeutic nurse-client relationship in the prevention of abuse; Discuss nurses" role and responsibilities when observing abusive behavior by a nursing colleague towards a client; Discuss the legal, ethical, nursing and medical issues involved in the use of restraints; Apply the use of restraints in accordance with the standards set by the cno. Restraint is a controversial measure used to restrict the movement or control the behaviour of a client. Ie: crib = not a restraint , bc babies cannot make the decision to roll out of bed: putting up side rails for adults= restraint. What is considered a restraint in one setting may not be in another. Physical restraints items which restrict or control movement may be attached physically to a person or create a physical barrier: something that is physically attached to you or surounding you. Ie: bed rails, side table, extremity restraints, belt restraint, elbow restraint, mitten restraint.
