reamed out for using soft wrist restraints

Published

Upon listening to report from the daylight nurse, I was told that the patient was a DNR and was ordered to be on a non-rebreather to keep sats >90%. The confused pt had been continually pulling at his mask and refused to leave it on. On nasal cannula at 6l, pt dropped into the 70s and on roomair into the 60s. The daylight nurse stated that she did nothing because she considered this patient refusal.

I felt that since the patient was confused, he was not in the right mind frame to refuse. I notified the physician and he ordered soft wrist restraints bilaterally. I applied them and performed hourly assessments.

When night shift came on, the nurse who was following me listened to report. I asked if she had any questions and she said "Yeah, why the hell did you put restraints on that guy. You're just cruel." I then stated that his sats were low on both nasal cannula and roomair and that I couldn't just chart that I knew he was 60% on roomair and do nothing. She suggested that rather than record his sats on roomair, I should have held the nonrebreather on his face, obtained a good pulse ox reading, then let him remove the mask as he pleases for the rest of the shift. She then stated that she hopes that she never has a nurse like me who allows my patient to suffer and be restrained.

I honestly was trying to do what was best for the patient in restraining him. I suppose I figured it would be better to suffer in restraints than to suffer gasping for breath. But now I am second guessing my actions. Was I wrong in what I did? Does the fact that he is a DNR make a difference? What should I have done? Advice would be greatly appreciated. Thank you!

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Hard to call, but I side with you. Can't imagine how it must feel to be gasping for air.

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Specializes in Critical Care/Coronary Care Unit,.

DNR doesn't equate do not treat. If you had a confused patient that was a full code, you wouldn't let them keep pulling off the oxygen. Now if the patient is a hospice patient...well that's a different story. In that case, the patient should be allowed to die comfortably...then I'd say don't restrain the patient and let them die with dignity while making it as comfortable as possible.

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DNR doesn't equate do not treat. If you had a confused patient that was a full code, you wouldn't let them keep pulling off the oxygen. Now if the patient is a hospice patient...well that's a different story. In that case, the patient should be allowed to die comfortably...then I'd say don't restrain the patient and let them die with dignity while making it as comfortable as possible.

the patient was not hospice... in fact, he just had a peg tube placed today and was pulling at that too.

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I agree DNR does not mean do not treat. Please refer to your hospital restraint policy. Be a patient advocate. I would have done the same thing per my hospital physical restraint policy and the doctor's order.

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Specializes in Family Practice, Mental Health.

I work in the ICU. It is a facility policy that we are not allowed to restrain a patient when on the BiPap.

If you ever get a chance, I suggest that you try one out for a few moments. It is somewhat like sticking your head out of the window while going 100 miles per hour down the road and being forced to breathe against a force like that. Most uncomfortable. There is a difference between a C-Pap and a Bipap.

A good reference for you would be the respiratory therapist. Ask them to share their knowledge with you. They are an excellent resource for your questions that surrounding the effects of the Bipap on a patient.

Hang in there.....not one single nurse amongst us knows it all. Now you know one more thing that another nurse has yet to learn.

If a patient's code status will allow us, we would advance to intubation if BiPap fails, whereupon we would sedate the patient and place restraints at that point.

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I work in the ICU. It is a facility policy that we are not allowed to restrain a patient when on the BiPap.

If you ever get a chance, I suggest that you try one out for a few moments. It is somewhat like sticking your head out of the window while going 100 miles per hour down the road and being forced to breathe against a force like that. Most uncomfortable. There is a difference between a C-Pap and a Bipap.

A good reference for you would be the respiratory therapist. Ask them to share their knowledge with you. They are an excellent resource for your questions that surrounding the effects of the Bipap on a patient.

Hang in there.....not one single nurse amongst us knows it all. Now you know one more thing that another nurse has yet to learn.

If a patient's code status will allow us, we would advance to intubation if BiPap fails, whereupon we would sedate the patient and place restraints at that point.

This patient was on a non-rebreather mask, not a bipap.

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Specializes in PICU, Sedation/Radiology, PACU.
I work in the ICU. It is a facility policy that we are not allowed to restrain a patient when on the BiPap.

If you ever get a chance, I suggest that you try one out for a few moments. It is somewhat like sticking your head out of the window while going 100 miles per hour down the road and being forced to breathe against a force like that. Most uncomfortable. There is a difference between a C-Pap and a Bipap.

A good reference for you would be the respiratory therapist. Ask them to share their knowledge with you. They are an excellent resource for your questions that surrounding the effects of the Bipap on a patient.

Hang in there.....not one single nurse amongst us knows it all. Now you know one more thing that another nurse has yet to learn.

If a patient's code status will allow us, we would advance to intubation if BiPap fails, whereupon we would sedate the patient and place restraints at that point.

When does the OP state the patient is on C-Pap or Bi-Pap? We are talking about a regular oxygen mask here...

OP, I think you made the right call. Confused patients often pull at tubes that they need to stay healthy- IV's, PEGS, even ET tubes. The physician obviously agreed with you.

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Specializes in Family Practice, Mental Health.
This patient was on a non-rebreather mask, not a bipap.

My bad.....don't know where I got BiPap. ??

Carry on.

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Specializes in Family Practice, Mental Health.
When does the OP state the patient is on C-Pap or Bi-Pap? We are talking about a regular oxygen mask here...

OP, I think you made the right call. Confused patients often pull at tubes that they need to stay healthy- IV's, PEGS, even ET tubes. The physician obviously agreed with you.

My bad....see previous post.

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If the doc ordered it... but you could have considered a warmed humidified high flow if the patient would tolerate as a less restrictive.

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Specializes in Med Surg/Tele/ER.

hmmmmm let them gasp for air, becoming more confused from lack of oxygen....or place soft restraints per dr orders....increasing sats, more a&o.....more able to comply with the NRB, and the need for it.

Wow! I think I will pick soft restraints. I also agree your RT may have been able to help you out if you have one available. As far as holding the NRB on his face & then charting the sats.....:eek: What an idiot!

BTW..a little something for anxiety might have been a good choice also.

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