Alternatives for
Physical Restraint
An Algorithm

Photo reprinted by permission
American Journal of Nursing February 1995

The University of Texas MD Anderson Cancer Center Restraints Improvement Group

Beverly Mitchell RN, Joni Herman RN, Eden Bautista RN,
Anna Mathew RN, Tracy Chien RN, Sara John RN,
Anna Cherian RN, Mary Zacharih RN, Angela Arnold RN,
Sirene Parreno RN, Maria Bunagan RN, Uselyn Deary RN,
Gayle Balmaceda RN, Marian Wilson RN, Monique Vincent RN,
The Quality Improvement Team,
The Education Team,
MICU & SICU Staff,
Gregory Botz MD, Olivier Wenker MD

The correct citation of this article for reference is:

The University of Texas MD Anderson Cancer Center Restraints Improvement Group: Alternatives for Physical Restraint; An Algorithm. The Internet Journal of Advanced Nursing Practice 1999; Vol3N1: http://www.ispub.com/journals/IJANP/Vol3N1/algorithm.htm ; Published July 1, 1999. Last Updated July 1, 1999.

Rule:

TREAT OR ELIMINATE CAUSES FOR ABNORMAL BEHAVIOR. THE STANDARD OF PRACTICE IS NON- RESTRAINT EXCEPT UNDER UNIQUE CIRCUMSTANCES AFTER EXHAUSTING ALL REASONABLE ALTERNATIVES.

Algorithm:

ASSESS PHYSICAL FACTORS

• AGE
• COGNITIVE LEVEL
• SLEEP PATTERN
• NUTRITION: THIRST /
• HUNGER
• TOUCH
• COMFORT
• PHYSICAL ACTIVITY
• EVALUATE RISK FACTOR AND ANTICIPATE NEED
• PROMOTE NORMAL SLEEP PATTERN
• MEET NEEDS OF THIRST AND HUNGER OR SUBSTITUTE OTHER ALTERNATIVES IE. ICE CHIPS
• THERAPEUTIC TOUCH
• PAIN MANAGEMENT
• ROM/PHYSICAL ACTIVITY
• TO CHAIR AND CHANGE POSITION EVERY 2 HOURS

ASSESS ENVIRONMENTAL FACTORS

• NOISE/TALKING
• LIGHTING
• PLACEMENT OF BED
• ARRANGEMENT OF EQUIPMENT
• TEMPERATURE
• UNFAMILIAR OBJECTS
• DECREASE NOISE LEVEL TAPE FAMILY VOICES/MUSIC
• KEEP DAY/ NIGHT LIGHT PATTERN
• VISUAL CONTACT OF PATIENT
• KEEP EQUIPMENT OUT OF VIEW
• UTILIZE BLANKETS/ FANS AS NEEDED
• RELIGIOUS OBJECTS, PILLOWS AND BLANKETS FROM HOME

ASSESS PSYCHOLOGICAL FACTORS

• ANXIETY/FEAR
• FATIGUE
• DEPRESSION/GRIEF DENIAL
• PARANOIA/MANIA
• BOREDOM
• COMMUNICATION BARRIER
• STRESS:POSTOPERATIVE HOSPITALIZATION
• SOCIALIZATION
• KEEP INFORMED AND EXPLAIN PROCEDURES
• REST PERIODS
• CONSIDER ANTI-DEPRESSANTS AND RE-EVALUATE MEDICATIONS
• OFFER TV / RADIO
• LANGUAGE INTERPRETER UTILIZE FAMILY AND FRIENDS/ HEARING AIDS/GLASSES
• EXPLORE COPING MECHANISM, REAFFIRM PLAN OF CARE
• FREQUENT REALITY ORIENTATION, INTRODUCE TEAM MEMBERS
• SUPPORT FAMILY VISITATION

ASSESS PATHO-PHYSIOLOGICAL FACTORS

• ALTERATION IN CNS
• PULMONARY ABNORMALITIES
• SYSTEMIC INFECTIVE PROCESSES
• METABOLIC DISTURBANCE
• DRUG INTOXICATION: THERAPEUTIC AND SUBSTANCE ABUSE
• ENDOCRINE DISTURBANCES
• NUTRITIONAL DEFICIENCIES
• FREQUENT ORIENTATION
• NEURO ASSESSMENT
• MAINTAIN AIRWAY AND ADEQUATE OXYGENATION
• TREAT INFECTION/ TEMPERATURE
• TREAT ELECTROLYTE ABNORMALITIES
• REVIEW MEDICATION AND LOOK FOR SYNERGISTIC REACTIONS. TREAT WITHDRAWAL
• TREAT ENDOCRINE IMBALANCES
• NUTRITIONAL SUPPORT

References:

Physical Restraints of Critically Ill Patients, A Human Issue; Psychosocial and Environmental Considerations in Critical Care. Critical Care Clinics of North America. Jean Oritz-Pruitt RN,MN,CCRN, CNRN Vol. 7 Num. 2 June 1995 p. 370

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