Question for UK hospital medical or Surgical nurses

[suehp]

Hi, Just wanted to ask a question about restraints or lack of in the UK.

I have been out of the UK for 6 months now (in Florida now) and have been out of hospital nursing for 12 years so hence my question:

"How you do manage to stop patients who are confused etc from falling out of bed, or pulling at their IV's etc with not having the use of restraints?"

I have found since studying for the NCLEX exam to nurse in the USA and now working here too the use of restraints is common place with the appropriate protocols etc etc. During my orientation the Nurse Educator was fascinated to learn how UK nursing differs to US nursing...and when we told her that we arent allowed to use restraints she was gobsmacked...lol

But as I said I have been out of the hospital enviroment for 12 years and wondered how you manage...

(To be honest I dont like the use of some of the restraints.)

[madwife2002, BSN, RN]

Hi Sue,

We dont use physical restraints in hospitals in the UK, unless things have changed since I left in December. I dont like using them either, when I used them I felt I was abusing the pt.

But I have to say we do use various forms of sedation so therefore this could be seen as restrainting the pt via medication.

Ps I owe you an email

[suehp]

Hi Sue,

We dont use physical restraints in hospitals in the UK, unless things have changed since I left in December. I dont like using them either, when I used them I felt I was abusing the pt.

But I have to say we do use various forms of sedation so therefore this could be seen as restrainting the pt via medication.

Ps I owe you an email

Hi there!!

I didnt think physical restraints were used in the UK but wasnt sure having been out of it for so long...

look forward to hearing from you soon!!

[letina]

Agree with you both, any form of restraint could be seen as abuse, certainly in general nursing, maybe a little different in the psych area, but not my area of expertise, so can't comment on that one. The Trust where I work at the moment is very big on 'conflict resolution' training.......in other words, let the patients feel free to harm themselves as much as they like, but 'protect yourself'.

[chapmajc]

I have nursed pt's that pull out IV's and high risk of falls. If there are no cot sides then I pulled the chairs and cabinets to the side of the bed along side the chest area (pillows on the arms of chairs to prevent injury). Then if they do fall that these would either break the fall or stop them half way. I also tucked the sheets in under the mattress around the middle of the body and left the feet free, so if they do fall then perhaps that few seconds would enable them to get their feet down first.

As for IV lines, I had a really confused young person with learning difficulties having chemo who pulled out his lines several times during each treatment. I tried to not let allow this person to see the line by covering it up with a pillow and magazine. A light sedative was also given. Distraction therapy is all you can really do, and have eyes in the back of your head.

I feel very sad for these people, they must be so scared.

[suehp]

I have nursed pt's that pull out IV's and high risk of falls. If there are no cot sides then I pulled the chairs and cabinets to the side of the bed along side the chest area (pillows on the arms of chairs to prevent injury). Then if they do fall that these would either break the fall or stop them half way. I also tucked the sheets in under the mattress around the middle of the body and left the feet free, so if they do fall then perhaps that few seconds would enable them to get their feet down first.

As for IV lines, I had a really confused young person with learning difficulties having chemo who pulled out his lines several times during each treatment. I tried to not let allow this person to see the line by covering it up with a pillow and magazine. A light sedative was also given. Distraction therapy is all you can really do, and have eyes in the back of your head.

I feel very sad for these people, they must be so scared.

Thanks for your info:thankya:

I agree it must be very scary for them as it is usually the elderly that I have seen restraints here....

I have seen the use of a lot of bed alarms and chair alarms which are great and the new hospital I am wokring in now have special beds where the bed alarm is built into it and has 3 zones to it, top middle and bottom. It also has a purple light that lights up at night (I have yet to see that as I start nights next week). Thankfully these are useful tools and not classed as restraints....

Glad to see that I am not the only one that feels uncomfortable with the use of restraints:uhoh21:

[english_nurse]

The thing is, anything that prevents a patient doing something of their own free will is a restraint in the eyes of the law, for example using beds/chairs that tip backwards, tucking in sheets, sedation etc

sometimes cot sides make things worse as patients climb over, giving them futher to fall

have nursed very confused falling patients on a mattress on the floor for saftey, looks awful, but effective.

hard to generalise really

i suppose as long as they are prescribed and are in the interests of safety thats ok but to use them because they are convieniant for the nurses or allow units to operate with less staff isnt on

[suehp]

The thing is, anything that prevents a patient doing something of their own free will is a restraint in the eyes of the law, for example using beds/chairs that tip backwards, tucking in sheets, sedation etc

sometimes cot sides make things worse as patients climb over, giving them futher to fall

have nursed very confused falling patients on a mattress on the floor for saftey, looks awful, but effective.

hard to generalise really

i suppose as long as they are prescribed and are in the interests of safety thats ok but to use them because they are convieniant for the nurses or allow units to operate with less staff isnt on

I have to say that the restraints used over here that I have seen have been in the interest of the pt. It has never been an issue of babysitting due to lack of staff..which is good. I just have a hard time using them becuase I never used them. It is the same as lifting - the hospital I just left lifted everyone apart from the grosly obese - well I came from a no lift facility in the uk and you all know the regulations on that over there. Thankfully the hospital I have gone to now is a no lift hospital!

[madwife2002, BSN, RN]

I have seen them used here as babysitting due to lack of staff. sometimes you get sitters but ost times there is no money for babysitters-sound familiar

[RGN1]

In general nursing we are not allowed to use any kind of physical restraint. You can get sedatives prescribed for very restless patients but this is controversial int he extreme but is something that is used as a last resort.

It does cause all sorts of problems, I remember having to re-insert an IV line three times in one shift, which is neither pleasant for the patient nor a great thing from an infection control point of view, not to mention that the bed needed changing each time because of the blood on the sheets! Add to that the short staff & you've got the recipe for a horrible shift. All you can do is try and splint & bandage as much as possible, again not ideal.

I think if we could at least use soft mitten restraints (no idea what they look like but I've read about them on N-CLEX questions & they don't sound extreme) it would help. As for patients who fall, there's just nothing we can do except hope we're not too short of staff to watch them well enough.

Mostly our patients are still nursed on long, Nightingale wards which helps. Some hospitals have bays of 4-6 patients & then other patients often alert you to a problem. For those in single rooms, it's just luck I'm afraid.

In psychiatry you are allowed to physically restrain patients as required as long as you follow the strict policies in place.

[english_nurse]

I have seen them used here as babysitting due to lack of staff. sometimes you get sitters but ost times there is no money for babysitters-sound familiar

yes we used to have something similar called bedwatch, very expensive so we dont have it now

funnliy enough at christmas we had a patient who could have benifitted from it, requested it but got refused, that patient punched me in the face and loosened my front tooth

thanks very much management i thought!!!

[letina]

There was an incident at a hospital within our Trust a few months ago....a nurse was badly beaten by a male patient on a general surgical ward. The nurse sustained a fractured jaw and lost several teeth....and NOBODY intervened for fear of being accused of "physically abusing" the patient. Security were called of course, but the other nurses were powerless to restrain the patient. Shameful

Sorry Sue.....went off topic a bit there, but this whole issue of restraint is becoming a farce here in the UK. As I said in my earlier post, some Trusts seem to be hiding behind this 'conflict resolution' training......in other words...."oh well, we've provided training to help you protect yourself, what more do you want?" :angryfire

But back on topic.......patients who pull out IV's or are likely to injure themselves in other ways, it's all about risk assessment, reducing those risks where possible, and documenting it.