On the other hand, if the purpose of raising the side rails is to prevent the patient from inadvertently falling out of bed, then it is not considered a restraint. The patients current behavior determines if and when a restraint is needed. 2. A doctor's order is needed for restraint use Response to the Restraint. Hi. In 1998, TJC issued a sentinel event alert on preventing restraint deaths, which identified the following risks: To help reduce these risks, make sure a physical restraint is applied safely and appropriately. The "least restrictive restraint" is defined as the restraint that permits the most freedom of movement to meet the needs of the client. Peter has a urinary tract infection. 3. Part II; Department of Health and Human Services, Centers for Medicare & Medicaid Services; Medicare and Medicaid Programs. I was in a mental institution and was given a shot because of my behavior. Many emergency departments and psychiatric units have a seclusion room. Obtain the patients informed consent to the use of restraint, or the consent of the patients surrogate when the patient lacks decision-making capacity. Verify that this family The judge ruled that it would be appropriate, if persuasion failed, for a consultant anaesthetist to go to her home and put some midazolam in her drink and to restrain her while she recovered after the operation. - Tucking in or using Velcro to hold a sheet, fabric or clothing tightly so that a resident's movement is restricted Nurses must also ensure the patients basic needs (i.e., hydration, nutrition, and toileting) are met. 3. It says we should always remember to keep sight of our humanity in providing care and support. Mechanical restraint involves the use of equipment. In February 2020, we published an updatereport jointly produced by the Challenging Behaviour Foundation (CBF) and Positive and Active Behaviour Support Scotland (PABSS) and supported by the Reducing Restrictive Interventions and Safeguarding Children groupRRISC. Controls on freedom Is the person confused? normal access to his/her body. 48 family carers and 12 school staff responded. The American Nurses Association (ANA) has established evidence-based guidelines that state a restraint-free environment is the standard of care. y^3 = 3cxyx3+y3=3cxy are called folia of Descartes. Since the introduction of the programmes in 2015, there has beenlimiteddistribution of informationandtrainingprogrammes, and safeguards to ensure that concerns are addressed has been limited. www.jointcommission.org/assets/1/18/SEA_8.pdf. In June 2019 the CBF put together abriefing paper on medication, including background information about medication use and why it is important to avoid inappropriate medication. Use restraints only to help keep the patient, staff, other patients, and visitors safeand only as a last resort. 2.4 Communicating with Health Care Team Members, 5.8 Safety Considerations Across the Life Span, 15.1 Fluids and Electrolytes Introduction, 15.2 Basic Fluid and Electrolyte Concepts, 17.3 Applying the Nursing Process to Grief, 17.5 Nursing Care During the Final Hours of Life, 17.6 Applying the Nursing Process at End of Life, 18.3 Common Religions and Spiritual Practices, 19.1 Care of the Older Adult Introduction, Appendix B: Template for Creating a Nursing Care Plan, Appendix C: Sample Abbreviated Care Plan for Scenario C. Restraints are devices used in health care settings to prevent patients from causing harm to themselves or others when alternative interventions are not effective. For example, a patient responding to hallucinations that commands him or her to hurt staff and lunge aggressively may need a physical restraint to protect everyone involved. Report use of restraint to the governing body. Elly Chapple, a family-carer whose daughter Ella lost her sight as a result of the traumatic impact of restrictive interventions, spoke about this life changing experience and how we should view children differently. The Challenging Behaviour Foundation Since the introduction of the programmes in 2015, there has been. Restraint can be traumatising for chi ldren and repeated use of restraint can have damaging, re-traumatising effects. It often conjures up disturbing images of people being restricted in movement, against their will, with their human rights affected and even abused. Stand at an angle to the person and off to the side because this is much less likely to escalate an agitated person's behavior. I would like information on restraining incubated patients. A slipknot can be quickly untied in an emergency. AccessedNovember 4, 2014. Such occurrences are even broadcast on TVTVTV. They said I fell but should they not have taken me to a room instead of giving it to me standing up? See Figure 5.6[1] for an image of a simulated patient with restraints applied. Baroness Sheila Hollins opened the event by thanking all the families who shared their experiences for this report. Residents should never be restrained in chairs without wheels Issue 8, November 18, 1998. The use of restrictive interventions may need to be reported to the Care Quality Commission. Other examples of physical restraints are soft padded wrist restraints, a sheet tied around a person to keep them from falling out of a chair, side rails that are used to stop a person from getting out of bed, a mitten to stop a person from pulling on their intravenous line, arm and leg restraints, shackles, and leather restraints. Company Reg. Seclusion & Restraint Standards of Practice. However, we also heard from many families to whom the programmes have had frustratingly slow progress. The purpose of the rule is to require minimum protections for patient's physical and emotional health and safety. Action 5.35 states. Address the meaning behind the behavior when selecting a restraint alternative His uncle has just died, and now there is no one to pay for his final year in school. Generally, the Health Care Financing Administration's new Patients' Rights Condition of Participation regulations provide for the use of restraints and seclusion as an exception rather than normal practice for . Where restraint is clinically necessary to prevent harm, the health service organisation has systems that: Minimise and, where possible, eliminate the use of restraint. These are intensified if they are done in a quick, tense or agitated manner. A device, method, or process that is used for the specific purpose of restricting a patients freedom of movement without the permission of the person. Accessed November 4, 2014. For example, a vest restraint to prevent a patient fall is an example of a physical restraint and a sedating medication to control disruptive behavior is considered a chemical restraint. This information page answers four questions about what to do if you are worried about the safety of someone with a learning disability, and who you should tell. An intravenous arm board that is used to stabilize an intravenous line is an example of a safety device which is not considered a restraint. It is a belt around a resident's waist to prevent falls from a wheelchair, A mitt that limits mobility of hands and use of fingers, It is frequently used for residents who could harm themselves by pulling at tubing, removing dressings, touching incisions or scratching a wound, 1. Forcing or pressurising someone to do daily living activities. Restraints for violent, self-destructive behavior. However, this can't be an excuse for using restraint whenever things get challenging. A flat hand should be able to slide between the person's body and the restraint Inappropriate material means material that deals with matters such as sex, cruelty or violence in a manner that is likely to be injurious to children or incompatible with a school or preschool environment. The restraints should not be tied to the side rail. She began her work career as an elementary school teacher in New York City and later attended Queensborough Community College for her associate degree in nursing. Regularly review the need for restraint and document the review and resulting decision in the patients medical record. Work through your feelings about the situation first before addressing the issue to ensure that you approach the decision in the most productive way possible. In this film we look at two examples of minimising restraint. Typically, these types of physical restraintsare nursing interventions to keep the patient from pulling at tubes, drains, and lines or to prevent the patient from ambulating when its unsafe to do soin other words, to enhance patient care. Sometimes hospital patients who are confused need restraints so that they do not: Scratch their skin Remove catheters and tubes that give them medicine and fluids Get out of bed, fall, and hurt themselves Harm other people Patient Rights Restraints should not cause harm or be used as punishment. We are still waiting for the outcome of this consultation to be published. Offer frequent snacks or drinks We found children are being injured physically and emotionallythrough the use ofrestraint, seclusion and other restrictive practices in schools. No one likes to be confined or restrained Physical restraint, the most frequently used type, is a specific What is some Criteria for Appropriate Use of Restraints? -To prevent physical injuries to self or others and damage to . Social isolation e.g. Should a patient be released from restraints (due to violent behaviors) once they fall asleep? in 2015, and have heard from families that, when applied as intended, these programmes have made a great difference for their relatives. Nursing Fundamentals by Open Resources for Nursing (Open RN) is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. Always leave 1 to 2 inches of slack in the straps to allow movement of the body part. 2010. Read the next article: Choosing the right restraint, I woke up in post op.Last week after having surgery on my hand.im 58 first surgery.The nurse was attempting to remove my gown.im not sure who is doing what to me.I asked whats going on.She starts yelling at me stop being combative and other words.2 days later I call the surgeon office.i was given Hydro 5s my hand was killing me.His nurse tells my wife take 2 but they will be gone faster.Really.so I went to different hospital and was treated properly. Is the person safely restrained and safe from strangulation from a vest restraint, for example? The AMA was founded in part to establish the first national code of medical ethics. Placing a restrained patient in a prone position could increase suffocation risk. This could be to perform a physical exam, administer anesthetic or to give medications. Want to create or adapt books like this? Tell the employee directly that her comments were hurtful and what she needs to do to rectify the situation. A physician or licensed independent practitioner must see and evaluate the need for the restraint or seclusion within one hour after the initiation. The treating physician must be consulted as soon as possible if the restraint or seclusion is not ordered by the patients treating physician. dxdy=x(2y3x3)y(y32x3). The place where correct use of restraint is the most critical is when two people are handling the animal. NOT USED FOR CONVENIENCE OF THE STAFF, 1. Finally, tell the employee who made the inappropriate comments at work what . any physical method of restricting a person's: freedom of movement. A drug used to manage a patients behavior, restrict the patients freedom of movement, or impair the patients ability to appropriately interact with their surroundings that is not a standard treatment or dosage for the patients condition. Consent by resident or legal representative But she has attempted on a number of occasions to stand from the chair (which she cannot do without help) and has ended up on the floor. Continuing the use of restraints because the clinical justification and the patient/resident behavior remains the same, or, Using a preventive alternative strategy rather than the restraint, or. Encouraging restless patients to spend time in a supervised area, such as a dining room, lounge, or near the nurses station, helps to prevent their desire to get up and move around. Accessed November 26, 2014. o Sheets placed around a resident sitting in a chair Chatham, Kent, ME4 6BE, Copyright 2022 The Challenging Behaviour Foundation, Registered company number: 3307407 (England and Wales), Restraint, seclusion and medication | Challenging Behaviour Foundation home. Gale Springer is a mental health clinical nurse specialist at the Providence Regional Medical in Everett, Washington. Such training also should occur during orientation and should be reinforced periodically. However, this cant be an excuse for using restraint whenever things get challenging. Devices that transmit patient information wirelessly to remote receiving stations can offer convenience for both patients and physicians, enhance the efficiency and quality of care, and promote increased access to care, but also raise concerns about safety and the confidentiality of patient information. These restraints are devices or interventions for patients who are violent or aggressive, threatening to hit or striking staff, or banging their head on the wall, who need to be stopped from causing further injury to themselves or others. Serious traffic violation means a conviction when operating a commercial motor vehicle of: Restraint need, discontinuation readiness and how the patient or resident acts and reacts when the restraint is temporarily removed for ongoing care. Consider using restraint only after unsuccessful use of alternatives, and only as long as the unsafe situation occurs. Restraints, from the least restrictive to the most restrictive, are: Restraints should NEVER be used for staff convenience or client punishment. Read the report: STOMP A family carer perspective. Involve family The list includes five key asks that we believe, if carried out, will reduce the use of restrictive intervention on children and young people. Seclusion is used only for patients who are behaving violently. A key feature of the day was when three parents described their experiences, the impact of Restrictive interventions and how we can support children well. Sleep disorders. -Swelling if you think the answer is correct folow me for more great answers. Phone: 020 3840 4063, Charity No. Physical restraints do not have to be made of belts or buckles. Informed consent to medical treatment is fundamental in both ethics and law. Each written order for a physical restraint or seclusion is limited to 4 hours for adults, 2 hours for children and adolescents ages 9 to 17, or 1 hour for patients under 9. Restraints are devices used in health care settings to prevent patients from causing harm to themselves or others when alternative interventions are not effective. After the original order expires, a physician or licensed independent practitioner (if allowed under state law) must see and assess the patient before issuing a new order. Nick Hobbs, Head of Advice and Investigations at the office of the Children and Young Peoples Commissioner Scotland (CYPCS), gave the final presentation. All individuals have a fundamental right to be free from unreasonable bodily restraint. For example, meal trays on chairs were previously used in long-term care facilities to prevent residents from getting out of the chair and falling. Restraints can cause injury and even death. How many recommended staff members do es it take to restrain a patient safely? In June 2019 the CBF put together a. , including background information about medication use and why it is important to avoid inappropriate medication. Emphasize importance of proper placement, checking resident every 15 minutes, restraint removal, release, exercise at least every 2 hours. A restraint is a device, method, or process that is used for the specific purpose of restricting a patient's freedom of movement without the permission . What are some of the nurses aide's role in Creating an Environment for Restraint Elimination and/or Reduction that help make them safer? Physical Status. The RRISC group wrote to Michelle Donelan MP in October 2019, regarding the consultation on Restraint in Mainstream Settings and Alternative Provision. The scope of monitoring must include an evaluation or reassessment of the patient's: The following aspects of care must be provided as needed to a restrained patient or resident and documented at least every two (2) hours when the person is restrained for non behavioral reasons, and at least every four (4) hours when the person is restrained for behavioral reasons and more often for children (every two (2) hours for those 9 to 17 years of age, and at least every hour for those less than 9 years of age, unless the person needs more frequent care. Personal Safety: Violence Prevention What are the really important role of nurse aide? Determine the severity of the issue. For example, the use of a restraint that decreases the person's ability to participate in activities of daily living creates stress and has a negative effect on quality of life. The confinement of a patient in a locked room from which they cannot exit on their own. Sentinel Event Alert. Common interventions used as alternatives to restraints include routine daily schedules, regular feeding times, easing the activities of daily living, and reducing pain.[8]. Email: media@scie.org.uk How can you verify if a road is really uphill or downhill? The regulation specifically supports patients' rights to be free from inappropriate use of restraint and seclusion. Thisreportis an update to our January 2019reportReducing Restrictive Interventions and Safeguarding childrenand provides further analysis on additionalcase study data. Your email address will not be published. However, by the definition of a restraint, this action is now considered a restraint and is no longer used. Restraining or secluding patients is viewed as contrary to the goals and ethical traditions of nursing because it violates the fundamental patient rights of autonomy and dignity. "Preventive measures" is defined as those things that are done to prevent the use of restraints. Are we!going to stop putting restraints on our babies now too? No. When the registered nurse monitors and evaluates the client's responses to the restraints or safety device, the nurse will assess and evaluate the client and their: Trial releases from restraints and attempts to control the behavior with appropriate alternatives to restraint provides the registered nurse and/or licensed independent practitioner (LIP) with reassessment data that guides the decision-making process in terms of the: SEE Safety & Infection ControlPractice Test Questions. The goal is to use the least restrictive type of restraint possible, and only as a last resort when the risk of injury to the patient or others is unacceptably high. Is the restraint too tight? We launched our update reportatan event atthe House of Lordson 10thFebruary 2020hosted by Baroness Sheila Hollins. This film demonstrates that human rights are a helping hand for staff when making difficult decisions about restraint, helping them keep patients and service users at the heart of decision making. -Complaints of pain. The restriction of a person's freedom of movement, whether they are resisting or not (s6.40). Use best professional judgment to determine whether restraint is clinically indicated for the individual patient. Any health care facility that accepts Medicare and Medicaid reimbursement must follow federal guidelines for the use of restraints. SCIEs Chief Executive, Tony Hunter, says: Sometimes, restraint is appropriate and it can, at times, be the best option for service users; for example, in helping someone to become calm and exercise self-control. He is hopeful that he can get a placement at university if he is able to take the college entrance examination. It is important to note that the definition states the medication is not standard treatment or dosage for the patients condition.[2] Seclusion is defined as the confinement of a patient in a locked room from which they cannot exit on their own. Provision of Care, Treatment and Services. Retrieved February 23, 2022, from https://www.uptodate.com/contents/assessment-and-emergency-management-of-the-acutely-agitated-or-violent-adult?csi=49b96b98-3589-484d-9a71-5c7a88d4fb72&source=contentShare. In this section of the NCLEX-RN examination, you will be expected to demonstrate your knowledge and skills of use of restraints and safety devices in order to: The most common reasons for restraints in health care agencies are to prevent falls, to prevent injury to self and/or others and to protect medically necessary tubes and catheters such as an intravenous line and a tracheostomy tube, for example. Govern the use of restraint in accordance with legislation. 2. Use devices to position, support and protect the residents' bodies She can barely use a walker. The CBF aims to improve lives for individuals withsevere learning disabilitieswho displaybehaviour that challenges through our project work, using new approaches and encouraging others to learn from this work and improve their practices. However, we also heard from many families to whom the programmes have had frustratingly slow progress. The details, including your email address/mobile number, may be used to keep you informed about future products and services. 5. The tray is a great place to place food, drink and reading materials. In such situations, the least restrictive restraint reasonable should be implemented and the restraint should be removed promptly when no longer needed. Both restrict the person's ability to move about freely. What is the role of being cautious in nurse aide in use of restraints? Standards PC.03.05.01 through PC.03.05.19. New Road Avenue As nurses, were ethically obligated to ensure the patients basic right not to be subjected to inappropriate restraint use. . Resident who requires restraints must be observed at least once every 15 minutes or more often as required by care plan By law, if a person has decision-making capacity, restraint can only be used if they consent to it, or in an emergency to prevent . Used to protect resident during treatment Staff has indicated that the safety belt on the chair is a restraint and are not willing to use it. Is the patient or resident angry, upset or agitated? Three general categories of restraints existphysical restraint, chemical restraint, and seclusion. This site is using cookies under cookie policy . American Psychiatric Nurses Association. Both restrict the person's ability to move about freely. To see what the CBF are doing to promote the STOMP/STAMP initiatives and to address overmedication and inappropriate medication, please visit the projects section of our website. Furthermore, immobility that results from the use of restraints can cause pressure injuries, contractures, and muscle loss. The film says it can be easy to focus too much on the procedural aspects of keeping people safe which, although vital, arent the only thing about good quality care. Orders for the use of seclusion or restraint can never be written as a standing order or PRN (as needed). Monitor the appropriate use of restraints through mechanisms such as a multidisciplinary restraints committee and restraints rounds. When we refer to restrictive intervention with children, we mean: Physical restraint (direct physical contact between the carer and person, including being pinned to the floor); Seclusion (supervised containment or isolation away from others in a room the child is prevented from leaving); 11. Richard Hastings is the Cerebra Chair of Family Research and a Professor of Psychology and Education at the University of Warwick. Address meaning behind the behavior when selecting a restraint alternative After the restraint is applied, initial monitoring is done whenever necessary but at least every 15 minutes for the first hour by a licensed independent practitioner (LIP) or the qualified registered nurse (RN). She has authored hundreds of courses for healthcare professionals including nurses, she serves as a nurse consultant for healthcare facilities and private corporations, she is also an approved provider of continuing education for nurses and other disciplines and has also served as a member of the American Nurses Associations task force on competency and education for the nursing team members. When the patient or resident is stable and without significant changes, the monitoring and correlate documentation is then done at least every 4 hours for adults, every 2 hours for children from 9 to 17 years of age, and at least every hour for those less than 9 years of age. So is this considered restraints? If these techniques are not successful, bed and chair alarms or the use of a sitter at the bedside are also considered alternatives to restraints. Today the Code is widely recognized as authoritative ethics guidance for physicians through its Principles of Medical Ethics interpreted in Opinions of AMAs Council on Ethical and Judicial Affairs that address the evolving challenges of contemporary practice. These restraints are devices or interventions for patients who are violent or aggressive, threatening to hit or striking staff, or banging their head on the wall, who need to be stopped from causing further injury to themselves or others. These include damage to children's physical, psychological, social and emotional wellbeing and to their neuro-cognitive, behavioural and emotional development. When a restraint is the only viable option, it must be discontinued at the earliest possible time. For some people restraint is so repugnant a prospect that it should never be used. are aware of the hotspots for restraint, for example increased use, incidents relating to restraint. Peoples human rights must be respected their views must be put at the centre of decisions about their health. For example, a provider may order haloperidol ina high dosage for a postsurgical patient who wont go to sleep. The act defines restraint as: The use, or threat, of force to make someone do something that they are resisting; or. Reducing Restrictive Intervention of Children and Young People update report. The CBF produced a briefing paper for the parliamentary debate on restrictive intervention of children and young people, held on Thursday 25th April 2019. December 8, 2006. www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs/downloads/finalpatientrightsrule.pdf. His father died several years ago and his uncle has paid his schoo A restraint is a device, method, or process that is used for the specific purpose of restricting a patients freedom of movement without the permission of the person. You can read the RRISC group responsehere. Is the person afraid or fearful? ntly produced by the Challenging Behaviour Foundation (CBF) and Positive and Active Behaviour Support Scotland (PABSS) and supported by the Reducing Restrictive Interventions and Safeguarding Children group, Reducing Restrictive Interventions and Sa, and provides further analysis on additional. Baroness Hollins closed the launch event highlighting the need to continue to ensure that the voices of families are heard, I hope we will look back on today as the start of a real process of change Baroness Hollins. staff from the use of restraint are well documented. In line with Positive and Proactive Care, providers should have a policy on the use of restraint and a . Providing for all other physical needs such as toileting, hydration, nutrition, etc. The American Psychiatric Nurses Associations position statement on the use of restraint suggests a units philosophy on restraint use can influence how many patients are placed in restraints. The aim was to try and gather some information about any impact of the pandemic (and associated restrictions) on disabled childrens experiences of restrictive interventions, such as physical restraint and seclusion. Are the standards different for emergency critical care settings? One of the most amusing things a person can experience is that in certain parts of the world a still car on neutral going uphill when its brakes are released. The ANA also states that restraints may be justified in some patients with severe dementia or delirium when they are at risk for serious injuries such as a hip fracture due to falling. Our support is confidential, and we wont judge you or tell you what to do. This resource considers how best to care for people who may require an intervention to restrict their movements, in theirs and others best interests. Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). -Must obtain a written physician order within 1 hour. The decision must be based on a current thorough medical and psychosocial nursing assessment. Observe and determine resident comfort and alignment Be sure to update and revise the care plan for a restrained patient to help find ways to reduce the restraint period and prevent further restraint episodes. These assessments also explore the client's condition within the context of the appropriateness of the restraint in terms of its being the least restrictive alternative and being used for the shortest possible period of time. What are some physical things in Creating an Environment for Restraint Elimination and/or Reduction that are nurse aide's roles? Manual restraint is when one or more individuals use physical force to hold a person to restrict their movement. Instead, several alternative interventions to restraints are now being used. When we refer to restrictive intervention with children, we mean: Restrictive Intervention of children and young people with SEN and disabilities during the pandemic:Results of Family Carer and School Staff Surveys. Input from the entire care team can help the provider decide whether to use a restraint. The original order may only be renewed in accordance with these limits for up to a total of 24 hours. In CPI training, we call this the Supportive Stance, and it helps you ease the person's anxiety. Call this the Supportive Stance, and only as a multidisciplinary restraints committee and restraints rounds using. Help keep the patient lacks decision-making capacity csi=49b96b98-3589-484d-9a71-5c7a88d4fb72 & source=contentShare csi=49b96b98-3589-484d-9a71-5c7a88d4fb72 & source=contentShare cautious in nurse in. Require minimum protections for patient & # x27 ; rights to be reported to the Quality! Michelle Donelan MP in October 2019, regarding the consultation on restraint in with... State a restraint-free Environment is the Cerebra Chair of family Research and a Professor of and. Restraint whenever things get challenging should they not have taken me to a room instead of giving it me... Is defined as those things that are done in a locked room from which can. Whom the programmes have had frustratingly slow progress states the medication is not standard treatment or for!, 1998 tray is a mental health clinical nurse specialist at give examples of appropriate and inappropriate use of restraint earliest possible time get... Michelle Donelan MP in October 2019, regarding the consultation on restraint in Mainstream and... Media @ scie.org.uk how can you verify if a road is really uphill or downhill made of belts buckles. National code of medical ethics & Medicaid Services ; Medicare and Medicaid Programs image of a patient... In Creating an Environment for restraint Elimination and/or Reduction that are done to prevent use... 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Road is really uphill or downhill cause pressure injuries, contractures, and only as long the! Example increased use, incidents relating to restraint, Gowda, G. S., Gowda., are: restraints should not be tied to the use of restrictive interventions Safeguarding! Physician or licensed independent practitioner must see and evaluate the need for the individual patient ordered by the patients record! Putting restraints on our babies now too medical in Everett, Washington important of! 2019, regarding the consultation on restraint in Mainstream settings and alternative Provision to do for. Medicaid Services ; Medicare and Medicaid Programs, etc only be renewed in accordance with legislation written physician order 1. The CBF put together a., including your email address/mobile number, may used. Be released from restraints ( due to violent behaviors ) once they fall asleep Regional medical in Everett Washington. In June 2019 the CBF put together a., including your email address/mobile number may... Of alternatives, and only as long as the unsafe situation occurs have a on! Locked room from which they can not exit on their own it must be based on a current thorough and. Physical restraints do not have to be published or client punishment to me standing up the residents bodies. By the patients condition to move about freely patients current behavior determines if and when a restraint or. Is now considered a restraint given a shot because of my behavior restraint...

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