Restraints, The Difficult Decision. Diehl P. Westport, Jacoby/ Storm Productions, Ine, for the JB Lippincott Company, 1986.
This excellent series consists of five video tapes that address different aspects of the knowledge and skills needed to safely apply restraints. An instructor's guide is included, giving learner objectives for each tape, important discussion points, and case studies. Examples of documentation records, illustrations of restraints and knots, and a posttest with answers for each tape are also in the guide. The tapes are brief enough to allow discussion during inservices with staff.
The author states this series is intended for use in acute care hospitals or skilled nursing facilities and not for psychiatric or long-term institutionalized patients. While no case illustrations are given of the latter, the principles should apply in any setting.
A multiethnic staff and patients makes the tape appealing. All age groups are represented. Emphasis on alternatives for avoiding use of restraints, is possible, is repeated throughout.
Tape 1: Overview (15 minutes) describes assessment, how to safeguard the patients' welfare, and the purposes of restraining if alternatives fail. The dangers of their use, other precautions, the importance of documentation, and reasons for discontinuing use are explained and illustrated.
Tape 2: Assessment and Documentation (17 minutes). The factors for use are further described, as well as nursing actions and documentation. Nursing conferences to discuss the decision to restrain and case studies are presented. Family members are encouraged to participate in the decision.
Tape 3: Legal, Social, and Emotional (25 minutes). The legal factors of negligence, assault and battery, and actions of a prudent nurse are established with case illustrations. The social factors discussed include patients' rights and dependency needs that may threaten self-esteem. Emotional factors describe the trauma to staff that may result. Verbalization of fears of combative patients and the use of mentors for new nurses are proposed.
Tape 4: Restraining Adults (17 minutes) presents practical points about equipment, tying knots, and types of restraints. Specific reasons for application, possible reactions of patients, and nursing care are given in detail. In addition, the need for documentation and the decision to remove restraints are reinforced. A flaw in this presentation surfaces when the use of bed linens is. However, reassurance is seen as essential to maintain the dignity of the patient.
Tape 5: Restraining Infants and Children (18 minutes) demonstrates the types of restraints, application, and reasons for use. Illustrations include both infants and older children. Conference are held with parents.
In summary, alternatives, decision making, mutuality, safety, and maintaining the dignity of the person and family are stressed. Basic knowledge and skills are presented. Policy modification in an individual institution is suggested. Although the use of restraints remains controversial, their use has not been eliminated from nursing practice. This program presents restraint use in the most safe, humane way possible.