Restraint Safety Lesson

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Class Period Length: 1 hour (students may begin the “you do” task during the lesson but complete it as homework)

Course: Nursing Education and all other Health Science courses 

Restraint Safety

STANDARD(s)

9) Accurately read and interpret policies and procedures for the following safety subjects aligned to the roles and responsibilities of a CNA. Participate in a facility safety training and apply the safety procedures in the classroom and clinical setting in order to prevent injury and provide safety for residents. Document completion of training topics on the appropriate work-based learning (WBL) and work site forms.

f. physical and mental restraints

OBJECTIVE

The student will be able to explain the policy and procedure for restraint use in the long-term care facility by creating a patient education artifact that explains restraints, reason for use, alternatives to restraints, physical/psychological problems associated with restraints, and resident’s rights.

TEACHER MATERIALS:

Prepared power point: Alternatives to Restraints computer for online discussion

STUDENT MATERIALS:

Course textbook, computer for online discussion and supplies (paper, pens, colored pencils) or computer for creation of the restraint artifact.

KEY POINTS

ASSESSMENT or EXIT TICKET

What (Knowledge):

the policy and procedure for restraint use

The patient/family education artifact will serve as exit ticket

How (Skills):

explain by creating a patient/family education artifact

Why (Real-World Relevance):

Medicare does not allow the use of restraints in LTC facilities. In order to protect patients and be in compliance with Medicare, all health care workers must know and understand restraint information and be able to keep patients safe without using restraints.

OPENING/DO NOW

Journal or chat entry: Have you ever thought about how it would feel to have all of your movements restricted so you could not scratch your nose or turn over if you were uncomfortable? How do you think that would make you feel?

INTRODUCING YOUR CONTENT (I DO)

Power Point with voice over script:

Okay we are going to talk about alternatives to restraints so since we can't restrain our patients in the nursing home, we can’t even put up a side rail because it’s considered restraints, We’re going to talk about some of the things we can do our patients stay safe without restraints.

So one of the things that we really want to make sure that we do in taking care of our patients' needs promptly. So we need to be aware when our patients may need something:

  •  we need to give them adequate food and fluid so they don't get hungry or thirsty because sometimes patients may get up and wander; they’re looking for food, 
  • they need to go to the bathroom 
  • we need to report signs and symptoms of pain promptly, we want to let supervisors know that, we want to let Med nurses know that, so that they can deal with that and take care of the patient 
  • we also want to make sure that we keep them positioned are appropriately and assist them with exercise 
  • We want to keep all those personal items nearby that they would use frequently. So if we put them up in a chair, put their table over their bed, or put their table near them so that they can get to their hearing aids, glasses, their telephone.  Many times patients fall getting up to answer a phone. So their telephone, call light, all those things that they may need... tissues the trash can 

So once we get our patients set up in a place that they're going to be for a while, make sure that they have all those necessary items with them. We always answer those call signals promptly, and that's what I was talking about if your patient needs to go to the bathroom. Make sure that we do that because sometimes they'll get up on their own and try to go to the bathroom and then and then, just check on them frequently. Sometimes you may walk in, and your patient hasn't called or used a signal lights, but they are getting up, and you can catch them if you just check on them frequently.

Also one of the ways that we can prevent the use of restraints is knowing the patients that are a fall risk and watch them carefully.  They are identified at Asbury, so we know what patients are falls risk, but honestly, anybody in a long-term care facility is probably a falls risk. We want to watch those people who are independent walkers and transfers. We still want to keep a good eye on them as well, because they’re conditions can change. They can have incorrect uses of equipment like walkers or a cane that we would want to report unsafe methods, so we can correct those. And report any physical or mental changes. Maybe our patients are not feeling well that day, and they are complaining of dizziness, or we see that they are disoriented. Maybe they're having some balance problems or coordination. We want to report any of those and take extra care for those patients, so they don't have any falls.

Also, we want to talk about ways that prevent the use of restraints. We want to maintain a safe, quiet, and calm environment for a residence. We talked earlier in this semester about overstimulation. Our patients can become agitated, so we need to kind of keep their environment quiet and calm.  Turn off that TV if it’s too loud, make sure there's no clutter, all that kind of stuff, and keep them comfortable, so that they won't want to leave or get up to change anything.  We want to provide them with comfortable chairs. If your chair is comfortable, then you will hopefully stay in that.  And then use security devices as needed. When you get to Asbury you will see different security devices that are in use, but they all make a similar-sounding alarm, so you need to kind of train yourself to hear that alarm and understand that when you hear that, it's a priority to get to that patient.

Some of the different alarms you may see would be a bed alarm; it alarms if a patient is getting out of bed or we have chair alarms that tells if a patient is getting out of the chair,  and we even have a called “wander mats” that tells if the patient steps on it, it can trigger the alarm. So all those are put in place for resident safety and for us to avoid using restraints. 

This slide is about promoting independence, and if you look there are a few scenarios that we're going to look at, and I'm going to give you some time to actually write down your thoughts in your notes about these scenarios. But while we are in the facility, we want to make sure that we're promoting as much independence as possible. We want to make sure our residents are helping as much as they can when we assist them with care. So the first point is encourage the resident to do as much as possible, so have them help you. Don't just automatically assume that you will do everything for the resident like with feeding or with denture care/dental care see what they can do, and then have them help. 

Your scenario here is: your resident cannot cannot independently brush their own teeth, so what could you do to promote Independence? So just jot down some things in your notes that you can do to promote that resident’s independence.

Allowing residents to make choices. This is very important that they feel that they are in control or they have a say in their own care and their environment.  So as is appropriate and as much as possible, allow them to make choices.

In this scenario, your resident has dementia and sometimes has difficulty making decisions, but how can you still offer choices?

And then we want to make sure that we're allowing our residents enough time to provide self-care. We don't want to rush through. You will have several patients that you will be helping with or are charged with caring with, but you want to give each resident time to process what they're doing and then also time to help you or help themselves with self-care. The scenario that goes with this is your resident is getting dressed and her lunch tray has arrived. What would you do to promote her independence in this situation? 

 

So make sure that you have written answers to your scenarios in your notes, and you should have no more than one page of notes

 

Students will (watch/process):

  • watch/listen to power point presentation on Patient Restraints, answer embedded questions, and take notes
  • read textbook content on restraints and take notes

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Stop and think or respond:

Another strategy for preventing falls is to give your patient a time-frame for when you will be back to check on them. For example, "Mrs. Jones, I am going to give another patient a shower right now. The shower will take about 30 minutes. I will be back to check on you when I am finished. Is there anything I can get you before I go take care of this shower?"

This reminds your patient that you are caring for others but have not forgotten them and they are reassured that you will return in a timely manner.

 

 

 

 

 

Stop and think or respond:

You are leaving your patient's room after providing a.m. care. What strategies do you need to use in order to prevent falls while you are gone?

Choose all answers that you would likely do.

  • Move personal items near the patient- phone, tissues, trash can, and call light.
  • Fill the water pitcher and place it on the patient's table.
  • Assess pain and report if applicable.
  • Explain that you will return and give the patient a time that they can expect to see you again
  • Tell the patient to be careful if they need to get up to use the restroom.
  • Report any changes in your patient's condition and make adjustments to provide for safety.

 

 

 

 

 

 

 

Stop and think or respond:

What types of security devices might you use to keep your patient safe?

  • All 4 side rails
  • bed alarm
  • wrist restraints
  • chair alarm
  • mat alarm

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Scenario 1: Your resident cannot brush her own teeth independently. She is unable to get up to the sink by herself and does not have fine motor skills to open the toothpaste but is able to hold the toothbrush. What could you do to promote independence? 

  • Set up supplies on her table, open the toothpaste, and provide standby assistance in case she needs additional help.
  • Take the patient to the sink where you have gathered her supplies. Open the toothpaste and provide standby assistance in case she needs additional help.

Scenario 2: Your resident has dementia and sometimes has difficulty making decisions. How can you still offer choices to him?

Choose all appropriate answers

  • Take the patient to the closet and let him look at all his clothes and decide on an outfit for the day.
  • Give the patient a choice between two different shirts and ask which he would like to wear.
  • Ask your patient what he would like to eat on his tray.
  • Ask your patient if he would like a bite of peas or potatoes.

Scenario 3: Your resident is getting dressed and her lunch tray has arrived. What would you do to promote her independence in this situation?

  • Assist her to put on her robe, eat lunch, and then finish dressing.
  • Put her lunch tray to the side and allow her time to finish dressing.
  • Ask her if she would like to finish dressing or eat lunch. Provide assistance to support her decision.

Stop and think or respond:

This presentation is specific to providing care for geriatric patients. How could these principles be applied to all patients?

What are some "big picture" takeaways that you could apply to pediatric patients? Adult patients? 

Are any of these strategies or principles of care applicable to all patients? Explain your answer.

Make sure to cover each question (4) in your answer. 

GUIDED PRACTICE (WE DO)

Teacher will (do): Lead a discussion either live or thru chat about the following questions:

  1. Why do you think patients are restrained?
  2. Is there ever a time when restraints are a good alternative to other safety measures?
  3. What are some problems restraints might cause?

Students will (watch/do):

Participate in the discussion

INDEPENDENT PRACTICE (YOU DO)

Teacher will (watch or assess):

Students will (do):

Assess the student’s artifact using a teacher made rubric appropriate for the type of artifact

Create a patient/family teaching tool (one-pager, infographic, etc.) that explains restraints, reason for use, alternatives to restraints, physical/psychological problems associated with restraints, and resident’s rights. Cite resources.

CLOSING

Teacher will:

Students will:

Review student artifacts looking for trends then create a “do now” for the next class meeting to form a better understanding about the students’ knowledge gaps for re-teaching purposes.

Finish patient education artifact and turn it in before the next class meeting

     
J. Bell, B. Everett. (2019) Alternatives to Restraints. [PowerPoint Slides]. Retrieved from https://edpuzzle.com/media/5ede5f442c5e913ef8236435