Nursing Home Restraints

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

The federal government is responsible for setting out regulations for nursing home facilities all over America. It requires that require that these facilities to adhere to the codes of conduct, uphold the constitutional rights of residents in these facilities and uphold professional conduct (G.J.Jorgest, 2006). In many states such as Iowa, the local government include clauses that are aimed at making the lives of those in these facilities more bearable either as they brave their illnesses or as they age. These clauses are designed to be consistent with the regulations set by the federal government and are in most cases stricter.

The use of restraints is seen in the Emergency Department(ED) on a regular bases and has been a new experience to myself as a student nurse. The College of Nurses of Ontario Restraints Practice Standard (2009) explains restraints may be used where patient are at risk to themselves or others, for treatment purposes and controlling behaviours. Restraints may be chemical, physical or environmental. Restraints have limited increase in patient safety and can increase the agitation, confusion and health risks present. In the emergency department majority of bed rails are kept in the up position regardless of the patients’ mental, physical or emotional state. A bed rail is considered an environmental restraint and therefore should be kept in the down

The two rules that are evident in the nursing home under study here are regulation 42 CFR ยง483.40 which states that each nursing home must ensure that the resident has the right to choose activities, schedules, and health care. This is a choice that the old citizens in the nursing home are allowed to make and they choose ones that are most suitable to them with the aid of their family members. The other Federal rule is regulation 42 CFR ยง483.25 which states that each nursing home will ensure that the resident receives adequate supervision and assistive devices to prevent accidents. Almost each old person within the facility was observed to be having some kind of walking aid that fits their condition as well as several social workers interacting with them regularly and seen walking up and down just to ensure that the dwellers are fine.

The General Accounting Office and the Health Human Services Office of Inspector General both have noted the lack of known data related to the use of these practices (Joint Commission on the Accreditation of Healthcare Organization [JCAHO], 2004). Research has revealed that the use of restraints varies dramatically from facility to facility with a wide range of facility and staff knowledge on how to prevent and avoid such use. According to Castle and Mor (1998), there are a growing number of stakeholders that have developed guidelines for restraints use and the quality of these guidelines have yet to be determined and their widespread application

That being stated, if a patient must be placed on restraints, qualified professionals must have a comprehensive understanding of patient outcomes that correspond with the use of restraints. First and foremost, skin integrity is placed at risk if proper placement and management of patient care while in restraints is not implemented as with the case of Mr. J. There is numerous evidence based research studies conducted that correlate the use of restrains with an increase in pressure ulcers (Baumgarten, Margolis, Localio, Kagan, Lowe, Kinosian, Abbuhi & Abbuhi, 2010).

In accordance to this theme, the TCAB design team developed goals and changes that would show improved outcomes. One of these “high-leverage changes” (Rutherford et al, 2009) was preventing patient injuries from falls. Patient falls is one of the high occurrences in patient safety and injury, as well as the leading cause of death of patients 65 and older (Rutherford et al, 2009). By incorporating the TCAB initiative, the pilot hospitals average of patient falls was reduced by fifty-two percent (Rutherford et al., 2009). One of the ways that patient falls were reduced was by involving the personal care attendants (PCA) in making frequent rounds with patients and asking them if they were comfortable or if they needed anything. By involving the PCA’s in falls prevention, the study showed an average fall rate per one thousand patient days decreased from 6 to 4.5 (Stefancyk, 2009). One of the main themes between the studies is preventing patient injury during their hospital stay. In doing so, the ethical principle of beneficence and nonmaleficence have been addressed. A second intervention was also implemented in reducing injuries to the elderly client was placing a sensory cart on the unit and to be utilizing

have been taught that 2 side rails up is a means to ensure patient safety but in some cases, it is already considered restraints. It has been proven through quantitative research the adverse effects of restraints,

Physical restraints that inhibit voluntary movement are sometimes used in acute and long-term care settings with the goal to prevent injury and protect residents. The Food and Drug Administration (FDA, 2006) and Centers for Medicare and Medicaid Services (CMS, 2008) stated that a protective restraint is any

Not only are you restricted from you family, you can not do things on your own, you will always need assistance. You will need assistance to eat, drink, or even itch your nose. You will need help performing any activities that require you to sit up or use your hands in any way. This experience is not a reward, in most cases the restraints are used as a punishment. If the patient is not cooperating, being violent or self destructive to the degree of where they are jeopardizing their physical health, they may be put in the soft limb restraints. There are many behavior requirements that will result in the use of the soft limb restraints, such as hitting, kicking, pushing, trying to remove their IV line, or other medical requirements, or even trying to leave the hospital room. The soft limb restraints are used to protect the patient. Although they are used for the better of the patient, I would not enjoy being tied down to a bed, I would feel unwanted, or even chained

While at Woodridge I observed some of the Fire/Life Safety codes, the facility appears to have adequate fire exits for the residents and staff. The facility has an elevator, but also has stairs on each level. The wheelchair and bedridden residents are on the main level, there is also a wheelchair ramp for the residents. The exits are well lit and the exits consist of the main entrance, back entrance and side entrance. There are a fire alarm and sprinkler system and also an emergency plan on each floor. The facility is considered a non-state operating nursing facility, which the State of Illinois would conduct a survey and certifies compliance and noncompliance. State certification is final and the state Medicaid agency determines whether a

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.

When I visit the facility during weekend, I make a brief stop at twenty rooms to play few songs of resident’s choice. The majority of residents in those room is bedridden, while the other has a mobility restriction. I initially began to play for those who has dementia; however, after realizing how lonely those residents who are bedridden, I decided to play for them as well to offer something that they could look forward each week. The coordinator told me that the residents are looking forward to hearing me play the violin each week. In addition to playing, I also interact with those residents to learn an appropriate bedside manner for the future, and I am now comfortable talking to elders.

At this time, the Assisted Living Facility requires $730,000.00 of debt funds. Below is a breakdown of how these funds will be used:

Recent attention in health care has been on the actual architectural design of a hospital facility, including its technology and equipment, and its effect on patient safety. To address the problems of errors in health care and serious safety issues, fundamental changes of health care processes, culture, and the physical environment are necessary and need to be aligned, so that the caregivers and the resources that support them are set up for enabling safe care. The facility design of the hospital, with its equipment and technology, has not historically considered the impact on the quality and safety of patients, yet billions of dollars are and will be invested annually in health care facilities. This provides a unique opportunity to use current and emerging evidence to improve the physical environment in which nurses and other caregivers work, and thus improve both nurse and patient outcomes.