Physical Restraint And Nursing Home Facilities

As health care workers we are under a legal obligation to protect an individual from any kind of abuse, whether it is physical, financial, emotional, sexual or psychological .Legislation, policies and procedures exist to promote a safer working environment and reduce the potential for risks occurring. They are tailored for the needs of each setting, known and understood by employers and employees and reviewed on a regular basis.

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.

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.

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

Physical Abuse – Physical abuse is more common in nursing homes than anyone wants to admit. Shoving and restraining a patient can be a form of physical abuse. Hitting, pinching, slapping, kicking, and any other type of physical contact that harms the patient

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

Despite these “rights” nurses in the United States and around the world still use restraints stating the main reason is for patient safety.

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 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 ethical issue of chemical restraints being incorrectly used within nursing practice, why it

The first research was found in the 'Journal of the American Psychiatric Nurses Association' titled 'Characteristics of patients with histories of multiple seclusion and restraint events during a single psychiatric hospitalisation' and aimed by means of a quantitative study to find solutions to

The article I have chosen for the purpose of this essay is “Use of physical restraints in nursing homes: clinical-ethical considerations” by Chris Gastmans and K Milisen. The ethical dimension of care is an essential part of good nursing practice, and ethical reflection is necessary for nurses to come to thoughtful and balanced decisions. Critical reflection on what constitutes good care is required in everyday care, but even more so in ethically charged situations such as those requiring physical restraint (Goethals, Casterle & Gastmans, 2012)

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.