4 Point Restraints in the ER. Is that Abuse?

[Vickymay]

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.

[EmergencyRN22]

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, BSN]

(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 ..." Sorry guys, it's been a long 4 shifts!

[NOADLS]

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]

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.

[Anna Flaxis, BSN, RN]

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.

[JustMeRN]

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.

[TheCommuter, BSN, RN]

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.

ADDENDUM: It just dawned upon me that CNM can also stand for clinical nurse manager. Still, I have never met a clinical nurse manager in any department who lacks basic knowledge regarding patient restraints.

[KelRN215, BSN, RN]

That's a strange comment.

What is strange about it? It answered your question clearly and concisely. There is a time and a place for restraints and drunken patients who are combative in the ER usually fit the bill. What is your suggestion to do with these patients? Let them throw stretchers? Let them punch their nurses?

Restraints are for the protection of the patient himself and the staff. I once took care of a teenager with severe autism who also had hydrocephalus. He needed to have his shunt externalized and since he was at extremely high risk of trying to pull out his EVD, he was put in restraints. He also had a sitter at the bedside but the sitter wasn't enough for this kid. Would you rather we allow him to pull out his EVD- which would have created a surgical emergency as this kid's hydrocephalus was severe enough that he wouldn't have lasted long without it?

[CapeCodMermaid, RN]

Maybe the OP received those degrees and didn't update her profile? Check the policy manual where you work. Even in a SNF we can use a restraint if it's clinically warranted. Putting an abdominal binder on someone who is trying to pull out their Gtube is a restraint but we do it sometimes.

[Rose_Queen, BSN, MSN, RN]

Maybe the OP received those degrees and didn't update her profile?

OP only joined last month, so that's doubtful.

OP, restraints are a safety issue, either for the patient to prevent harm to himself or to protect the staff caring for violent patients. Restraints aren't taken lightly; the regulations surrounding them are quite thorough and intense. There must be a valid reason: to prevent physical violence from the patient, to prevent inadvertent removal of necessary invasive monitors/IVs/NGTs/foleys/etc. It's a benefit must outweigh the risk scenario.

My brother was once in the ER at the same time as a patient in need of acute psychiatric care. This patient was not restrained, and became physically violent to the point that his fist striking the wall could be heard outside the building. Would it have been safe to let the patient continue this behavior? Absolutely not! Instead, it took a team of 10 men to physically restrain him so that he could be sedated and then placed in restraints- to protect him and the staff caring for him, as well as other patients in the ER.

[ScrappytheCoco]

Have you ever been physically assaulted by an intoxicated patient in the ED? I have. That's what is abusive...not restraining a violent patient according to protocol.

[DnCali]

I also work in the ER in LA. We do use 4 point leather restraints....the scenarios that I have used them are typically for violent behavior. Patients who are physically abusive to the police and medical staff are the ones that end up in these restraints. Patients in these restraints are observed and documented on q 15 minutes. The MD must do a face to face evaluation within the hour and renewal is every 4 hours for an adult. Most of the time the patients drugs/alcohol wear off and restraints are removed. It is so much easier to have no restraints as the documentation is crazy! Patients who are confused and not a harm to others, but may be pulling their lines, are placed in soft wrist restraints. Personally, all the cases of 4 points I have encountered, have been valid. A 6'3" 230 pound man swinging at me, as I try to provide care, is someone who needs a restraint intervention! I have had that happen with a psych patient. My orientation included a review of the restraint policy. Restraints are always used as a final resource. Your manager or preceptor should be able to give you guidance on the facilities use and policy regarding different types of restraints.