Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Promoting Safety: Alternative Approaches to the Use of Restraints model for approach to care

   Prevention, Alternative Approaches & Assessment:

  • Client Safety: myths & truths; risk factors; psychological impacts
  • Cultural Contest, Harm Reduction Philosophy, Ethics
  • Assessment: algorithms/tool; prevention & safety strategies
  • Prevention Strategies:
    • Behaviour Support
    • Individualized Plan of Care
    • Understanding behaviour re unmet needs
    • Sensory teaching, self-soothing strategies
    • School/Curriculum & education programs

   Crisis Management & De-escalation Interventions:

  • Communication: cognitive impairment
  • De-escalation Techniques: emergency vs. non-emergency
  • Verbal/Non-verbal Diffusing Skills
  • Understanding the Crisis Escalation Process
  • Post-Crisis Activities: debriefing
  • Harm Reduction
  • Observation & Evaluation Practices

   Restraint Use as a Last Resort:

  • RN/RPN Scope of Practice
  • When All Other Alternatives Have Proven ineffective
  • Safe Use of Restraints: application; monitoring; tapering use; and discontinuation
  • Debriefing
  • Organization:
  • Culture, philosophy, policy
  • Quality improvement program