restraints?

[fuzzywuzzy, CNA]

We have a very unmanageable, sometimes combative lady with chair and bed alarms who frequently gets up to transfer/ambulate alone (hence the alarms). She always sits right on the (rounded) edge of her chair and sometimes she sways back and forth, pretty violently. The other day she was doing that and it looked like she was going to fall right on her face, and she refused to sit back. I put the footrest up on the chair but 2 seconds later it would start to fall down. I was afraid she would end up on the floor either way, so I propped it up with the trashcan.

Later I got yelled at by a nurse who said she heard the alarm, found the woman walking around the room, and then saw what I'd done with the trashcan. She said that putting the trashcan there was a restraint.

If she could still get up and walk around, how was this a restraint? I was thinking of her safety, not trying to restrain her. I knew she would still be able to get out of the chair. I have had other residents ask me to put the cans under their footrests. When I took the CNA class the book listed some things that are restraints and some that aren't, but some of them seemed really weird. Is there a clear way to tell what is or is not a restraint?

[justme1972]

Later I got yelled at by a nurse who said she heard the alarm, found the woman walking around the room, and then saw what I'd done with the trashcan. She said that putting the trashcan there was a restraint.

If she could still get up and walk around, how was this a restraint? I was thinking of her safety, not trying to restrain her. I knew she would still be able to get out of the chair. I have had other residents ask me to put the cans under their footrests. When I took the CNA class the book listed some things that are restraints and some that aren't, but some of them seemed really weird. Is there a clear way to tell what is or is not a restraint?

Any obstruction to free movement is considered a restraint.

Putting up all 4 bedrails is a restraint...however, we all know that a determined patient can crawl over them...however, it's still a restraint.

If you propped the foot rest up, that means it's original mechanical function has failed...it won't "go down" automatically upon her rising from the chair and putting her leg weight on it...therefore, putting the trashcan underneath it increased her chances of a fall....this was significantly increased since her frame of mind was obviously impaired.

I don't agree with yelling at anyone, however, theoretically the nurse was correct.

The next time I would stay with the patient, hit the call bell and have a nurse to come and assess the situation...that way you have done your job.

[One Flew Over]

Agreed. Even little crazy things you'd never think of, like tucking in the sheets snugly to keep someone from 'playing' with their incontinence; Or putting mittens on someone who picks at an ulcer are considered restraints.

[fuzzywuzzy, CNA]

See, I think that's confusing! I remember seeing a picture of a lap cushion in my CNA book that was "not" a restraint, even though they can't get out of it. There were other examples that seemed to make no sense too. So I thought as long as they can take it off (and are alert enough to know how to do it), it's fine.

Oh well, now I know.

[AudreyJ]

See, I think that's confusing! I remember seeing a picture of a lap cushion in my CNA book that was "not" a restraint, even though they can't get out of it. There were other examples that seemed to make no sense too. So I thought as long as they can take it off (and are alert enough to know how to do it), it's fine.

Oh well, now I know.

What it sounds like you're describing is the lap buddy. It hooks onto the wheelchair in a manner that makes it difficult for the resident to take it off. Technically that's considered a restraint. Illinois no longer allows ANY bed rails, not even two at the top. My facility replaced them with Halos and everyone hates them.

Anything that impedes the residents free mobility is a restraint. Even broda chairs are considered restraints and we had to jump through hoops to get them for some residents. We all live and learn, don't take it too hard :)

[yousoldtheworld]

Illinois no longer allows ANY bed rails, not even two at the top. My facility replaced them with Halos and everyone hates them.

That is so ridiculous to me. While I understand why they have to be careful about "restraints" (I once came into my shift and a night shift aide had actually used a sheet tied to the lower part of each side of the bed across a patient's chest to keep them from getting out of bed! And somehow though she got written up, she didn't lose her job!!) but the top bed rails? We usually have left them up on every bed at every facility I've worked at, including the hospital. The patients need them for mobility purposes. It also seems like it would be way too easy for a patient to fall out of bed, and were that to happen, we would be the ones responsible. Silly.

I think Indiana's a bit different in regards to this. Here, we can use the lap buddy on certain patients if they have demonstrated that they can remove it. We can also use the top bedrails on all the beds UNLESS a patient requests the bedrails be down. We can also put up 3 or 4 bedrails if the patient requests, and the request is documented (I have one patient who likes to have all four rails up to sleep). For a seatbelt, posey vest, wrist restraint, etc, though, we need doctors orders for them.

I guess it's just different everywhere. I'm all for patient rights, but I think sometimes they go overboard with this restraint business. If you can't keep your patient safe, what good is it? There just isn't enough staff to have every fall risk patient monitored 24/7.

[PsychNurseWannaBe, BSN, RN]

Restraints are a very touchy thing... regardless of intent. Some things I see.

1. Aides tying call lights to the patient w/c so it is within reach - restraint!

2. Putting a resident in a chair with a bedside table next to them and then placing a w/c in front of the table so the table can not be moved and the resident can't get out... restraint!

3. Placing a resident in a chair that is too low for them to get out of, restraint.

There are sooo many ways to accidently restrain someone. Many times than not, it truly was an oversight and it was done with the best intentions. Also, as an FYI you can verbally restrain someone. Always get the nurse if you have questions.

[Speed Freak]

Also, as an FYI you can verbally restrain someone.

Wish that would have worked with my kids! I am just going to start my training as a CNA and all I know about restraints is what I have learned and practiced with Mrs. Speed Freak and I will not go into that any further.