Nursing Home Restraints

Abuse is a big hazard in the nursing home setting for example a member of staff could be secretly treating the patient with disrespect by calling them names, not washing them, and hurting them physically. This could lead the patient feeling worthless, upset and angry which would affect the patient emotionally and physically and may cause them to stop eating.

Unfortunately, many residents in nursing homes today are being starved, dehydrated, over-medicated, and suffer painful sores. Often times they are isolated, ignored, and deprived from social contact and stimulation. Care givers are often overworked and grossly underpaid which often results in them showing rude and abusive behavior to the residents. “Studies have found that individuals in poor health are more likely to be abused than individuals who are in relatively good health. In addition, caregivers who are dependent on the elder financially are also more likely to perpetrate abuse” (De Benedictis, 2011). A simple request for such things as water or an escort to the bathroom may cause the care giver to respond in a rude and offensive way demonstrating inappropriate behavior. According to an article written by Bryan Robinson (2002), “Helen Love, a 75-year-old grandmother of three, looked into the video camera and told of being severely beaten by a nursing home caregiver who discovered she had soiled herself. He choked me and he went and broke my neck," said Love, who had to wear a metal halo in the videotaped deposition from July 1998. “He broke my wrist bones, in my hand. He put his hand over my mouth.” Two days later, Love died.

Barry Corbet states his experience in a nursing home in his essay “Embedded.” A nursing home is a private institution for elderly or sick people who are unable to care for themselves. Corbet’s essay says “Nursing homes are environments of isolation and disempowerment” (Corbet 165). “Nursing homes are not just for old people, they can be for people with disabilities also” (Corbet 164). Both age and disabilities can be a huge factor when considering a nursing home.

When you hear the words, “Nursing Home”, what comes to mind? Sad, helpless, elderly individuals? The smell of urine? An overall, unpleasant place to reside in? Unfortunately, this generic description is accurate amongst majority of the nursing home facilities across the United States. More often than not, the elderly suffer from inhumane living conditions while residing in a nursing facility. Quite often we hear stories on the news about cases of elder abuse in the nursing home and we automatically think physical, mental, or emotional abuse from caregivers. However, the fact that these individuals are also living amongst unsanitary, inhumane conditions, and ran by a staff that includes

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 first part requires the nursing homes to establish an Infection Control Program. The second part focuses on preventing the spread of infection by isolate residents to prevent infection and by “prohibiting employees with communicable diseases for direct contact with residents or their food,” and requiring hand washing after each direct contact with residents. Third, nursing homes are required to handle, store, process, and transport linens to prevent the spread of

Gulpers et al. (2013) research study titled Reduction of Belt Restraint Use: Long-Term Effects of the EXBELT Intervention showed significantly reduced restraining belt usage and use of other physical restraints over the course of 24 months after an EXBELT intervention program of 13 nursing homes in the Netherlands. The intervention included a policy change in the nursing homes disallowing new use of restraining belts and reducing existing use of restraining belts, and a thorough educational program from two nurse specialists including consultation and availability of alternative interventions. Policy change and availability of alternative interventions had the greatest impact on reducing physical restraining in this study. The educational component alone was inadequate in reducing physical restraining.

One thing every living organism has in common on this planet-- age. No one wants to age or face the fact that aging is inevitable. However, since it’s impossible to beat the never ending time clock that is life; everyone wants to be as comfortable as possible when age finally does catch up with them. When the majority of people think of comfortability in old age, they think of living in their own homes and being surrounded by their loved ones. Not many individuals want to be placed into a nursing home type facility because they can’t imagine themselves being comfortable that way. Nonetheless, even though being placed in a home does take away some of an elderly person’s independence, usually the independence lost is in activities that person can no longer do for themselves. Indeed, nursing homes do have their own set of scary stories behind them; life lost, independence lost, and privacy lost, yet many of those stories are outdated. Upon investigation, it would be easy for anyone to scare themselves out of a nursing facility due to the stories that are out there. Yet, upon even further research people would be able to see how far the United States has come in their development and evolution of nursing care facilities. The care of the elderly in the form of nursing homes has faced a tough evolution starting off with a harsh past, to what nursing homes are like now, and what people can expect for the future of these homes.

J’s scenario is pressure ulcer. From analyzing Mr. J’s case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing-sensitive indicator in this case is restraints. As I have mentioned earlier the use of restraints in Mr. J’s case seems appropriate as he pose great fall risk which may further complicate his current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning, history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care throughout the hospital, the quality improvement department should scrutinize, and keep track of the

As the healthcare system in this country has changed, so have traditional nursing homes. Families have the right to expect that their loved ones will be taken care of by professionals in a caring environment. Unfortunately, may people are being abused and neglected in nursing homes. It is very clear that abuse is a serious problem among nursing home patients, and something needs to be done to put a stop to it.

The NHRA sets the regulations for the use of retraints, in addition to these stated requirements the NHRA calls for an assessment of problematic behaviors, physician concurrence prior to the institution of restraints, use of restraints as a last resort, and explaining the restraints and why it is being used on the resident. The use of restraints is regulated by the NHRA and the practice is discouraged, however a majority of nursing home residents will be subjected to the use of them.

Congress. Codified as section 1819 and 1919 of the Social Security Act, the landmark legislation declared that every nursing home must protect and promote the rights of each resident, including, “The right to be free from … any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms.” When the Nursing Home Reform Act was adopted it was widely accepted to use restraints as an acceptable and widely-used option to manage the behavior of residents who wandered; were agitated; or who in the view of treatment staff, simply needed to be restrained. However, the standard use of restraints was not supported by a body of research that found that physical restraints had

Introduce Topic: In 1987 President Ronald Reagan passed the Federal Nursing Home Reform Act. This Act, also known as the Omnibus Budget Reconciliation Act (OBRA), brought reform and a set of standards of care for people living in certified nursing facilities. (Hollis) Included in these set of standards, is the “Resident’s Bill of Rights”, which states that residents of nursing facilities have “The right to be free from … any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms”. (U.S. Code Title 42 Chapter 7)

Deveau and Leitch challenge the idea of restraints being positive for a pediatric mental health setting. “Restraining children may lead to physical and mental harm for children subject to such practices” (Deveau, Leitch, 2014, p. 588). Presented earlier was the idea that restraints used on a pediatric patient should ultimately be beneficial to the patient and those within the patient’s environment. Unfortunately, that may not always be the case. Like other nursing interventions, risk factors are also associated with restraints. Deveau and Leitch’s performed a studied and gathered that within the United States of America there were 142 restraint-related deaths within a one-year time span (2014, p. 588). Blood clots, restricted breathing and blunt trauma, abrasions and bruising may also be associated with risk factors that may occur during physical interventions

While the prevalence of physical restraints in long term care facilities was around 37 percent 20 years ago, recent CMS rules has kept the numbers down to 5 percent in the US (Agens 2010). However, that is not the case in other countries with well-established healthcare systems. The prevalence of physical restraint use in these countries are as follows: 20 percent in Hong Kong, 28 percent in Finland, and over 31 percent in Canada (Feng 2009). Also, in Dutch nursing homes and hospitals, the prevalence