Restraints for patients' safety or nurses' safety?

pediatriclpn · Feb 27, 2005

Once upon a time I worked at a LTC. There was a resident postCVA, many years. R sided paralysis, R arm elbow, wrist and hand contractures. She had come in due to family inability to care for her anymore. She would insist on sitting on toilet or bedside commode for every void or bm. Not a problem in my book, she was keeping her dignity. And I would much rather use one or the either myself. But CNA's and nurse on the floor working 3-11 would get tired of her ringing her call bell to get on and off commode. We had beds with 4 rails. She had 2 up on one side to assist her with turning, and she would actually lay up against them when in bed. The aides took her call bell away, and closed her door, so that they wouldn't have to hear her call out, which she couldn't do very well, since she was aphaisic. (sp?) Anyway, she tried to get out of bed herself, broke her hip, not found until midnite. When 11-7 started their checks. They did not know that she didn't have her call bell, and sometimes her door would be closed at her insistence. Anyway, hip replacement surgery, returns to us, same needs as before, but no longer bears weight well, now requires 2 assist for stand and pivot. 3-11 shift did not learn their lesson last time, put up all 4 rails, no call bell within reach, door closed. She climbed thru the bed rails, fell, leg caught in between rail and bed, twisted and broken at an angle, stayed that way for ? hours, lost leg above the knee. Needless to say, the nurse and aides on duty that night lost their jobs. Side rails can be useful to keep people from falling, but you need to make sure that your patient understands their use. Hope this was helpful.

Pediatric Critical Care Columnist · Feb 27, 2005

I've had occasion to be responsible for several patients restrained for my protection. One Saturday morning I was floated to the ER to help them out. I hate floating and saw my opportunity to minimize my discomfort at being out of my element by volunteering to babysit the drunk teenagers who were sobering up. :uhoh3: The girl had attempted suicide by ETOH poisoning, and really wanted to be left alone while she got over the bed spins. One boy was very polite and funny, and completely mortified when his parents arrived to take him home. The third one, however, was another story. He was in four point leather restraints when I got to the room. I found out why the first time I approached the stretcher. First he tried to take a swing at me, and when that didn't happen, he lunged at me to try to head-butt me. Every time I went near the stretcher I was treated to more of the same. I'm just thankful he never took a notion to spit at me. :nono:

More recently I was assigned to a teenager who had OD'd on baclofen and lorazepam. Our poison control people didn't emphasize the nasty effects of combining benzos with baclofen, so our docs were trying to sedate her with midazolam. :smackingf All it did was make her completely psychotic. She hadn't slept in about 96 hours when I got her, and she was restrained with strips of sheeting. Both wrists and ankles were abraded to the point of bleeding and she was covered in bruises. She was verbally abusive whenever she had a lucid period. At one point she called me a white-trash whore. My reply was, "But we've only just met. How did you know that about me?" She looked stunned then changed her approach. The security staff who were sent to help with protecting both her and me were pretty much useless. The first one was a tiny Asian woman who couldn't have done a thing if this girl had decided to freak. The second one was a university student who spent the entire night studying. She alternated between flirting with him and heaping invective on him. During the night we weaned the midaz and added in some chloral hydrate. Amazing the change in her. She went out the psych floor later that day.

meownsmile, BSN, RN · Feb 27, 2005

Wow,, first the nurses who took her call bell should have been canned pronto.

I dont work psyc, but at my facility we dont use any restraints unless first ordered by the doctor, having exhausted all avenues to redirect patients. Then the family has to be called, informed, and given the opportunity to come in and help keep the patient from getting up, or whatever. If by chance they do get wrist restraints to prevent pulling tubes or a vest restraint, it is release and reposition every 2 hours with documentation of BR, etc.

When i worked with DD individuals, we were taught defensive moves and that the only right WE had was to run. The individual was only able to be actually restrained for very short periods (minutes) to prevent them from any iminent danger (jumping out a window, infront of cars etc).

V. Nightingale · Feb 27, 2005

janfrn said:
I'm just thankful he never took a notion to spit at me.

A surgical mask or non rebreather applied to the patient's face works wonderfully to discourage this behavior

I work in ED and we use restraints for both patient and caregiver safety. Mostly they're applied to keep the pt. from falling out of bed ( a last resort, but we don't always have personnel to stay at the bedside with someone who is confused and repeatedly tries to get out of bed), or with patients who are combative (fighting a lavage, or trying to hit/bite/kick staff). Restraints are a last line of defense after other methods have been tried, and we almost always try to use soft restraints to the wrists only, but attempting to harm staff members will buy you four point leathers in a hurry!