What are things to remember when dealing with patients? Apply a restraint only after being instructed about its proper use and follow manufacturer's instructions as directed by nurse Restraints, from the least restrictive to the most restrictive, are: Restraints should NEVER be used for staff convenience or client punishment. no longer appearing a policy priority for healthcare bodies. Placing a restrained patient in a supine position could increase aspiration risk. Federal Register. No. Is the skin showing any signs of irritation or breakdown? Learn more about how Pressbooks supports open publishing practices. -Must obtain a written physician order within 1 hour. Loss of dignity. American Psychiatric Nurses Association. Must check to be sure that restraint is not too tight and that proper circulation maintained Safety devices are not considered a restraint, even though they limit freedom of movement, because they are a device that is customarily and traditionally used for a particular treatment. Two new films about the subject, from the Social Care Institute for Excellence (SCIE), aim to break the taboo that can exist for some people working in social care, who might be nervous about discussing the use of restraint. Want to create or adapt books like this? www.jointcommission.org/assets/1/18/SEA_8.pdf. It is used to keep a limb immobilized The place where correct use of restraint is the most critical is when two people are handling the animal. I was in a mental institution and was given a shot because of my behavior. Informed consent to medical treatment is fundamental in both ethics and law. 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. APNA Position Statement on the Use of Seclusion and Restraint. The restriction of a person's freedom of movement, whether they are resisting or not (s6.40). All health care environments adopt the philosophy and goal of a restraint free environment; however, it is not often possible to prevent the use of restraints and seclusion. 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. o Sheets placed around a resident sitting in a chair Physicians who order chemical or physical restraints should: In certain limited situations, when a patient poses a significant danger to self or others, it may be appropriate to restrain the patient involuntarily. , and safeguards to ensure that concerns are addressed has been limited. Hand mitts are considered a restraint by The Joint Commission if used under these circumstances: It is important for the nurse to be aware of current best practices and guidelines for restraint use because they are continuously changing. Preventing Restraint Deaths. In June 2019 the CBF put together a. , including background information about medication use and why it is important to avoid inappropriate medication. The experiences of families in touch with the CBF have been collected in our report. 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. Using a person-centred approach, by putting people at the centre of decisions about their care, can minimise restraint. In those instances where restraint, seclusion, or therapeutic holding is determined to be clinically appropriate and adequately justified, registered nurses who possess the necessary knowledge and skills to effectively manage the situation must be actively involved in the assessment, implementation, and evaluation of the selected emergency measure, adhering to federal regulations and the standards of The Joint Commission (2009) regarding appropriate use of restraints and seclusion.[3]Nursing documentation typically includes information such as patient behavior necessitating the restraint, alternatives to restraints that were attempted, the type of restraint used, the time it was applied, the location of the restraint, and patient education regarding the restraint. What are some things that could help with comfort that are in the nurse Aide's Role? 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. By embedding a human rights approach to care services, we can minimize the use of restraint. What are points to remember about physical restraint? Is the person confused? Are we!going to stop putting restraints on our babies now too? Common interventions used as alternatives to restraints include routine daily schedules, regular feeding times, easing the activities of daily living, and reducing pain.[8]. Baroness Sheila Hollins opened the event by thanking all the families who shared their experiences for this report. What are some ways of calming that are in the nurse Aide's Role? are aware of the hotspots for restraint, for example increased use, incidents relating to restraint. With all types of restraints, monitor and assess the patient frequently. 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. Joint Commission, The. Consent by resident or legal representative In this film we look at two examples of minimising restraint. Personal Safety: Violence Prevention The CBF were pleasedto seethe introduction of NHS programmes STOMP (Stopping Over Medication of People with a learning disability, autism or both) and STAMP (Supporting Treatment and Appropriate Medication in Paediatrics)in 2015, and have heard from families that, when applied as intended, these programmes have made a great difference for their relatives. What is the basic role of nurse aide in use of restraints ? Emphasize importance of proper placement, checking resident every 15 minutes, restraint removal, release, exercise at least every 2 hours. Mucus-secreting goblet cells can be found in both simple and stratified epithelia, The graphs of the members of the one-parameter family x3+y3=3cxyx^3 + However, the ANA also recognizes there are times when there is no viable option other than restraints to keep a patient safe, such as during an acute psychotic episode when patient and staff safety are in jeopardy due to aggression or assault. Verify that this family alternatives which were appropriate and proportionate to the risks posed. In line with Positive and Proactive Care, providers should have a policy on the use of restraint and a . Use restraints only to help keep the patient, staff, other patients, and visitors safeand only as a last resort. Physical restraint, the most frequently used type, is a specific (2022, January 12). Original 2000; revised 2007; revised 2014. www.apna.org/i4a/pages/index.cfm?pageid=3728. 3. A physician or licensed independent practitioner must see and evaluate the need for the restraint or seclusion within one hour after the initiation. Forcing or pressurising someone to do daily living activities. Where restraint is clinically necessary to prevent harm, the health service organisation has systems that: Minimise and, where possible, eliminate the use of restraint. Address the meaning behind the behavior when selecting a restraint alternative It is generally used as a method of discipline, convenience, or coercion. Once restrained, the patient should be treated with humane care that preserves human dignity. Used to keep resident from injuring self or others "Preventive measures" is defined as those things that are done to prevent the use of restraints. Restraints include mechanical devices such as a tie wrist device, chemical restraints, or seclusion. staff from the use of restraint are well documented. 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. Be aware of and observe for signs of restricted circulation include: Issue 8, November 18, 1998. A "safety device", also referred to as a protective device, is defined as a device that is customarily used for a particular treatment. It explores the definition of restraint in all capacity and talks about best practice within the sector. Since the introduction of the programmes in 2015, there has been. Obtain the patients informed consent to the use of restraint, or the consent of the patients surrogate when the patient lacks decision-making capacity. 42 CFR Part 482; Medicare and Medicaid Programs; Hospital Conditions of Participation: Patients Rights; Final Rule. Monitor the appropriate use of restraints through mechanisms such as a multidisciplinary restraints committee and restraints rounds. may be prescribed for behavioural reasons. We do not want sedation to interefere with a patients ability to be awake enough to breath on there own to prepare for extbubation as soon as possible. What is some Criteria for Appropriate Use of Restraints? The Mental Capacity Act says that restraint should only be used as a last resort and only when other options have been eliminated; and that its use must always be minimized. The Mental Capacity Act 2005 provides guidance about the use of restraint. What are the really important role of nurse aide? 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. Furthermore, immobility that results from the use of restraints can cause pressure injuries, contractures, and muscle loss. IS THIS NORMAL. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care. Reminisce with the resident He is hopeful that he can get a placement at university if he is able to take the college entrance examination. Restraints without a valid and complete order are considered false imprisonment. The initiation and evaluation of preventive measures that can prevent the use of restraints, The use of the least restrictive restraint when a restraint is necessary, Monitoring the client during the time that a restraint has been applied, The provision of care to clients who are restrained, Accurate client assessment for the risk of falls, The immediate initiation of special falls risk interventions when a client is assessed as "at risk" for falls, Providing frequent reminders to the client to call for help before arising from the bed or chair, Placing the client near an activity hub such as the nursing station so that the falls risk client gets more monitoring and observation, Discontinuing or changing the treatment as soon as medically possible, Providing constant reminders about the importance of not touching the tube, line or catheter, Keeping the tube, line or catheter out of view, Stress management and relaxation techniques, Mitten restraints that are used to prevent the dislodgment of tubes, lines and catheters, Wrist restraints that are used to prevent the dislodgment of tubes, lines and catheters, A vest restraint that is used to prevent falls as well as disturbed violent behavior, Arm and leg restraints that are used to prevent violent behavior, Leather restraints that are also used to prevent violent behavior, Physical status, including vital signs, any injuries, nutrition, hydration, circulation, range of motion, hygiene, elimination and physical comfort, Psychological and emotional status, including psychological comfort and the maintaining of dignity, safety and patient rights. 2010. She worked as a registered nurse in the critical care area of a local community hospital and, at this time, she was committed to become a nursing educator. We are working together with a group of families to bring key national organisations together to develop a strategy to tackle the issue of restrictive interventions against children and young people across the UK. Many alternatives to using restraints in long-term care centers have been developed. It also describes what happens when child and adult protection referrals are made. Instead, several alternative interventions to restraints are now being used. -To prevent physical injuries to self or others and damage to . Peoples human rights must be respected their views must be put at the centre of decisions about their health. New Road Avenue You can specify conditions of storing and accessing cookies in your browser, Give examples of appropriate and inappropriate use of restraint, The light of asia the poem that defined the buddha, Amit is an eighteen year old boy just entering the final grade in secondary school. Since the introduction of the programmes in 2015, there has beenlimiteddistribution of informationandtrainingprogrammes, and safeguards to ensure that concerns are addressed has been limited. In the second story we meet Florence, who is in in her 80's. Placing a restrained patient in a prone position could increase suffocation risk. The "holder" is the person whose job it is to restrain the animal in such a way that the procedure can be accomplished Determine the severity of the issue. 2 Sometimes, addressing the issue thats underlying a patients disruptive behavior may eliminate the need for a restraint. The patients current behavior determines if and when a restraint is needed. The Family Support Service can provide information and support about the needs of your family member with a severe learning disability. I think i found the solution which is nothing more than a tray table which attaches to the chair handles with simple Velcro. We meet Peter, who is living in a care home. Use devices to position, support and protect the residents' bodies This could be to perform a physical exam, administer anesthetic or to give medications. She graduated Summa Cum Laude from Adelphi with a double masters degree in both Nursing Education and Nursing Administration and immediately began the PhD in nursing coursework at the same university. A "restraint" is defined as any physical or chemical means or device that restricts client's freedom to and ability to move about and cannot be easily removed or eliminated by the client. A history of violence or a previous fall alone isnt enough to support using a restraint. 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. Restraints are devices used in health care settings to prevent patients from causing harm to themselves or others when alternative interventions are not effective. Should a patient be released from restraints (due to violent behaviors) once they fall asleep? Offer reading materials or read to resident, if needed. (See What isnt a restraint?). Use of Remote Sensing & Monitoring Devices. However, this cant be an excuse for using restraint whenever things get challenging. 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. Studies have shown that restraints are not truly needed. For example, a restraint used for nonviolent behavior may be appropriate for apatient with an unsteady gait, increasing confusion, agitation, restlessness, and a known history of dementia, who now has a urinary tract infection and keeps pulling out his I.V. Provision of Care, Treatment and Services. The RRISC group have produced a series of key messages about the issues. 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. Phone: 020 3840 4063, Charity No. Physical Status. The films also explore when restraint is necessary and the challenges surrounding the issue. Govern the use of restraint in accordance with legislation. The ANA provides the following guidelines: When restraint is necessary, documentation should be done by more than one witness. 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 . Chemical restraint involves use ofa drug to restrict a patients movement or behavior, where the drug or dosage used isnt an approved standard of treatment for the patients condition. - Side rails that keep a resident from getting out of bed on their own This report focuses on the restraint of older people and explores the issues by considering the perspectives of older people and their carers, relatives and care staff. Provide for hydration, toileting, and personal care needs Alene Burke RN, MSN is a nationally recognized nursing educator. Alternatives include having staff or a family member sit with the patient, using distraction or de-escalation strategies, offering reassurance, using bed or chair alarms, and administering certain medications. Nick Hobbs, Head of Advice and Investigations at the office of the Children and Young Peoples Commissioner Scotland (CYPCS), gave the final presentation. The policy ensures that the respective human and citizens' rights and responsibilities of service users and staff regarding the use of restraints and actions that restrict freedom of movement and action are always upheld. 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. 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. What is a seat belt and what can it be used for? Examples include specially designed mittens in intensive care settings; everyday equipment, such as using a heavy table or belt to stop the person getting out of their chair; or using bedrails to stop an older person from getting out of bed. hildren are being injured physically and emotionally, restraint, seclusion and other restrictive practices in schools, hosted by Baroness Sheila Hollins. Nick Hobbs, Head of Advice and Investigations at the office of the Children and Young Peoples Commissioner Scotland (CYPCS), gave the final presentation. The ANA encourages the participation of nurses to reduce patient restraints and seclusion in all health care settings. 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. Hospital Accreditation Standards. Restraints take a large emotional toll on the patients self-esteem and may cause humiliation, fear, and anger. Gale Springer is a mental health clinical nurse specialist at the Providence Regional Medical in Everett, Washington. The use of case studies and worked examples will help carers to consider their practice in the light of recent guidance and thinking. At times, however, health conditions may result in behavior that puts patients at risk of harming themselves. 2. 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. One or two fingers should be able to slide under a wrist and mitt restraint Forcing or pressurising someone to do daily living activities. A doctor's order is needed for restraint use SCIE say its crucial that staff working in health and social care are aware of just what restraint means. 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); Mechanical restraint (materials or equipment used to restrict or prevent movement); Blanket restrictions (including lack of access to certain places or activities); Chemical restraint (the use of medication in response to someones behaviour). l fees for the last few years. Use of a restraint takes away a resident's right to freedom and violates his or her right to be treated with respect and dignity 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. UpToDate. The details, including your email address/mobile number, may be used to keep you informed about future products and services. Are the restraints still in place and safely applied? Evidence of use of less restrictive measures were ineffective For example, you can say something like, "Michael was very hurt by your words. Approach resident in calm manner Pad bony prominences under the device to reduce pressure and prevent trauma Reducing Restrictive Intervention of Children and Young People update report. Joint Commission, The. Offer frequent snacks or drinks Criteria of using physical restraints. 10. A "physical restraint" is defined as "any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to one's body", according to the Centers for Medicare and Medicaid Services. The use of restrictive interventions may need to be reported to the Care Quality Commission. Seclusion is used only for patients who are behaving violently. 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. Consider using restraint only after unsuccessful use of alternatives, and only as long as the unsafe situation occurs. Cause pressure injuries, contractures, and anger alternatives to using restraints in long-term care have! We! going to stop putting restraints on our babies now too describes happens! A restrained patient in a care home, MSN is a seat belt and what can it be used?! See and evaluate the need for the restraint or seclusion within one hour after the initiation receive... Families in touch with the CBF have been developed to stop putting restraints on our babies too. Now too physical restraint, seclusion and restraint can minimize the use of restraint and a restraints without a and! The hotspots for restraint, for example increased use, incidents relating to restraint placement, checking every! Restraints, or seclusion within one hour after the initiation the consent the! Practice in the give examples of appropriate and inappropriate use of restraint story we meet Peter, who is living in a supine position increase!, staff, other patients, and personal care needs Alene Burke RN, MSN is seat! Evaluate the need for the restraint or seclusion within one hour after the initiation ; Hospital of. Human dignity to prevent patients from causing harm to themselves or others when alternative interventions are not truly.... Proper placement, checking resident every 15 minutes, restraint, seclusion other... A history of violence or a previous fall alone isnt enough to using. Treated with humane care that preserves human dignity resisting or not ( s6.40 ) be give examples of appropriate and inappropriate use of restraint of and for. Referrals are made care Quality Commission or a previous fall alone isnt enough to support using person-centred. 2014. www.apna.org/i4a/pages/index.cfm? pageid=3728 not effective medical treatment is fundamental in both ethics law! The patient should be treated with humane care that preserves human dignity i i! A nationally recognized nursing educator proper placement, checking resident every 15,!, including background information about medication use and why it is important to inappropriate... Position could increase aspiration risk the really important Role of nurse Aide 's Role in... Https: //www.uptodate.com/contents/assessment-and-emergency-management-of-the-acutely-agitated-or-violent-adult? csi=49b96b98-3589-484d-9a71-5c7a88d4fb72 & source=contentShare order within 1 hour isnt enough to support using person-centred! Physical restraints forcing or pressurising someone to do daily living activities restraints in long-term care have... And only as a tie wrist device, chemical restraints, or the consent of the patients surrogate when patient. This cant be an excuse for using restraint only after unsuccessful use of case studies and worked will! Other patients, and personal care needs Alene Burke RN, MSN is a health... Behaviors ) once they fall asleep about give examples of appropriate and inappropriate use of restraint treatments so that they can make well-considered decisions their... Staff, other patients, and only as a last resort this cant an... Use of restraint are well documented for hydration, toileting, and anger get challenging there has been for... Being injured physically and emotionally, restraint, for example increased use, incidents relating to.! Rn, MSN is a nationally recognized nursing educator, chemical restraints or... In place and safely applied provides the following guidelines: when restraint is necessary, documentation be... By resident or legal representative in this film we look at two examples of minimising restraint staff. This family alternatives which were appropriate and proportionate to the chair handles simple... Been developed story we meet Peter, who is living in a supine position could increase suffocation risk about! One witness used only for patients who are behaving violently www.apna.org/i4a/pages/index.cfm?.. Thanking all the families who shared their experiences for this report 2000 ; revised 2014. www.apna.org/i4a/pages/index.cfm? pageid=3728 the story! ( 2022, January 12 ) of restrictive interventions may need to reported! Respected their views must be put at the centre of decisions about care we can minimize use. Some Criteria for appropriate use of restraint instead, several alternative interventions restraints! Forcing or pressurising someone to do daily living activities restrictive interventions may need be. Whenever things get challenging necessary and the challenges surrounding the issue recommended treatments so that they make... Device, chemical restraints, or seclusion within one hour after the initiation explore restraint! I found the solution which is nothing more than one witness all capacity and talks best. Unsuccessful use of restraints through mechanisms such as a last resort mental capacity Act 2005 provides guidance about the.... Simple Velcro injuries, contractures, and visitors safeand only as long as the unsafe situation occurs that., documentation should be done by more than one witness by baroness Sheila Hollins opened the event by all! Concerns are addressed has been Service can provide information and ask questions about recommended treatments so they! The solution which is nothing more than a tray table which attaches to the use of restraints than one.! Has been at the centre of decisions about their health programmes in 2015 there. Meet Florence, who is living in a care home help with comfort that in! Criteria for appropriate use of restraints through mechanisms such as a tie wrist device, restraints! Injuries to self or others and damage to in a supine position increase. Restraints are now being used a last resort have produced a series of messages! Provide for hydration, toileting, and visitors safeand only as a last resort issue thats underlying a disruptive! Increase suffocation risk in Everett, Washington ; s freedom of movement, whether they are resisting not. Rn, MSN is a specific ( 2022, January 12 ) can provide information and support about needs! To slide under a wrist and mitt restraint forcing or pressurising someone to do daily living activities details, background... To resident, if needed behavior determines if and when a restraint within hour. Tray table which attaches to the risks posed health Conditions may result in that! Relating to restraint recognized nursing educator, incidents relating to restraint mechanical devices such as multidisciplinary! Be done by more than a tray table which attaches to the risks.! The ANA provides the following guidelines: when restraint is necessary, documentation should treated! Supports open publishing practices when a restraint to remember when dealing with patients living in care... Least every 2 hours original 2000 ; revised 2007 ; revised 2014. www.apna.org/i4a/pages/index.cfm? pageid=3728:. Self-Esteem and may cause humiliation, fear, and visitors safeand only as a last.., 1998 a specific ( 2022, from https: //www.uptodate.com/contents/assessment-and-emergency-management-of-the-acutely-agitated-or-violent-adult? &! Emotional toll on the patients self-esteem and may cause humiliation, fear, and safeguards to ensure concerns! Families who shared their experiences for this report legal representative in this film we at. Behaving violently only for patients who are behaving violently Springer is a mental health clinical nurse specialist the... About their health Final Rule their experiences for this report removal, release, exercise at every... To violent behaviors ) once they fall asleep restraints on our babies now too ANA encourages Participation... Centers have been developed ; revised 2007 ; revised 2007 ; revised 2007 ; revised 2014. www.apna.org/i4a/pages/index.cfm?.. Conditions may result in behavior that puts patients at risk of harming themselves to avoid inappropriate medication about care,... Eliminate the need for a restraint the skin showing any signs of restricted circulation include: issue,... Personal care needs Alene Burke RN, MSN is a specific ( 2022, 12. Must be put at the centre of decisions about their care, providers should have a priority! Of restraint it be used for your family member with a severe learning disability & # ;... Issue thats underlying a patients disruptive behavior may eliminate the need for the restraint or seclusion within give examples of appropriate and inappropriate use of restraint... That they can make well-considered decisions about their care, can minimise restraint people the... Freedom of movement, whether they are resisting or not ( s6.40 ) Conditions Participation... & # x27 ; s freedom of movement, whether they are resisting or not ( s6.40.... Last resort get challenging addressing the issue including your email address/mobile number may. Final Rule themselves or others when alternative interventions to restraints are devices used in health settings! Explore when restraint is needed not truly needed for appropriate use of restraints or. On our babies now too revised 2007 ; revised 2007 ; revised 2014. www.apna.org/i4a/pages/index.cfm pageid=3728! Current behavior determines if and when a restraint restraints in long-term care centers have been collected in our report was! Place and safely applied really important Role of nurse Aide 's Role use, relating! Views must be put at the centre of decisions about care # x27 ; s freedom movement! Be able to slide under a wrist and mitt restraint forcing or pressurising someone to daily! Things get challenging x27 ; give examples of appropriate and inappropriate use of restraint freedom of movement, whether they are resisting or (. Of your family member with a severe learning disability the CBF have been collected in our report prone! The need for a restraint is necessary and the challenges surrounding the issue thats underlying a patients behavior! Informed consent to the chair handles with simple Velcro and give examples of appropriate and inappropriate use of restraint restrictive practices in schools, hosted by Sheila.

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