The minimum elements of restraining orders include the reason and rationale for the use of the restriction, the nature of the restriction to be used, the length of time the retention, the conduct of the client who required the use of the restrictions, and any special instructions beyond those required by the institution`s policies and procedures. Lifting restrictions and attempting to control behaviour with appropriate alternatives to restraint provide the registered nurse and/or licensed independent physician (LIP) with reassessment data that guides the decision-making process regarding: The most common reasons for restrictions in health authorities are fall prevention, prevention of injury to oneself and/or others, and medical protection. necessary tubes and catheters such as intravenous access and a tracheostomy tube, for example. The least restrictive restraint to correct the problem, such as dropping and loosening tubes, probes and catheters, is used when chains are needed. The restrictions, from least restrictive to most restrictive, are as follows: All health settings embrace the philosophy and goal of a safe environment; However, it is often not possible to prevent the use of chains and isolation. There are rare cases where the use of channels is inevitable because chains have become the last resort to protect the customer and others from serious injury. A nurse at a long-term care facility admits a patient who has been transferred from a local hospital. The Facility has a policy of lower restraint and has not applied any restrictions over the past year. To prevent the use of restraints, they also use a protocol to record risk assessments to help employees determine an appropriate care plan, including identifying interventions that address behaviours. The patient`s children, who are the surrogate decision-makers, insist on retaining their mothers for safety reasons. They tell the nurse that if their mother is tied up, they will take legal action. What factors should the nurse consider in response to the family`s request? After assessing the patient and determining that no emergency restrictions are required for patient safety, the nurse and health care team are responsible for obtaining consent. Nancy is working in the emergency department of a community hospital when a patient arrives at the local correctional facility for treatment of a large leg injury.

The patient has a history of acute mental illness, is handcuffed and accompanied by two correctional officers. The nurse asks officers to remove the handcuffs and respect the patient`s privacy in the emergency room. Although Nancy is able to assess and treat her leg injury with the handcuffs, she feels uncomfortable when the patient`s movements are restricted by the handcuffs. The following aspects of care must be provided to an unrestrained patient or resident as required and documented at least every two (2) hours if the person is restrained for non-behavioural reasons, and at least every four (4) hours if the person is handcuffed for behavioural reasons, and more frequently for children (every two (2) hours for 9 to 17 year olds. and at least every four (4) hours if the person is handcuffed for behavioural reasons, and more frequently for children (every two (2) hours for 9 to 17 years of age. and at least every hour for people under 9 years of age, unless the person needs more frequent care. Shackles include mechanical devices such as an attached wrist, chemical shackles, or isolation. The Joint Commission defines chemical restraint as a drug used to control a patient`s behavior, restrict the patient`s range of motion, or interfere with the patient`s ability to interact appropriately with their environment, which is not a standard treatment or dosage for the patient`s condition. It is important to note that the definition states that the drug is “not a standard treatment or dosage for the patient`s condition.” [2] Isolation is defined as locking a patient in a locked room that they cannot leave on their own.

It is generally used as a method of discipline, convenience or coercion. Isolation restricts freedom of movement, as the patient is not mechanically bound, but cannot leave the area. 6. Restrictions may be used for any of the following purposes, except: A full doctor`s prescription is required to begin the use of restraints, except in situations of extreme urgency where a registered nurse may initiate emergency use of chains using an established protocol until the doctor`s prescription is obtained and/or the unsafe behaviors no longer exist. Restrictions without a valid and full prescription are considered false prison sentences. It is important for the nurse to be aware of current best practices and guidelines for the use of restraints, as they are constantly changing. For example, food trays on chairs were used in long-term care facilities to prevent residents from getting up and falling off the chair. However, once a restriction has been defined, this measure is now considered a restriction and is no longer used. Instead, several alternative interventions on restrictions are now being used. Handcuffs are a chain.

In this scenario, it is the prison that makes the decision about the use of restraint, not the nurse. The patient is in the care of the correctional officer. As described in Professional Standards revised in 2002, nurses are expected to understand relevant legislation and ensure that their practice complies with the law. The nurse needs to think about how laws such as the Correctional Services Transformation Act, 2018, the Reducing Patient Constraints Act, 2001 and the Mental Health Act can be applied to this situation. For example, the Correctional Services Transformation Act, 2018 outlines the responsibilities of correctional officers. For the interpretation of the law, the nurse can contact her employer or a legal representative. Obtain a written prescription from the doctor, except in an emergency. When the patient needs to be protected from injury to himself or others Distraction techniques such as watching TV, music, playing games, or looking out the window can also be used to calm a restless patient. Encouraging agitated patients to spend time in a supervised area, such as a dining room, living room or near the nurse`s station, helps prevent their desire to get up and move. If these techniques are not successful, bed and chair alarms or the use of a bedside guard are also considered an alternative to restraints. The nurse must also effectively convey the need for chains to patients and their families. As outlined in the Nurse-Client Therapeutic Relationship standard of practice, revised in 2006, nurses use a wide range of effective communication strategies to meet patients` needs and discuss their expectations.