Medical restraints are interventions used in clinical environments to ensure patient safety when behavioral changes present a risk of harm. They are employed only after less restrictive methods have been attempted or deemed ineffective. Mitt restraints are a specific, less restrictive category of these devices, designed to prevent a patient from using their hands to interfere with medical care or injure themselves. The use of any physical restraint requires a physician’s order and continuous, careful monitoring by the healthcare team.
Defining Hand Mitt Restraints
A hand mitt restraint is a large, padded, soft, glove-like device that covers a patient’s hand. These devices are designed without individual finger slots, resembling a boxing glove or an oversized oven mitt. The primary purpose is to significantly reduce the dexterity and fine motor control of the fingers. Mitt restraints are typically secured around the wrist with straps, such as hook-and-loop fasteners or ties, to prevent the patient from removing them. They are considered less restrictive than full limb restraints because they allow arm movement while preventing the patient from grasping, scratching, or picking at things.
Clinical Reasons for Application
Mitt restraints are ordered when a patient cannot cooperate with necessary medical treatment and poses a risk to their own safety. The primary indication is to prevent the removal or disruption of life-sustaining or necessary medical equipment. This includes stopping a confused patient from pulling out intravenous (IV) lines, urinary catheters, or feeding tubes. Mitts are also used to protect the integrity of a surgical site or serious wound that the patient might otherwise pick at or scratch, which could lead to infection. Finally, in cases of severe confusion or altered mental status, mitts prevent self-injury, such as scratching the face or eyes.
Potential Adverse Effects and Safety Monitoring
Despite their protective intent, physical restraints introduce a number of serious risks and potential adverse effects for the patient. One of the most significant physical risks is impaired circulation to the hand and wrist if the securing strap is applied too tightly. This constriction can lead to tissue damage, nerve injury, or severe swelling, requiring immediate intervention. Another common complication is skin breakdown, friction burns, and pressure injuries, especially at the wrist where the mitt is secured.
The psychological impact of being restrained can be profound, often leading to increased fear, agitation, and emotional distress. In vulnerable patients, restraint use has been linked to an increased risk of developing or worsening delirium and may contribute to post-traumatic stress disorder (PTSD) in survivors of intensive care.
For these reasons, continuous and frequent safety monitoring is a mandated protocol when mitt restraints are in use. Nursing staff must perform regular checks, often specified as frequently as every 15 minutes to two hours depending on the facility and the patient’s condition. This monitoring includes checking the circulation of the restrained limb by assessing the color, temperature, and pulse of the hand and fingers. Staff must also assess the patient’s skin integrity for any signs of redness, swelling, or pressure damage. The mitts must be removed periodically for a brief period, typically every eight hours, to allow for skin care, range-of-motion exercises, and repositioning of the limb.
Alternatives to Physical Restraint
Healthcare providers must explore and implement alternative, less restrictive strategies before resorting to the use of mitt restraints.
Alternative Strategies
- A simple yet effective alternative is increasing the level of direct observation, either through continuous one-on-one “sitter” presence or moving the patient closer to the nursing station. This constant human presence can often de-escalate agitation and allow for immediate redirection.
- Environmental modifications can play a large role in prevention, such as optimizing pain management, lowering the bed, and ensuring adequate but non-disruptive lighting.
- Distraction techniques are valuable, especially for confused patients, and can involve providing stimulating activities like folding towels, playing soft music, or offering a comfort item to hold.
- Technology-based solutions, such as bed or chair alarms, can alert staff when a patient attempts to get up or move unsafely, thereby preventing falls and eliminating the need for a physical restriction.