Non Behavioral Restraint Analysis

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

The nursing supervisor has multiple issues to address in this scenario, the use of restraints and formation of a pressure ulcer are of a great concern, but I believe these are easily rectified with training and follow-up audits to ensure

There are a few ethical issues that in the provided scenario which need addressing from the nursing shift supervisor. The first occurs when the Certified Nursing Assistant (CNA) fails to appropriately address the possibility of a developing pressure ulcer. A wound care team can be consulted about developing an educational program about pressure ulcers for hospital staff. Also, there is the issue of restraints. The ordering physician should be contacted about the necessity of restraint use. Along with the wound care team, data could be collected about the use of restraints and the subsequent development of

All patients are at risk of pressure injuries. This risk is exacerbated when immobility and limited access to the surgically draped patient are a part of

Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.

The term “safety comes first” or more simply put, “safety first,” is a message that patients not only want to hear, but also want to know is the focus of the professionals that are caring for them; in particular, when they are under anesthesia and have limited or no ability to speak up or lookout for themselves. The National Patient Safety Agency (NPSA) has implemented two initiatives; Rocognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients (NPSA, 2007) and How to Guide: Five Steps to Safer Surgery (NPSA, 2010). Understanding that human beings make up the healthcare professional workforce, it is evident that tools and checklist can and will only be as good as the how people utilize and follow

A restraint is any physical or chemical measure in the healthcare setting to keep a patient from being free to move (Craven, Hirnle & Jensen, 2013). Nurses are presented with dilemmas in deciding whether to use restraints to protect the patient from falls, harming themselves or others, suppress agitation and to facilitate treatment. Improper usage and misconceptions of restraining can have negative consequences including physical and psychological issues. Physical and psychological disadvantages from restraining could include low blood pressure, decreased circulation, thrombosis, constipation, urinary incontinence, depression, fear and increased confusion (Yeh et al., 2004). Educating nurses may reduce restraint usage by increasing

Patients that we received often wants to either harm themselves or others, and these patients are also considered violent which lead to the frequent use of restraints and seclusion. Using these methods represent a danger to not only staff but also for the patients. Many injuries occur during these confrontations. The need to minimize the use of restraints and seclusion on the unit is necessary for patients and staff safety.

Patients with physical or mental disabilities should be sedated in order for them to get the proper dental care that they need because they may not be able to cooperate during the procedure. As stated by Dr.Bain, D.D.S, Patients with medical conditions such as Down’s syndrome and cerebral palsy may have physical limitations that keep them from sitting comfortably in the patient chair and staying still during dental treatment. Patients with physical disabilities may have a hard time remaining calm. The physical disability of the special needs patient may cause them to fidget and move around a lot. This can make it more difficult for them to keep their head straight or their mouth open for the dentist. In addition, patients that lack good communication skills may also have a hard time cooperating with treatment because they are unable to communicate to the dental staff or their caregiver any discomfort or pain they feel during treatment. This makes it harder for the dentist to complete the treatment correctly because the patient may have a difficult time informing their needs to the dentist or the assistant. As a result, the patient will not be able to cooperate with treatment if they are experiencing pain or discomfort. If the patient can not communicate to the dental staff that something is causing them pain or discomfort the patient is not only going to be very uncomfortable, but they are also going to remember the procedure as a traumatic

First, the Residents may more quickly experience the benefit from the interventions as well as from the reduction of restraints, potentially decreasing injuries, and increasing their quality of life (Dunabar, Neufeld, White, & Libow, 1996; Label & Goldstein, 2005). This action step may also result in the facility developing more ethical and legal policies and practices in regards to restraint use thus providing better care to Residents, and may even reduce costs (Label & Goldstein, 2005). Additionally, this would be an opportunity for the therapist to further demonstrate the unique value of the field of Occupational Therapy. Based on this potential outcome and the ethical and legal basis, this action step seems to be an appropriate course of action for the therapist to take when faced with this ethical

• Since 1991, anesthetic and surgical techniques have improved, resulting in lower surgical risk for many patients. Concurrent with these changes, the VHA has implemented a rigorous program of surgical attending oversight of the process of care by resident operators, particularly in surgical suites.

This article discusses the issues about the use of restraints toward the inmates in the federal penitentiary in Lewisburg Pennsylvania. The article goes on into the story of Sebastian Richardson and how refused to have a cell mate that he saw as threating and potently dangerous based on his nickname “Bam Bam” and “The Prophet”. The two would have had to share a cell no larger than a parking space says the article. Richardson refused to accept “The Prophet” as a new call mate, and then was taken out of his cell thirty minutes later was taken to the laundry room and stripped and put in paper clothes and shackles. Richardson also, stated that one of the guards left a window open while he was restrained to freeze him on purpose, and also that

While the use of physical restraint on elderly patients is necessary in specific situations, the practice should be very limited at all times. Although it will continue to be used worldwide, measures must be taken by all healthcare providers to gradually minimize the use of restraints in healthcare facilities, reduce the risks that are associated with the practice, offer reasonable alternatives for patient care, and ensure the safety of the patients as well as their caregivers.

In the intensive care unit, every plan and action of all the health care team such as doctors, nurses, nursing supervisor, anesthesiologist and interns can be a factor to determine a life or death situation, as all the patient are in a critical and physically vulnerable condition. It is very crucial to take factor that influence patient safety and quality of care into consideration, especially human factor and ergonomics in order to have better patient outcome and improve recovery; clinicians, leaders and management should be able to acknowledge this (Carayon et al., 2013; Gurses et al.,2012b; Institute of Medicine, 2012).