physical restains?

hxs181 · Dec 18, 2004

hi can you please help me doing research for my school. I'm a student nurse in pennsivina. i was hoping you could answer a few questions for me on the topic.

1. do you feel there is a place in nursing today for physical restains and if so where?

2. have you ever used physical restains in nursing?

3. if yes to number 2 what was your reaction to useing them/it?

please also let me know how long you have been a nurse or student nurse, thanks so much for your help.

Helen

lapappey · Dec 19, 2004

hi can you please help me doing research for my school. I'm a student nurse in pennsivina. i was hoping you could answer a few questions for me on the topic.
1. do you feel there is a place in nursing today for physical restains and if so where?

Absolutely; whenver the pt is in danger of hurting himself or others.

2. have you ever used physical restains in nursing?

Yes, on an almost daily basis in the PACU (recovery room), to protect (generally confused) patients from themselves (self-extubation, pulling out foleys, IV's, A-lines & other lovely things), or when patients get very combative (occasionally happens after anesthesia and on all kinds of meds, not to mention off certain "meds" that you can't get in the hosp :uhoh3:

...)

3. if yes to number 2 what was your reaction to useing them/it?

Always just seemed necessary to me, never really had moral/ethical qualms about it. I'd certainly rather have a restrained pt than a pt with a damaged urethra/hemmoraghing A-line/no IV access/take your pick anyday. I think when patients were combative and restrainets became necessary (this is a somewhat different situation, security generally comes in and does this although I've been known to slap the leathers on myself when it's necessary) this has always been a little bit more "difficult" to deal with, but, again, it's for the patient's safety and the safety of my other patients and my colleagues.

Fiona59 · Dec 19, 2004

I'm sure you mean RESTRAINTS.

Need a doctor's order for them. Most facilities near me follow a least restraint policy. Plus even when you get an order for them families go two way, they want them off or they want them on without an order. Even had a family once that brought in a homemade restraint that they had been using on granny at home....

hxs181 · Dec 19, 2004

I'm sure you mean RESTRAINTS.
Need a doctor's order for them. Most facilities near me follow a least restraint policy. Plus even when you get an order for them families go two way, they want them off or they want them on without an order. Even had a family once that brought in a homemade restraint that they had been using on granny at home....

yes i ment restraints, sorry i have major problems spelling Thanks for answering tho. I do know you have to get an order, i'm looking more for opions on the use of them and when people think they should be used.:)

laurakoko · Dec 19, 2004

My hospital has a NO RESTRAINT policy. I am all for it. The policy is utilized everywhere EXCEPT ICU, where there are strict rules regarding them and the risk manager must be notified on call when a patient is placed on restraints.

Morguein · Dec 19, 2004

Yes, there are places in nursing where restraints are necessary. I work in the ICU and we use them on many of our patients there, because most of them are intubated, have A-lines, PA-lines, are confused or aggitated. The last thing you want is a patient who extubates himself and ends up needing to be re-intubated after going into respiratory distress. Many patients wake up from sleep and forget where they are and immediately go for the Endotracheal tube to pull it out. They can pull their A-line out and basically bleed to death if not caught in time. There are patients who do fine without restraints, but the restraints are taken off gradually, one-by-one and they are watched very very closely. I don't see anything wrong with restraining patients as long as they truly need it; and as long as it is explained to the patient and/or family members as to why they need it.

jackiemc08 · Jan 5, 2005

My husband had a bicycle accident on 8/11/04, which resulted in a severe brain injury. He was in ICU for almost 3 weeks. I had been with him the entire time. When he was transferred to the floor awaiting discharge to a rehab facility, he required constant monitoring. I asked for a sitter for the 11-7 shift so I could sleep. He had undergone bilateral craniectomies for the brain swelling, leaving 2 LARGE cranial defects on the sides of his head. He was unable to understand what was going on. Because of this, he would swing his legs over the bedrails in an attempt to get up. He also tried to remove the oxygen tubing connected to his tracheostomy. I had to replace the tubing over and over again during the day. He hugged me and pulled my hand to his lips.

The next morning, I returned about 20 minutes earlier than anyone anticipated. When I got to the room, I found my husband with a VERY frightened look on his face and the sitter and RN standing at his bedside. His left hand was tied to the bedframe with a roll of kerlix!

If you know anything about a head injury, you know that when coming out of the coma, the patient is confused. You would also know that agitation should be avoided because swelling, BP, and pulse increase dangerously.

There was NO order for a restraint, the restraint was not an approved one- it was a dang roll of Kerlix! I felt TERRIBLE for leaving him to sleep. I still can't forget the look on his face. It was heart wrenching.

Please don't EVER do this to a patient or a family member!!!

Jackie McDonald, RN, BSN, COHN-S, CCM

Elenaster · Jan 7, 2005

Jackie - I'm very sorry that happened to your husband (all of it) and I absolutely agree that makeshift restraint was terribly inappropriate and I'm quite sure in violation of the hospital restraint policy.

To the OP, having worked in Neuro ICU, we couldn't provide patient safety without the use of approved restraints due to the fact that many of our patients are extremely confused and may harm themselves or others. We always use the least restrictive device, mainly soft wrist restraints and have a strict protocol that we follow for assessing the restrained patient. Additionally, we also try to take the restraints off as soon as possible, especially if the patient can be re-directed to not pull on lines, etc.

ladylynx · Jan 15, 2005

My husband had a bicycle accident on 8/11/04, which resulted in a severe brain injury. He was in ICU for almost 3 weeks. I had been with him the entire time. When he was transferred to the floor awaiting discharge to a rehab facility, he required constant monitoring. I asked for a sitter for the 11-7 shift so I could sleep. He had undergone bilateral craniectomies for the brain swelling, leaving 2 LARGE cranial defects on the sides of his head. He was unable to understand what was going on. Because of this, he would swing his legs over the bedrails in an attempt to get up. He also tried to remove the oxygen tubing connected to his tracheostomy. I had to replace the tubing over and over again during the day. He hugged me and pulled my hand to his lips.
The next morning, I returned about 20 minutes earlier than anyone anticipated. When I got to the room, I found my husband with a VERY frightened look on his face and the sitter and RN standing at his bedside. His left hand was tied to the bedframe with a roll of kerlix!
If you know anything about a head injury, you know that when coming out of the coma, the patient is confused. You would also know that agitation should be avoided because swelling, BP, and pulse increase dangerously.
There was NO order for a restraint, the restraint was not an approved one- it was a dang roll of Kerlix! I felt TERRIBLE for leaving him to sleep. I still can't forget the look on his face. It was heart wrenching.
Please don't EVER do this to a patient or a family member!!!
Jackie McDonald, RN, BSN, COHN-S, CCM

My heart goes out to you...I have seen this done so many times. I have tried to encourage my colleagues to attempt to converse with the patient, even if you think they don't understand. Even with an order, in the case of someone like yourself, I would call the family member closest to the patient and see if they can talk to them on the phone or just come in. Many families are greatful, because they were greatful for the little sleep they did get or they were up worrying anyway and wanted to be called if something was wrong. When it's a loved one, there is no such thing as too early or too late. We have to sometimes compare patients to children in daycare.

Also on the medical standpoint, many patients have died in restraints, so we must take this seriously. I wonder if any of you have seen the "veil beds" return. As humiliating as they looked, they were safe.

jackiemc08 · Jan 15, 2005

My husband had a Vail bed when he was in the rehab hospital. I ASKED for it. It kept him safe without frightening a person who couldn't understand. The nurse there wanted to restrain him and I told her she would NOT do it. She asked if I had ever cared for a head injured patient and I replied, "Yes, I most certainly have." She was a lot nicer to me for the remainder of the stay.

Why would you want to restrain a person who just doesn't understand? There are many other ways and I was more than willing to stay with him. His speech centers were severely damaged (yes, they think he has two- left handed) and he did not understand speech or any other kind of communication. He did understand kisses and hugs and he recognized people. Sometimes I am ashamed to be a nurse when people associate the ones like that with the profession.

stbernardclub · Jan 15, 2005

Where ia Pennsivina at????????????????????

hi can you please help me doing research for my school. I'm a student nurse in pennsivina. i was hoping you could answer a few questions for me on the topic.
1. do you feel there is a place in nursing today for physical restains and if so where?
2. have you ever used physical restains in nursing?
3. if yes to number 2 what was your reaction to useing them/it?
please also let me know how long you have been a nurse or student nurse, thanks so much for your help.
Helen