Restraints A physical restraint is any manual method, physical or mechanical device, or material or equipment that immobilizes or reduces the ability of a patient to move freely (CMS, 2008). The Omnibus Reconciliation Act (1987) includes chemical restraint as a form of restraint. The use of restraints has been associated with serious complications and even death. The Centers for Medicare and Medicaid Services (CMS) (2008), ANA (2001), and TJC (2014) set standards to reduce the use of all types of restraints in health care settings (i.e., that all patients have the right to be free from seclusion and physical or chemical restraints, except to ensure the patient's safety in emergency situations). They also describe the procedures to follow to restrain a patient, including who orders the restraints, when to write the order, and how often to renew the written order. Restraints can be used (1) only to ensure the physical safety of the patient or other patients, (2) when less restrictive interventions are not successful, and (3) only on the written order of a health care provider (TJC, 2014). The regulations also describe documentation of restraint use and follow-up assessments. Enclosure Bed/Side Rails The determination as to whether or not side rails would be considered a restraint is based on “intent.” Therefore: if the intent of raising the side rails is to prevent a patient from voluntarily getting out of bed or attempting to exit the bed, the side rails would be considered a restraint. If the intent of raising the rails is to prevent the patient from inadvertently falling out of bed, then it is not considered a restraint. Also, if a patient does not have the physical capacity to get out of bed regardless if side rails are raised or not, then the use of side rails is not considered a restraint.
Use of an enclosure bed or net bed that preventions the patient from freely exiting the bed is considered a restraint. An exception is the use of an enclosed crib for infants and/or toddlers. Hand Mitts Hand mitts would be considered a restraint if: 1) The mitts are pinned or otherwise attached to the bed/bedding or wrist restraints are used in conjunction, and/or 2) The mitts are applied so tightly that the patient's hands or finger are immobilized, and/or 3) The mitts are so bulky that the patient's ability to use their hands is significantly reduced, and/or 4) The mitts cannot be easily removed intentionally by the patient in the same manner it was applied by staff considering the patient's physical condition and ability to accomplish the objective. If the mitts meet any of the above criteria, it would be considered a restraint. State Statutory Issues in Nursing Practice Licensure A State Board of Nursing or Nursing Commission licenses all RNs in the state in which they practice. The requirements for licensure vary among states. All states use the National Council Licensure Examinations (NCLEX®) for RNs and licensed practical nurse examinations. Licensure permits people to offer special skills to the public, and it also provides legal guidelines for protection of the public.