physical restraint

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the forcible confinement or control of a subject, as of a confused, disoriented, psychotic, or irrational person; it may be either physical or chemical. Restraint of any kind is used only when the patient's behavior presents a danger to himself or herself or another person. It is never used for the convenience of staff or as a substitute for conscientious nursing care.

Chemical restraint refers to the quieting of a violently psychotic or irrational person by means of medication. Physical restraints include restraining mitts to prevent removal of drainage tubes, restraints of upper and lower limbs to limit mobility and prevent the patient from climbing out of bed or physically harming someone at the bedside, and waist and body restraints such as a camisole (straitjacket). Even though the patient might not fully understand the need for restraint, a brief explanation of why it is being done should be given.

Assessment of the need for physical restraint includes a systematic determination of the level of confusion or disorientation exhibited by the patient and objective observations of his behavior. If possible, the cause of the patient's behavior should be identified, e.g., trauma, drug or alcohol intoxication, electrolyte imbalance, elevated temperature, pain, fear, or mental exhaustion. Findings of the assessment should be well documented in specific terms for legal reasons as well as to inform other caretakers and provide continuity of care.

Alternatives to physical restraint include reality orientation for disoriented patients (clocks, radio, television, newspapers, and magazines will all aid patients to orient themselves to reality); controlling the environment to minimize confusion and stimulation (restraints can intensify anxiety and confusion); and constant attendance at the bedside.

Since restraint of patients subjects them to the hazards of immobility, it is essential that they be monitored closely, their vital signs checked regularly, and their position changed at least every two hours. The use of restraints is an active area of nursing research. The most appropriate and least restrictive type of restraint should always be the one chosen.
Types of restraints: A, Chest restraint; B, Hand mitt restraint; C, Belt restraint; D, Mummy restraint. From Lammon et al., 1996.
jacket restraint camisole.
physical restraint
1. see restraint.
2. in the nursing interventions classification, a nursing intervention defined as the application, monitoring, and removal of mechanical restraining devices or manual restraints which are used to limit the physical mobility of a patient.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.
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