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4 Point Restraints in the ER. Is that Abuse?

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Vickymay Vickymay (Member)

Just started work as a RN nurse in the ER in LA and some drunken patients are put in 4 point restraint. Another elderly man was also in wrists restraints. Is this abuse? Since the hospital in Arizona where I worked before which was a different state from California did not do this.

MunoRN, RN

Specializes in Critical Care. Has 10 years experience.

The use of restraints need to be for a valid purpose (to facilitate treatment, to protect the patient, to protect staff, etc) and the least restrictive form of restraint that is still effective needs to be used and only after less restrictive measures have failed. If those requirements are met, why would that be abuse? There are many situations where alternatives to restraints will work just as well, but not always, how would things like the safety of the patient be protected in situations where no alternatives are effective?

AtHomeNurse

Has 16 years experience.

I suggest you ask for more education on your facilities restaint policy. Or try looking it up. Restraints used appropriately are not abuse. Restraints are (or were at one point) a jcaho issue, any accredited facility should have a policy.

Morainey, BSN, RN

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

They may be in restraints for injurious behavior (ex: with potential to harm themselves or others) or to prevent interfering with care (such as a confused person pulling at medically necessary interventions, like IV lines, Foley catheter tubing, or NG tubes, just to name a few). Your facility should have a policy on this which clearly defines when restraints are indicated.

Altra, BSN, RN

Specializes in Emergency & Trauma/Adult ICU.

I'm assuming you are in your orientation period since you stated you just started this position. If you have not yet been over restraint policies and practices with your preceptor, please ask for this education.

Are you saying that restraints were never used in your previous place of employment, and you are unaware of their appropriate clinical use?

Are you saying that restraints were never used in your previous place of employment, and you are unaware of their appropriate clinical use?

Well--No they were not.

The use of restraints need to be for a valid purpose (to facilitate treatment, to protect the patient, to protect staff, etc) and the least restrictive form of restraint that is still effective needs to be used and only after less restrictive measures have failed. If those requirements are met, why would that be abuse? There are many situations where alternatives to restraints will work just as well, but not always, how would things like the safety of the patient be protected in situations where no alternatives are effective?

That's a strange comment.

EmergencyRN22

Specializes in Emergency Room.

That's a strange comment.

Thats a strange response to a well spoken answer addressing your question.

Check your employee manual as well - good practice to be very familiar with your employers policies and protocols.

That's a strange comment.

What is strange about it? It's clarity, or its accuracy?

AnnieOaklyRN, BSN, RN, EMT-P

Specializes in ED, Pedi Vasc access, Paramedic serving 6 towns.

If the drunk person punches a nurse, is that abuse?

If a demented patient grabs a nurse, is that abuse?

Annie

TheCommuter, BSN, RN

Specializes in Case mgmt., rehab, (CRRN), LTC & psych. Has 15 years experience.

That's a strange comment.
Your title indicates you are an RN and a certified nurse midwife (CNM), yet your user profile indicates you are a pre-nursing student. Which is it?

I would expect an advanced practice nurse such as a CNM to have a wider breadth of knowledge on simple issues such as restraints. After all, CNMs are educated at the master's degree level. It is also unusual for CNMs to work in emergency departments as staff nurses.

Be mindful that members are not permitted to claim they have degrees and licensure that they have not yet earned.

JBudd, MSN

Specializes in Trauma, Teaching. Has 40 years experience.

4 points are used when a (usually intoxicated or high) person is out of control, usually demonstrated by trying to hit/bite/kick/grab/spit on staff, or being unable to be safe when left alone (getting out of bed when too drunk to be able to stand). No it not abuse, it is maintaining pt and staff safety.

Our 4 points usually then get sedated, and as soon as they are "out" (chemically restrained), the physical restraints are removed. As others have said, there are very specific guidelines that must be put into facility P&Ps; which include close observation and charting on such things as circulation distal to the restraints. Also, MD must evaluate in person and sign off on restraint orders.

(and.... "RN nurse" is repetitive, as RN means Registered Nurse)

EmergencyRN22

Specializes in Emergency Room.

Looking into the Op's past posts, I wonder if perhaps English isn't his/hers primary language. We may have some comprehension road blocks.

Id hate to jump to conclusion the OP may not be completely truthful about his/her education and license.

CamillusRN

Specializes in OR, CVICU/CTICU.

(and.... "RN nurse" is repetitive, as RN means Registered Nurse)

Bahahahaha! Just imagining a CD skipping tracks - "I'm a Registered nurse-nurse-nurse-nurse ..." :roflmao: Sorry guys, it's been a long 4 shifts!

This is one reason I would be enticed to work in the acute / ER. If my patients are being difficult, they get restrained. I'll [probably] never have that benefit in LTC. Restraints are not abuse. Restraints are a divine art that takes years of mastery. To be able to have that incorporated in nursing is a privilege that should not be taken for granted.

azhiker96, BSN, RN

Specializes in PACU. Has 10 years experience.

Looking into the Op's past posts, I wonder if perhaps English isn't his/hers primary language. We may have some comprehension road blocks.

Id hate to jump to conclusion the OP may not be completely truthful about his/her education and license.

I don't think TheCommuter was jumping to any conclusions. They were just asking for clarification on a disconnect between reported education level and certification. That seems reasonable to me.

Regarding restraints, the facility policy is the best resouce. Also check with your preceptor. In PACU we sometimes need restraints to keep a confused pt from pulling out lines or drains. We also sometimes have forensic patients who have different restraints to prevent elopement.

Restraints can lawfully be used for either medical or behavioral reasons.

If a patient is pulling at their lines or tubes, restraints can be used for the purpose of keeping their lines/tubes intact.

If the patient is a danger to themselves or others, restraints can be used to keep them or others safe from their behavior.

Of course, other methods of managing symptoms need to be tried first, and the restraints must be discontinued as soon as the behavior that instigated them has resolved.

AtHomeNurse

Has 16 years experience.

Heres a story for you where restraints were not used, but could have, and maybe should have been.

A patient brought to the ER for violent and self destructive behavior. Due to the overload of the mental health community in our area he had to wait in the ER. After 2 days in an ER holding area he became violent. He was not restrained. An LNA goes in to deliver a meal and gets beaten so badly he spends months in the hospital and rehab with head injuries.

I suppose it is as much a story of the sad state of mental health care. But, if that patient had been restrained when he started becoming aggressive would things have been different? It would suck for him, yes. Mentally ill, confused, scared. Not necessarily his fault, but in the end his rights to be restraint free came above the employees right to a safe work environment, and that employee will never be the same. Very unfortunate.

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