What Is a Mitten Restraint?
A mitten restraint is a large, soft, padded glove designed to cover a patient's hand. The defining feature of this device is its thumbless construction, which prevents the patient from grasping or picking at objects. A mitten restraint is not intended to immobilize the arm but rather to hinder the patient's ability to manipulate items with their fingers. This is particularly useful for patients who are confused, agitated, or impulsive, and may be prone to interfering with their own medical treatment. Examples of such behavior include pulling out IV lines, catheters, or feeding tubes, or scratching wounds.
Unlike more restrictive options like wrist or vest restraints, mitten restraints are considered a less invasive intervention. In many healthcare policies, they are categorized as a lower tier of restraint, to be considered before progressing to more restrictive measures. However, even as a 'less restrictive' option, their application must always be justified by a clear medical need and should only be used after all other alternatives have been exhausted.
Types of Mitten Restraints
Healthcare providers have a variety of mitten restraint types available, chosen based on patient needs and facility protocols. Some common variations include:
- Padded Mitts: These feature soft padding, often fiber-filled, to protect the patient's hands from self-inflicted injury and provide comfort. They are commonly secured with hook-and-loop fasteners or tie straps.
- Mesh Mitts (Peek-a-Boo Mitts): These include a mesh back for breathability and allow for visual inspection of the patient's hands without removing the mitt. Some feature a dedicated inspection flap.
- Finger Separator Mitts: Certain designs incorporate internal finger separators to provide additional control and prevent the patient from forming a fist. These are often used for patients with a history of skin integrity issues.
- Lockable Mitts: In more extreme circumstances, some mitts are designed with magnetic or friction buckle lock systems to prevent the patient from removing them independently.
Ethical and Legal Guidelines for Use
The use of any physical restraint in a healthcare setting is a serious matter, and strict ethical and legal considerations govern its application. Healthcare staff must adhere to regulations set by bodies such as The Joint Commission and the Centers for Medicare & Medicaid Services (CMS).
Physician's Order and Consent
Except in an emergency, the application of a mitten restraint requires a physician's explicit order. This order must clearly state the medical reason for the restraint, the specific type to be used, and the duration. Informed consent should be obtained from the patient or their surrogate, who must be fully informed about the reason for the restraint and what needs to happen for it to be removed.
The 'Least Restrictive' Principle
One of the core principles of restraint use is the requirement to use the least restrictive device possible. This means a mitten restraint should be considered before a wrist restraint, and non-restraint alternatives should be attempted first. The restraint should never be used for staff convenience or as a form of punishment.
Proper Application and Monitoring
Correct application is critical to prevent injury and ensure patient safety. Caregivers must ensure the restraint is not too tight, checking that at least two fingers can fit between the strap and the patient's wrist to prevent circulation restriction. Continuous monitoring of the patient is required, including checking skin integrity, circulation, and the patient's overall well-being.
Mitten Restraints vs. Other Physical Restraints
| Feature | Mitten Restraint | Wrist Restraint | Vest Restraint |
|---|---|---|---|
| Restrictiveness | Least restrictive; allows arm movement but prevents grasping. | More restrictive; immobilizes or limits arm movement at the wrist. | Most restrictive; limits torso and upper body movement. |
| Primary Purpose | Prevent grasping or picking at medical devices and self-harm. | Limit movement of one or more limbs to prevent pulling lines or injury. | Prevent unassisted bed or wheelchair exits and dangerous falls. |
| Use Case | Confused or impulsive patients who pick at catheters or dressings. | Patients with aggressive or violent tendencies requiring full limb control. | Patients at high risk of falling or exiting a bed/chair unsafely. |
| Associated Risks | Skin irritation, agitation, physical deconditioning. | Higher risk of psychological distress, injury, and circulation issues if applied incorrectly. | Risk of strangulation, serious injury, or death if not monitored and applied properly. |
Alternatives to Mitten Restraints
Before resorting to any form of restraint, healthcare providers must explore and document less restrictive alternatives. These interventions aim to de-escalate situations and manage patient behavior without physical limitation.
- Enhanced Monitoring: Increasing the frequency of check-ins, moving the patient closer to the nurse's station, or assigning a sitter for constant observation can be effective.
- Distraction and Redirection: Providing patients with engaging activities or objects can keep their hands busy and divert their attention. Examples include activity aprons, fidget toys, or plush items.
- Environmental Adjustments: Reducing environmental stimulation, such as excessive noise, can calm agitated patients. Ensuring the environment is safe and familiar can also help.
- Bed and Chair Alarms: Electronic alarms can alert staff if a patient attempts to get out of bed or a chair, allowing for immediate intervention without physical restraint.
- Camouflaging Tubing: Covering or hiding visible tubes and lines can reduce a patient's impulse to pull at them.
- Pain Management: Pain can be a significant trigger for agitation. A thorough pain assessment and treatment can often resolve the underlying issue driving unsafe behavior.
Risks and Benefits of Mitten Restraints
Benefits
- Preventing Self-Harm: Mittens are effective at stopping patients from scratching themselves or exacerbating existing wounds.
- Ensuring Treatment Continuity: They prevent the patient from pulling out essential medical devices, ensuring that life-saving treatment is not disrupted.
- Reducing Sedation: In some cases, using a low-restrictive restraint like a mitten can reduce the need for sedative medications to manage a patient's agitation.
Risks
- Psychological Distress: Being physically restrained can cause fear, anxiety, anger, and increased agitation in patients.
- Physical Effects: Prolonged use can lead to physical deconditioning, reduced mobility, and, if improperly fitted, pressure injuries or poor circulation.
- Misapplication: Improperly secured mitts can potentially cause injury or, if the patient can remove them, may negate their purpose.
Conclusion
A mitten restraint is a specific type of medical device used in healthcare settings to protect patients from self-harm and prevent the disruption of essential medical treatment. While considered a less restrictive option than other physical restraints, its use is guided by strict ethical principles, legal standards, and patient safety protocols. The application of a mitten restraint is always meant to be a last resort, following thorough attempts at less restrictive alternatives. By understanding what is a mitten restraint and adhering to proper protocols for its application, healthcare providers can ensure patient safety while minimizing the negative physical and psychological impacts of restraint. Responsible and ethical use of this tool requires a continuous focus on the patient's dignity, autonomy, and well-being.
Learn more about ethical guidelines regarding medical restraints from the AMA Code of Medical Ethics.
