Freedom From Restraints : A Clinical Practice Guideline

As health care workers we are under a legal obligation to protect an individual from any kind of abuse, whether it is physical, financial, emotional, sexual or psychological .Legislation, policies and procedures exist to promote a safer working environment and reduce the potential for risks occurring. They are tailored for the needs of each setting, known and understood by employers and employees and reviewed on a regular basis.

The purpose of this post is to discuss the nurse’s scope of practice. The American Nurses Association (ANA) has established guidelines to provide nurses a safe parameter to work within, while also protecting the patient. These laws are based on the competency, knowledge, judgment, and skills required by nurses in order to provide safe care for the public (National Council of State Boards of Nursing, 2015). It is imperative that nurses know their scope of practice within their state to avoid being charged with a violation of the Nurse Practice Act (Wilkinson & Treas, 2011). I will be discussing my states scope of practice in this posting.

The use of less lethal weapons that are approved by TDCJ are by using restraints, protective equipment, chemical agents, and less than lethal ammunition. The restraints are defined as a measure or condition that keeps someone or something under control or within limits. Restraints in corrections system are used to escort offenders from place to place and controlling the offenders. The restraints that are approved by TDCJ are hand and leg restraint cuffs and a belt restraint. The officer puts on the hand and leg restraint cuffs which are a pair of lockable linked metal rings hooked together with a chain that is approximately four inches long for hands and twelve inches long for legs. Then belt restraint are used as a strong wrap around the offenders waist that has chains that connect the hand and leg restraint cuffs to the belt restraint. These restraints together keep the offender from having full mobility. Which according to most studies, it has helped prevent attacks on officers (Smith,R.2009). The use of protective equipment such as riot helmets, riot shields, riot batons, and stab vest. These protective equipment are mainly used when an offender or offenders are causing a violent public disturbance, or riot; it was to calm the violent offenders, yet protect the officers from being injured or killed. By having the riot helmets, shields, and batons helps

Encounters with these patients are often begun with law enforcement calling for rescue, as they got a disturbance call first. There have been many reported cases of these patients dying in police custody and it becoming a topic of controversy over police brutality, etc., when in reality these patients were adequately restrained to protect themselves and others. Since the patients can not break free of these restraints, they essentially have an over stimulation of their nervous system, leading to arrhythmias, which leads to cardiac arrest. Other times when these patients end up in cardiac arrest is due to

I recommend everyone using physical techniques of any kind be trained on the risks of positional asphyxiation. Whenever, I physically restrict a person’s movement there is a risk of injury, and no physical holds are 100% safe. In this book, I cover body positioning for physical interventions, standing holds, and seated holds. I do not authorize or encourage a prone restraint without the proper training; and this type of restraint is not covered in this book. However, the SafeClinch Training System does allow for “prone containment” for those organizations allowed to use it; once SafeClinch instructor certification has been achieved. Here is an example of what the prone position looks like. Notice, since the person is in the prone position

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

There are a few ethical issues that in the provided scenario which need addressing from the nursing shift supervisor. The first occurs when the Certified Nursing Assistant (CNA) fails to appropriately address the possibility of a developing pressure ulcer. A wound care team can be consulted about developing an educational program about pressure ulcers for hospital staff. Also, there is the issue of restraints. The ordering physician should be contacted about the necessity of restraint use. Along with the wound care team, data could be collected about the use of restraints and the subsequent development of

Risk for trauma related to misuse of seat restraints and physical proximity to vehicle pathways.

Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.

Restraints prevalence is another NIS that could assist the nurses in the above scenario to identify

When nurses are held to a professional standard, staffing becomes safer and more efficient. The professional standard created by the American Nurses Association Code of Ethics (ANACEN) for Nurses is commonly used. The standard is made up of nine points that ensure patients will receive the highest quality of care. The purpose of the standard is to determine whether nurses have the assets, abilities, responsibility, and expertise to make judgments concerning professional practice and optimum care for patients and families (Clevenger, et al. 2005). The goal of safe staffing is to provide optimal care for patients and the patients’ families, so facilities should invest in nurses with a high degree of professionalism who can

Restraints is an intervention used to confine a person to prevent injury to self or others. Different types of restraints include physical, chemical and seclusion. A physical restraint is anything that prevents the patient from being able to freely move. This can include seat belts, wrist restraints, vests, bed rails, etc. A chemical restraint is using a drug for sedation which also restricts movement or freedom. An example of a chemical restraint can be an antipsychotic. These drugs can be used to reduce anxiety, aggression, and violent behavior. Lastly, seclusion is isolating or confining the patient to a room where they cannot leave. This form of restraint is also to protect the patient from harming them self or others. The use of restraints or seclusion can be a useful intervention if all other interventions have failed. Patients should not be harmed with these restraints so it is crucial they are done properly. Patients who are put in restraints

That being stated, if a patient must be placed on restraints, qualified professionals must have a comprehensive understanding of patient outcomes that correspond with the use of restraints. First and foremost, skin integrity is placed at risk if proper placement and management of patient care while in restraints is not implemented as with the case of Mr. J. There is numerous evidence based research studies conducted that correlate the use of restrains with an increase in pressure ulcers (Baumgarten, Margolis, Localio, Kagan, Lowe, Kinosian, Abbuhi & Abbuhi, 2010).

The American Medical Association has described it as "a barbaric practice that needlessly inflicts excruciating pain and humiliation." The practice contravenes the United Nations convention against torture. Along with AMA, the Federal Bureau of Prisons, the U.S. Marshals Service, the American Correctional Association, the American College of Obstetricians and Gynecologists (ACOG), the American Civil Liberties Union (ACLU) and the American Public Health Association all oppose shackling women during labor, delivery, and postpartum recovery because it is unnecessary and dangerous to a woman's health and well-being. Shackling risks include increased duration and painfulness of labor as women who are shackled to a hospital bed cannot walk or change position. In fact, the vast majority of female prisoners or detainees incarcerated are non-violent offenders and restraining these prisoners and detainees increases their potential for physical harm from an accidental trip or fall ("Act to prohibit the shackling of pregnant prisoners"). Additional risks include delays if emergency operations are needed and increased risk of postpartum hemorrhaging as restraints on a pregnant woman can interfere with the medical staff's ability to appropriately assist in childbirth ("Act to prohibit the shackling of pregnant prisoners"). Especially for incarcerated women who lack adequate

While the use of physical restraint on elderly patients is necessary in specific situations, the practice should be very limited at all times. Although it will continue to be used worldwide, measures must be taken by all healthcare providers to gradually minimize the use of restraints in healthcare facilities, reduce the risks that are associated with the practice, offer reasonable alternatives for patient care, and ensure the safety of the patients as well as their caregivers.