A nurse is caring for a client who is confused and attempts to climb out of bed. Which restraint alternative should the nurse try FIRST?

RESTRAINT ALTERNATIVES must be exhausted before physical restraints are applied. Restraints are a last resort because they carry significant risks: increased agitation, aspiration, pressure injuries, psychological trauma, and death. JOINT COMMISSION and CMS standards require documentation that alternatives were tried. ALTERNATIVES TO RESTRAINTS: (1) REORIENTATION: Speak calmly and frequently; orient to place, time, and situation; explain what's happening; (2) ENVIRONMENT SAFETY: Bed in lowest position; side rails up (usually 2-3 rails, not all four — 4 rails = restraint in many states); remove items the confused client could harm themselves with; (3) CALL LIGHT: Ensure it's accessible and the client knows how to use it; (4) CLOSE MONITORING: Move the client closer to the nurses' station; increase check frequency; (5) ADDRESSING UNMET NEEDS: Pain (confusion often stems from inadequately managed pain); bladder (urge to void causes many fall attempts); hunger/thirst; sleep deprivation; (6) FAMILY PRESENCE: A familiar face and voice significantly reduces confusion-driven agitation; (7) ACTIVITY: Appropriate exercise during the day reduces nighttime restlessness; (8) REMOVE TRIGGERS: IV lines, catheters, tubes can be confused as irritants and removed — consider whether each can be covered, secured, or removed; (9) SITTERS: Trained patient companion who stays with client. IF RESTRAINTS ARE REQUIRED: Specific medical order required; must specify type, location, duration; reassess every 2 hours (release, reposition, toilet, circulation check); document continuously.