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Least Restraint Programs . Presented by: Shirley L Robinson Leisureworld North Bay Family Council. Definition & Policy Direction. Policy Direction: Least Restraint Least restraint means all possible alternative interventions are exhausted before deciding to use a restraint.

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least restraint programs

Least Restraint Programs

Presented by:

Shirley L Robinson

Leisureworld North Bay Family Council

definition policy direction
Definition & Policy Direction

Policy Direction: Least Restraint

Least restraint means all possible alternative

interventions are exhausted before deciding

to use a restraint.

This requires assessment and analysis of what is

causing the behaviour. Most behaviour has meaning. When the reason for the behaviour is identified, interventions can be planned to resolve whatever difficulty the client is having that contributes to the consideration of restraint use.

For example, if a client has poor balance or is frequently falling, interventions, such as giving the client a walker, can be developed

to help protect the client’s safety while allowing

freedom of mobility.

A policy of least restraint indicates that other interventions have been considered and/or implemented to address the behaviour that is interfering with client safety.

  • What are Restraints?

Restraints are physical, chemical or environmental

measures used to control the physical or

behavioural activity of a person or a portion of

his/her body.

Physical restraints limit a client’s movement.

Devices such as a table fixed to a chair, tilt wheelchair or a bed rail that cannot be opened by the client,

are physical restraints. Environmental restraints

control a client’s mobility.

Examples include: a secure unit or garden, seclusion or a timeout room. Chemical restraints are any form of psychoactive medication used, not to treat illness, but to intentionally inhibit a particular behaviour or movement.

College of Nurses of Ontario Practice Standard: Restraints



A nurse in a long-term care facility is admitting

a client who has been transferred from a local

hospital. The facility has a least restraint policy

and for the past year has used no restraints. It

has a risk assessment protocol used on admission

to help staff determine an appropriate plan

of care that identifies behaviours that may

lead to consideration of restraint use.

Since implementing a least restraint policy,

the facility has found that falls have not increased. The falls that have occurred have resulted in significantly less injury. Additionally, the incident

of skin breakdown has declined by 50 percent.

The family is insisting that their mother be

restrained to protect her safety. They tell the

nurse that if they do not restrain their mother

and she falls, they will initiate legal action.


This situation, like many involving the use of

restraints, is an ethical dilemma. While nurses

respect client choice, limits do exist. As explained

in the Ethics practice standard, client choice might

be limited by policies that promote health or by the

resources available in a particular situation. When

clients request nurses to perform an act that may

cause serious harm, nurses need to inform clients in

a non-judgmental manner of the potential risks and

harm associated with the practice.

The nurse in this scenario needs to explore the

implications of the request. The family believes

that if no restraint is used, their mother’s safety

will be jeopardized. The nurse is able to provide

education about the risks of restraint use and

the alternatives available. If the family continues

to request that restraints be used, the nurse

respects the family’s choice but needs to explain

that because the facility has a no restraints

policy, it does not have restraints available or

the resources to use restraints safely. Knowing

this information, the family can then make

an informed decision about where to place

their mother. Client and family needs are best

met when these discussions occur before the

admission takes place.

College of Nurses of Ontario Practice Standard: Restraints

t eresa malotte rn assistant director of care
T eresa Malotte, RN & Assistant Director of Care

When first educated as management, rounds were done through the building and time was spent with the staff while they were on the units. Groups discussions were held about 15 - 20 min to discuss the changes as well as the policy, and each staff then signed their name to education sheets. Tracking was done to indicate who received the info.

A lot of one on one education was provided to staff on the topic. Information was covered at staff meetings and brought oo our charge nurse meetings as well. Quarterly are audits were done at the beginning, but only a percentage, now we do them all.

A review is done all the charts for those residents who have restraints. We ensure the consents and doctor orders are complete and current. We also check that the documentation is being done correctly. Our night staff check the restraint flow sheets and leave a memo for follow up. The managers then follow up with staff involved.


Friday April 3, 2009 -- Camille Jensen, Writer & Online Production

Editor (axiomnews.ca)A new video on Leisureworld’s policy to minimize restraints in its 26 long-term care homes is being created

in an effort to educate families on the importance of eliminating the use of restrictive devices.Developed by the education department in collaboration with a number of Leisureworld homes, the video

will dispel myths about the safety of restraints and showcase the more proactive approaches for resident safety.Beverly Zangari, staff educator with Preferred Health Care Services which provides education to Leisureworld, says the organization has adopted a least restraint minimization policy and wants families to be aware of some of the negative implications of restraints.

The video is encouraging greater communication with the resident's family to help Leisureworld staff learn more about the resident’s previous habits that can be incorporated into their care plan.

The filming of the video took place at five Leisureworld homes — Richmond Hill, Scarborough, Tullamore, O’Conner Court and St. George — and features directors of administration and care, front-line staff and family members sharing their experiences on the subject.

“The video is going to give many, many sides of the story of why zero restraint or restraint reduction is the goal of Leisureworld and making sure at the same time that the resident is as safe as possible.”

Ruth Ramirez, communications specialist for Preferred Health Care Services and Leisureworld, produced the film and says the many testimonials gathered will send a powerful message on the need to find other ways to support residents.Once completed, Ramirez says the video will be used with families and at family council to help more people understand the need to decrease the use of restraints.

Used by permission received from C. Jensen axiomnews.ca Apr.23/09

end of presentation

For more information and additional articles see our back info table for copies of more Least Restraint Articles profiled in the March 2009 Ontario Long Term Care Magazine.

Thank you to OLTCA for permission to copy.

You can also go the OLTCA Website if you wish to see contents of all of the March 2009 Magazine.


End of Presentation

Thank you for the opportunity to share this information with all of you!

College of Nurses of Ontario Practice Standard: Restraints