Lesson 4 - Restraints
All individuals have a humane and legal right to live free of restraints.
As a caregiver, there are 3 things you need to understand about restraints:
There were 3 types of restraints used in the past:
Examples of physical restraints include:
Other physical restraints include:
Examples of chemical restraints
Examples of environmental restraints include:
When do things become a restraint?
Whether or not something is a restraint can depend on the intent of how something is used or done. For example, you have a client who enjoys sitting in his favorite recliner but is unable to get out of it without help.
The chair would not be considered a restraint if he was closely monitored while in the chair and a caregiver was readily available to help him when he wants to get out.
The chair could be considered a restraint if a client is put in the chair for the convenience of the caregiver, not monitored, and the client is unable to get out of it when he wants.
Risks associated with restraints
The most common reasons given in the past for using restraints were to
prevent injuries or control potentially dangerous behavior. The truth about restraints is they do NOT:
The risks of using restraints outweigh the largely unsupported claims of safety.
The physical risks of using physical restraints can include:
The emotional risks of using physical restraints can include:
The risks associated with chemical restraints can include:
Alternatives to restraints
Restraints are not the answer. Less restrictive methods are equally effective without the risks associated with the use of restraints. Any thought to restrain a client should instead trigger an investigation and understanding of what is causing the behavior or problem. Care strategies should then be put in place to address the individual needs of the client without the use of restraints.
Some examples of alternatives to restraints are listed below. Depending on the circumstances, you may want to talk with professionals specializing in the development of programs to help resolve specific behavior and/or safety concerns identified.
Examples of physical alternatives include:
Examples of environmental modifications include:
Effective Problem Solving
here are four steps used to successfully solve problems, including:
By becoming more aware of these steps, you can use them to solve problems that come up at work.
Step #1 – Understanding the problem
What causes you to think there’s a problem? Gather information and think about what is happening. Get to the root cause of the problem.
Stop and identify:
Use the “Why” technique for getting to the root cause of any problem. Ask “why” the problem exists. Repeat “why” four more times. By the fifth “why”, you should be at the root cause of the problem.
Things to remember
Things to avoid
Problem solving with others
Each person involved needs to share his/her perspective and perception of the problem. The goal of this sharing is to reach a common agreement of what the problem is. It works best if the problem is viewed as something to solve together, not a battle to be won. Often, a problem will get redefined or even resolved as it is discussed.
Step #2 – Brainstorming possible options/solutions
To get to the best solution consider many possible options. One of the best ways to do this is brainstorming. If the problem involves others, have them involved with brainstorming ideas as well. Come up with as many solutions as possible. Even silly ideas can be the seeds of a great solution.
Things to remember
Things to avoid
Step #3 – Picking a solution/option, planning, and doing it!
Look at the positives and negatives of each option before making a decision.
Pick what you think is the best option and plan out how you are going to do it.
It may be that the best choice is obvious or that you will have to decide which solution has the best chance of solving the problem.
Things to remember
Things to avoid
Problem solving with others
When solving a problem involves other people, agree on what criteria will be used to decide which solution to try. This could include taking a vote and letting the majority rule, agreeing the entire group must reach consensus, evaluating and rating each idea against a set list of criteria, or even tossing a coin.
Pick an option/solution that is fair and beneficial to everyone and focuses on the best solution. This will help the group avoid a contest of wills where the strongest person wins. Make sure everyone is clear about what steps or actions he/she needs to take to resolve the problem. Each person needs to be committed to taking these actions.
Step #4 – Getting feedback
The final step of problem solving involves getting feedback. Ask yourself and the people involved how the solution is working. If changes need to be made, look at the brainstormed options and try a different solution.
Things to avoid
• Assuming the problem will always stay solved once the plan is put in to Action
As a caregiver, there are 3 things you need to understand about restraints:
- The types of restraints that have been used in the past.
- The risks associated with using restraints.
- Safe alternatives to be used with clients instead of restraints.
There were 3 types of restraints used in the past:
- Physical restraints - anything used to prevent or limit movement or access to one’s body;
- Chemical restraints - drugs not required to treat medical symptoms used to control mood, mental state, or behavior; or
- Environmental restraints - locked rooms or barriers which confine a person to a specific space.
Examples of physical restraints include:
- A tie, belt, or vest used to keep a client from getting out of a bed or a chair;
- Clothing a client cannot independently remove, such as a top that buttons in the back to stop a client from taking it off;
- A reclining or lounge chair, couch, or bed the client can’t get out of;
- Bed rails that cannot be independently lowered;
- "Lap buddies” in a wheelchair.
Other physical restraints include:
- Holding a person’s hand down against his/her will;
- A “bear hug” used to restrict a person’s movements;
- Holding a person’s legs or arms to prevent him/her from getting out of bed.
Examples of chemical restraints
- Any medication or substance (even if prescribed by a doctor) may be a chemical restraint if it is given:
- When there are no symptoms or indications for its use;
- In too large of doses;
- For the convenience of staff;
- Without appropriate or enough monitoring.
Examples of environmental restraints include:
- Locking someone in a room;
- Seclusion rooms.
When do things become a restraint?
Whether or not something is a restraint can depend on the intent of how something is used or done. For example, you have a client who enjoys sitting in his favorite recliner but is unable to get out of it without help.
The chair would not be considered a restraint if he was closely monitored while in the chair and a caregiver was readily available to help him when he wants to get out.
The chair could be considered a restraint if a client is put in the chair for the convenience of the caregiver, not monitored, and the client is unable to get out of it when he wants.
Risks associated with restraints
The most common reasons given in the past for using restraints were to
prevent injuries or control potentially dangerous behavior. The truth about restraints is they do NOT:
- Decrease falls or prevent injuries;
- Make clients feel more secure and protected;
- Prevent lawsuits or malpractice claims; or
- Make caregiving more efficient and less worrisome for staff.
The risks of using restraints outweigh the largely unsupported claims of safety.
The physical risks of using physical restraints can include:
- Increased incontinence and/or chronic constipation;
- Pressure sores and other risks of immobility;
- Injury or possible death from a client trying to remove or get out of a restraint.
The emotional risks of using physical restraints can include:
- Increased feelings of hopelessness, fear, depression, anger, and humiliation;
- Changes in behavior, mood swings;
- Reduced social contact, loss of independence.
The risks associated with chemical restraints can include:
- Increased agitation and confusion;
- Over sedation (being tired and groggy all the time);
- Dizziness, increased risk of falls, and hip fractures.
Alternatives to restraints
Restraints are not the answer. Less restrictive methods are equally effective without the risks associated with the use of restraints. Any thought to restrain a client should instead trigger an investigation and understanding of what is causing the behavior or problem. Care strategies should then be put in place to address the individual needs of the client without the use of restraints.
Some examples of alternatives to restraints are listed below. Depending on the circumstances, you may want to talk with professionals specializing in the development of programs to help resolve specific behavior and/or safety concerns identified.
Examples of physical alternatives include:
- Assessment for pain and medications used properly for pain relief;
- Massage to soothe and calm an agitated or anxious person;
- Use of wheelchairs that are in good working order and correct size.
- Structured daily routines;
- Walking or pacing in a safe area such as an enclosed courtyard;
- Organized physical exercises;
- Greater reliance on available family or friends for direct supervision;
- Using an activity board that fits on a client’s lap;
- Music;
- Reading.
Examples of environmental modifications include:
- Door buzzers;
- Bracelet alarms;
- Chair alarms;
- Signs, yellow barrier tape;
- Visual barriers such as large plants (that do not block entrances/exits or in
- Any way cause other safety concerns);
- Exit alarms;
- Increased or decreased lighting as needed for a client;
- Reduced level of noise.
Effective Problem Solving
here are four steps used to successfully solve problems, including:
- Understanding the problem.
- Brainstorming possible solutions.
- Picking a solution, planning, and doing it!
- Getting feedback about how it worked.
By becoming more aware of these steps, you can use them to solve problems that come up at work.
Step #1 – Understanding the problem
What causes you to think there’s a problem? Gather information and think about what is happening. Get to the root cause of the problem.
Stop and identify:
- What is happening?
- When is it happening?
- With whom is it happening?
- Why is it happening?
Use the “Why” technique for getting to the root cause of any problem. Ask “why” the problem exists. Repeat “why” four more times. By the fifth “why”, you should be at the root cause of the problem.
Things to remember
- Remain open-minded.
- Be as specific as possible.
Things to avoid
- Trying to solve a problem before having a good understanding of what the problem is.
- Reacting to a problem instead of logically sorting through it.
- Focusing on a symptom of a problem not the cause.
Problem solving with others
Each person involved needs to share his/her perspective and perception of the problem. The goal of this sharing is to reach a common agreement of what the problem is. It works best if the problem is viewed as something to solve together, not a battle to be won. Often, a problem will get redefined or even resolved as it is discussed.
Step #2 – Brainstorming possible options/solutions
To get to the best solution consider many possible options. One of the best ways to do this is brainstorming. If the problem involves others, have them involved with brainstorming ideas as well. Come up with as many solutions as possible. Even silly ideas can be the seeds of a great solution.
Things to remember
- Be creative when coming up with your options.
- Don’t stop with the first couple of options - keep thinking.
- Respect all ideas. This is not the time to evaluate them.
Things to avoid
- Only using the more obvious solutions; not being creative.
- Only thinking of a one or two options.
Step #3 – Picking a solution/option, planning, and doing it!
Look at the positives and negatives of each option before making a decision.
Pick what you think is the best option and plan out how you are going to do it.
It may be that the best choice is obvious or that you will have to decide which solution has the best chance of solving the problem.
Things to remember
- Think about the resources you have available (time, money, desire of others, energy it will take to get it done).
- Think through how the plan and solution will affect other people.
- The client’s preferences and needs.
Things to avoid
- Selecting the easiest solution because it is the easiest.
- Not thinking about the outcome of the plan and solution.
- Not thinking through all of the steps.
Problem solving with others
When solving a problem involves other people, agree on what criteria will be used to decide which solution to try. This could include taking a vote and letting the majority rule, agreeing the entire group must reach consensus, evaluating and rating each idea against a set list of criteria, or even tossing a coin.
Pick an option/solution that is fair and beneficial to everyone and focuses on the best solution. This will help the group avoid a contest of wills where the strongest person wins. Make sure everyone is clear about what steps or actions he/she needs to take to resolve the problem. Each person needs to be committed to taking these actions.
Step #4 – Getting feedback
The final step of problem solving involves getting feedback. Ask yourself and the people involved how the solution is working. If changes need to be made, look at the brainstormed options and try a different solution.
Things to avoid
• Assuming the problem will always stay solved once the plan is put in to Action