Restraints

This template is helpful in identifying and altering the antecedent and consequences to change behaviour. Registered Nurses’ Association of Ontario. (2012). Appendix L of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 113). Source: Omelan, C. (2006). CME: Approach to Managing Behavioural Disturbances in Dementia. Canadian Family Physician, February, 52, p. 193 Reprinted with permission from the Canadian Family Physician

This decision tree from The Ottawa Hospital provides a visual decision making guide to determine risk and restraint alternatives. Registered Nurses’ Association of Ontario. (2012). Appendix N of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author. (page 116).  All requests to adapt the Alternative to Restraints Decision Tree must be directed to the Ottawa Hospital, Department of Nursing Professional Practice

The Behaviour Monitoring Log from Penn Nursing Science helps determine the meaning of untoward events through examining patterns of behaviours/occurrences. Registered Nurses’ Association of Ontario. (2012). Appendix M of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 114-115).  Adapted from: Strumpf, N., Robinson, E.J.P., Wagner, J.S., & Evans L.K. (1998). Restraint-Free Care: Individual Approaches for Frail Elders. New York: Springer Publishing, pp. 44-46. Reprinted with permission from Penn Nursing Science.

A sample Jeopardy game illustrates a fun way to evaluate learning.   Registered Nurses' Association of Ontario. (2014). Best practice Jeopardy: Alternative to restraints edition. Long-Term Care Best Practices Program, Toronto, ON.  

This tool is used to assess the residents’ level of confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects- as present or absent. Registered Nurses’ Association of Ontario. (2012). Appendix G of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 99-100). Source: Almvik, R. & Woods, P. (April 2003). Short-Term Risk Prediction. The Broset Violence Checklist. Journal of Psychiatric and Mental Health. Nursing, 10(2), pp. 236-238 Reprinted with permission from John Wiley and Sons

This tool is used to determine reasons caregivers attribute using physical restraints with the elderly. Registered Nurses’ Association of Ontario. (2012). Appendix K of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 108-110).  Developed by Lois Evans and Neville Strumpf (1986). University of Pennsylvania School of Nursing: revised 1990 & 2010. Website: www.nursing.upenn.edu  

This tool helps the resident and caregiver discuss individualized behavioural triggers and preferred measures of response. Registered Nurses’ Association of Ontario. (2012). Appendix T of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 125).  Reprinted with permission from St. Joseph`s Health Care. Hamilton, Ontario

The 5 questions in this tool are used to assess care preferences of patients if they become upset or have difficulty dealing with emotions. Registered Nurses’ Association of Ontario. (2012). Appendix I of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 102-103).  Copyright NY State Psychiatric Institute, Reprinted with permission from David J. Hellerstein, MD.

These tips and interventions help caregivers to examine their own practices and best strategies to prevent escalation of behaviours. Registered Nurses’ Association of Ontario. (212). Appendix U of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 126-127). Provided by the Milwaukee County Mental Health Division, Milwaukee, WI. Adapted from Dr. Gudeman's Interaction with Patient on Interventions with De-Escalating Patient 10/99

This debriefing tool provides examples of questions to ask the resident after they have been restrained or secluded. Registered Nurses’ Association of Ontario. (2012). Appendix X of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 139).  Used with permission: Stone Institute of Psychiatry, Northwestern Memorial Hospital Chicago, IL

This interview guide Subjective Experience of Being Restrained (SEBR) can be used with patients in hospital and then in nursing homes. Registered Nurses’ Association of Ontario. (2012). Appendix E of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author. (pp. 94-96).  Copyright 1986 University of Pennsylvania School of Nursing  

This assessment tool is used primarily by mental health professionals to “estimate” a persons’ probability of violence. Registered Nurses’ Association of Ontario. (2012). Appendix H of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 101).  Reprinted with permission from Ronald Roesch, Professor, Director of Mental Health Law and Policy Institute, Simon Fraser University  

The Mutual Action Plan (MAP) takes into account the resident's individual style of learning and communicating. Registered Nurses’ Association of Ontario. (2012). Appendix O of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 117-118). MAP Behavioural Profile - Draft 2009/11/18 adapted from: Safe Management Group Inc. 2008. Copyright 2009, Ontario Shores Centre for Mental Health Sciences. All rights reserved. Reproduction in whole or in part by any means without written consent of Ontario Shores is prohibited by law.

This observation and documentation record is when chemical restraints, seclusion and/or mechanical restraint are used. Registered Nurses’ Association of Ontario. (2012). Appendix W of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 131-138).  Copyright Centre for Addiction and Mental Health (2009). This material is prepared solely for internal use at CAMH. No part of this document may be reproduced in any form for publication without the permission of CAMH.

Organizational data collection tool that can be used when restraints are used as a “last resort”. Registered Nurses’ Association of Ontario. (2012). Appendix Y of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 140-142).  All requests to use or adapt the Appendix Y, Organizational Audit Form must be directed to the Ottawa Hospital, Department of Nursing Professional Practice for permission.

This individualized de-escalation plan considers cause and effect and solutions focused on the resident’s strengths. Registered Nurses’ Association of Ontario. (2012). Appendix R of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 122-123).  Reprinted with permission from The Massachusetts Department of Mental Health  

A tool to assist with comparing your organization’s current practice with evidence-based RNAO best practice recommendations. Registered Nurses Association of Ontario (2022). Opportunity Analysis Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, ON.

This link takes you to the University of Iowa Geriatric Education Center website that provides you access to multiple resources. Follow the link to publications in infoconnect for restraint-free resident care. McKay, S. (n.d.). Info-connect: Restraint-free resident care. University of Iowa Geriatric Education Center.   

This document outlines interventions that can be used with residents exhibiting signs of aggression, disorientation, frequent falls and or inappropriate behaviours. Registered Nurses’ Association of Ontario. (2012). Appendix P of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 119-120).  Used with permission from Caressant Care

This tool helps the resident identify their responses to stress and their individualized coping strategies. Registered Nurses’ Association of Ontario. (2012). Appendix S of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 124).  Copyright Centre for Addiction and Mental Health (2008). Reprinted with permission from CAMH

This tool evaluates the client risk and treatability related (i.e. violence, self-harm, suicide, absconding, substance use, self-neglect, and victimization). Registered Nurses’ Association of Ontario. (2012). Appendix F of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (pp. 97-98). Reprinted with permission from British Columbia Mental Health & Addiction Services

This decision tree can be used to this determine if a siderail is a restraint or if alternatives are available. Registered Nurses’ Association of Ontario. (2012). Appendix Q of Promoting Safety: Alternative Approaches to the Use of Restraints. Toronto, Canada: Author.  (p. 121).  Source: Talerico, K. & Capezuti, E. Myths and Facts About Side Rails: Despite Ongoing Debates About Safety and Efficacy, Side Rails Are Still a Standards Component of Care in Many Hospitals. So How Do You Determine Their Safe Use? AJN: American Journal of Nursing, Volume 101, Issue 7, pp. 43-48. Reprinted with permission from Wolters Kluwer Health