Have you ever done something against the law to protect your patient?

akulahawkRN, ADN, RN, EMT-P · Jun 20, 2013

I would have to say that I have never done anything that would be considered illegal in regards to protecting them against themselves or someone else. I'm not saying that I am a perfect angel either, but I do understand the limitations that I have to work with and consistently strive to stay within those boundaries. There may be times that placing a patient restraints is necessary, and you should understand precisely when you are able to put a patient into restraints without an explicit order to do so.

The end result is that you just really have to understand what you can do and when you can do it and why. I personally would not do anything to jeopardize my license because that would eliminate any further chance I have to provide for my family. You just have to be very very careful about doing things when you start getting close to the line of legality. I would never advocate that anyone cross the line because that can bring more problems than it is worth.

Caffeine_IV · Jun 20, 2013

4 side rails is a restraint and I see a lot of people that do this.

jadelpn, LPN, EMT-B · Jun 20, 2013

It is considered a restraint. With that being said, there are orders that one can obtain pertains to long term care for the most part, that allow for safety restraints ie: a seatbelt in a wheelchair, HOWEVER, every policy is different, as are regulations. And there needs to be documentation, and the ability for the patient to release the seatbelt if they wanted to.

Tying a patient to a wheelchair with a sheet is not good practice. Especially if one of the main reasonings is ever "it gets on my nerves".

The family can complain about this, and you not having an order, would be held responsible. If you are noticing that the patient is a fall risk in a wheelchair, that needs to be addressed. An order for a seatbelt, a specialized cushion (is the patient's bottom hurting, hence the rocking?) Is this a medication side effect? Can the patient be put in a recliner when restless? Does the patient need a tolieting program (people get antsy when they need to go to the bathroom). Additionally, pain needs to be addressed. If the rocking is a pain response, then the patient is not being medicated appropriately.

Does the patient communicate, follow command? Can you ask where she would be most comfortable? Is a wheelchair a feasible option if the patient is completely contracted?

Think about it this way. If you were unable to move well, couldn't walk, was put in a wheelchair that you could not move yourself--anyone would be uncomfortable and restless. Add this to pain, and I would be rocking too.

Patient could benefit from PT/OT. Patient could benefit from frequent changes of scenery. Patient could benefit from being put in alternate chairs. Patient could also benefit from activities that may be going on in the facility.

I get that it is sometimes impossible to be everything to everyone. But you could question the patient on the behavior, see what you can do so that the patient is comfortable, and follow facility polcies on safety restraints.

In acute care, it is different. (and am not sure if you are an acute care nurse). In my state (and other states it could vary) A doctor needs to order and be present at the time restraints are used. Every 15 minutes CSM's are checked and documented. Every hour one restraint needs to be released, and alternated. There is never a "PRN" restraint order, and every 4 hours the MD must physically come and assess the patient and decide if further restraint is needed, or patient needs to be released from restraints.

With all that being said, there are "no restraint" facilities. What is your facility policy on restraints? Make sure that you always have an order to back any action that you are employing on a patient.

Esme12, ASN, BSN, RN · Jun 20, 2013

I had a patient on my list who had severe arthritis and who would not sit still in her wheelchair. She was too weak to stand up and her joints were locked in position. She had severe pain.
When she was on my list, her rocking back and forth used to get on my nerves. I was always afraid she would fall out of her chair. The last thing I ever want to see is an arthritic patient fall.
She had no order for a restraint and I put a sheet around her waist. This brought me some attention from a visiting family member. I explained that I would rather get in trouble than see her fall. I noticed that the sheet I used on her did not seem to bother her.
I never did get in trouble for this. I do not remember the staff saying anything to me about it.

Is this homework?

You mentioned this before in another thread a few months ago.....https://allnurses.com/general-nursing-discussion/need-more-inference-782937.html#post6911343

You may NOT restrain a patient by any means without an order regardless of you good intentions or your personal annoyance.

It is called assault. Your facility can and will lose accreditation for unlawful restraint and be fined by the Joint Commission and can be shut down. You can and will lose your job as well as be held personally responsible.

Have I ever done anything illegal for a patient.....the answer is NO!

hiddencatRN, BSN, RN · Jun 20, 2013

Well, if I had I certainly wouldn't be posting about it on the internet.

classicdame, MSN, EdD · Jun 20, 2013

restraints are not illegal if done appropriately (including documentation). I think your actions were well-intended, but not appropriate. If something had happened you might have been liable civilly and criminally. You should have followed your first instinct and treated it like a restraint.

RNsRWe, ASN, RN · Jun 20, 2013

Counting down the hours until someone posts something they wished they hadn't...or don't know enough to know they shouldn't.

wooh, BSN, RN · Jun 21, 2013

You mean like the time that I killed that family member that was annoying my patient? As long as the body is never found...

SoldierNurse22, BSN, RN · Jun 21, 2013

You mean like the time that I killed that family member that was annoying my patient? As long as the body is never found...

*Sigh* Paging the computer screen clean-up crew to my apartment yet again... :roflmao:

amoLucia · Jun 21, 2013

You mean like the time that I killed that family member that was annoying my patient? As long as the body is never found...

You mean like next to Jimmy Hoffa under the 50 yard line at the NJ Meadowlands???