Essay The Improper Use of Patient Restraints

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.

Problem: Patient falls have long been a common and serious problem in hospitals across the nation, causing

Mother Behind Bars examines a lot of inadequate policies and procedures that these states have in place for federal and state correctional facilities. This report card bring up the issue on prenatal care, shackling, prison nurseries, and family based treatment as an alternative to incarceration however in this paper I will focus on the restraints on these pregnant inmates. New Jersey received a grade of D for shackling policies. Besides New Jersey thirty-seven other states obtain a D/F for their failure to comprehensively limit, or limit at all, the use of restraints on pregnant women transportation, labor, delivery, and postpartum recuperation (National Women’s Law Center, 2010). The use of restraints can compromise the health and safety of the women and the unborn child. Shackling pregnant women is dangerous and inhumane; women prisoners are still routinely shackled during pregnancy and childbirth. The reason these women are shackled is for safety and security, despite the fact that shackling pregnant women is degrading, unnecessary and a violation of human rights some state still condone this practice.

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.

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

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

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

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.

The purpose of this paper is to critique the research article, Mohler & Meyer’s “Attitude of nurses towards the use of restraints in geriatric care: A systemic review of qualitative and quantitative study 2014. The incident I am going to discuss in this paper is of Mr. P., an 85-year-old man, admitted to this facility about 4 months ago. His history includes coronary heart disease, cataract, dementia, hypertension, macular degeneration and Alzheimer’s. Mr P. scored 28 of 30 on the Folstein Mini-Mental State Test, he missed the date and recalled 2 of 3 objects in 5 minutes (Folstein, Folstein, and McHugh 1973). His medications include; Analgesics, antihypertensions, antipsychotics

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 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.

A restraint can be any device that is used to restrict a person’s right of movement (Singh, pg. 232). The different devices that are used include; vests, belts, hand mitts, bedrails, etc. Nursing homes have found that restraints come with more disadvantages then advantages. Restraint disadvantages include; increase in patients injuries, decrease in activities of daily living, and psychological problems. The main purpose of having restraints is to protect other patients and staff from any harm. These findings have lead to many nursing homes implementing a restraint free environment. Nursing homes believe that having a restraint free environment will also make patients have a safer environment.

Every academic discipline in any profession is governed by its rules and policies developed and prone to amendment from time to time after viewing or arises of an issue. Nursing as a profession practice and an academic discipline is however not an exemption to this (Lasater et al., 2015). The nursing practice has different policies governing the procedures, and that promotes health and wellbeing of the patients as well as creating a conducive environment for nurses and the people they interact with in delivery of their services such as medical therapists, technicians, among others (Blegen et al., 2007). These policies ensure that there is a smooth running of the activities for the nurses as well as the patients. There exists a broad array of policies, but in this paper, the registered nurse safe staffing Act system will be looked into particularly in Florida.

I believe that the frequent use of physical and chemical restraints on patients is completely unethical, especially if the restraint is not necessary. Personally speaking, physical and chemical restraints should only be utilized if the situation absolutely calls for them, and there are no other alternatives. For instance, if the patient is exhibiting aggressive behavior, or if the patient is highly likely to severely harm himself or herself, as well as those around him or her, then a restraint may be required. Otherwise, restraints should be used as little as possible.