What is the nurses job in regards to restraints in a nursing home?

[ArtofGrace]

Hi everyone! I am a Nursing student and am researching what a nurse does in regards to physical restraints in a nursing home. I haven't found really any information as to a detailed description of what a nurse's jobs would be.

Any advice or help would be greatly appreciated! :)

[roser13, ASN, RN]

Not quite sure what you mean by a nurse's "job" with regard to restraints.

Restraints (chemical or physical) are used only with an MD order.

[imintrouble, BSN, RN]

Where I am only very limited restraints are used. Lap buddies. Reclined geri-chairs. Even bottom side rails aren't allowed. Restraints in LTC are very limited.

For any type of restraint anywhere in health care, an MDs order is required.

[Hospice Nurse LPN, BSN, RN]

In my state, physical restraints are not legal. Chemical restraints, side rails, and lap belts require a physician's order.

[Hospice Nurse LPN, BSN, RN]

I don't want to go back to the old days where people are tied down. I also think "they have the right to fall" is the height of lunacy.

SO TRUE!

[Cat_RN, ASN, BSN, RN]

Around here it's pretty extreme. (And senselessly so, to a point..)

No restraints at ALL. No ride rails, no Posey vests, no Posey MITS, no lap-buddy's, no chairs that are enclosed with wheels, you can't even have a BED against a WALL!

People are allowed to fall on their head, scratch/punch themselves silly, pull out their IV's and PEG tubes, and when in a maniacal fit, (ie: psych and craniotomy pt's), allowed to potentially seriously injure us and/or themselves because it's 'dignifying' to not 'restrain' them.

And it's supposedly all for the GOOD of the pt..

[jkaee]

As you can see, the rules can vary depending on the state you live in or the facility you work in.

Let's start out with the definition of a restraint. A restraint is anything that prohibits the residents freedom of movement. So, I can have a self-release belt on a WC. If the resident can release it himself, then it's not a restraint. If he can't release it, then it is a restraint.

You should have documentation of all the restraint alternatives that have been used on the resident and were unsuccessful.

You need a doctor's order for the restraint.

All residents in restraints must be released from their restraint every two hours. We write a doctors order for that as well, so the nurse has to sign off that it's being done.

Resident's should be released from their restraints at meals (For instance, you can't feed someone if they are in their Merry Walker). There are, of course, exceptions to this.

Quarterly reviews need to be done and documented regarding the continued need for the restraint.

Hope this helps!

[ShannonRN2010, BSN, RN]

If you work in a restraint free facility, the nursing role would be in plan and implement interventions to prohibit the incident from happening again. Like if you have a pt. that falls when they get out of bed, you could to a low bed against the wall with a bed alarm.

[pielęgniarka, RN]

Where I am at (LTC) restraints are not to be used except in extreme cases where the patient is a danger to herself or others, and nothing else is working. The nurse does need a doctors order and POA consent prior to initiating a restraint, which also explains the risks and benefits of a restraint. We also have to do a restraint assessment. You have to document what you have attempted what has not worked so far, to show you've attempted many other things, to justify the use of a restraint. When the restraint is in place you have to have a frequent check & release schedule. Restraints are not to be used long term, only temporarily.

[CapeCodMermaid, RN]

I run a 'restraint appropriate' facility. We do not use restraints as the first option, but if all else fails we use them.

Assess the resident...assess the need for a restraint. Use the least restrictive means of restraint. MD order, consent from the resident or family member and a restraint reduction assessment at least quarterly. Don't forget to include in your order times to release and reposition as well as restraint free times if possible.

[SuesquatchRN, BSN, RN]

We use them when necessary. Mostly lap buddies and chairs with trays for those who keep forgetting they can't stand.

[NotFlo]

We're restraint-free here, so we just have alarms up the ying-yang and let 'em fall.