The Use of Physical Restraint Essay

The Occupational Safety and Health Act purpose is to assure that individuals are working in safe environments. OSHA has been around for over 40 years and has come with many advantages as well as disadvantages. According to OSHA, “nursing homes and personal care facilities has had one the highest injury and illness rates, workers have faced numerous amounts of health hazards, and disorders compared to other work places”. These obstacles occurring in the health care work force has lead to the NYS Safe Patient Handling Act. This act consists of programs ensuring workers are better educated on how to prevent injuries, reduce disorders and improve quality of care towards patients.

Deprivation of liberty safeguards (DOLS) can be defined as removing the freedom of an individual over eighteen years old without capacity under the supervision of healthcare professionals (Rlordon & Alzheimer’s society 2010). DOLS code of practice was implemented since 2009 and is supported by the mental capacity act 2005 and the act ensures legal compliance with the human rights act (Conroy et al 2011). DOLS is effective in intensive, palliative and domestic setting care in assessing the depravity of liberty in an individual’s environment (HM Government 2015). For example, a Burns ITU patient is sedated and ventilated to controlled pain and breathing, therefore deprived of the liberty of independence and consciousness. For an individual to

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.

I recommend everyone using physical techniques of any kind be trained on the risks of positional asphyxiation. Whenever, I physically restrict a person’s movement there is a risk of injury, and no physical holds are 100% safe. In this book, I cover body positioning for physical interventions, standing holds, and seated holds. I do not authorize or encourage a prone restraint without the proper training; and this type of restraint is not covered in this book. However, the SafeClinch Training System does allow for “prone containment” for those organizations allowed to use it; once SafeClinch instructor certification has been achieved. Here is an example of what the prone position looks like. Notice, since the person is in the prone position

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 number one priority of the Registered Nurse should be to provide holistic, patient-centred, safe and evidence based care to every patient. Patients who are admitted into hospital or seek healthcare services externally through clinics or the community usually expect to receive the safest and the highest quality of care possible from that facility. Registered Nurses have a major responsibility to ensure that this is achieved. To help guide nurses and other healthcare workers in the right direction, the Nursing and Midwifery Board of Australia created and enforced the “Registered Nurse Standards for Practice”. These standards aim to assist healthcare practitioners in providing high quality and safe care to every client. The standards also aim to prevent any form of harm or negative consequence to the patient during and after their time in any healthcare facility. This paper will discuss the reportedly increasing issue of elder abuse, the responsibilities of the Registered Nurse and the associated Standards of Practice when faced with a patient or family that is experiencing this type of harm. The standards discussed in this paper will be Standards 2.5, 2.9 and 6.6.

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

This unit is primarily concerned with those people who are most dependent upon your assistance. The level of assistance they need can vary from needing help to get out of a chair to being completely dependent on others to move them, to turn them over and to alter their position in any way, for example, if they are unconscious or paralysed. It is essential that people are moved and handled in a sensitive and safe way. This is also vital for you as a worker, to prevent injury to yourself. It is possible to minimise the risk to both you and the people whom you support by following the correct procedures and using the right equipment.

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.

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

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

For example, a lap belt intended to prevent an individual from falling out of a wheelchair is considered a physical restraint if the person is unable to willingly remove the belt. Arguments in favor of physical restraints promote their use for fall prevention, control of aggressive behavior, and protection of treatment devices such as feeding tubes (XXX). However, the use of physical restraints has also been linked to injury, pressure ulcers, incontinence, cognitive decline, and death (XXX). In recent years, there has been a decrease in physical restraints because it has been widely accepted as a sign of poor quality care, but this decline is not observed uniformly across all populations (Kunetzka, 2014; Phillips, 2000). Residents with dementia, physical impairments, and a history of falls continue to be at risk of being restrained in long-term care settings (Grunier, 2008). Although the utilization of restraints in these populations is prevalent, the safety and efficacy of these practices is inconclusive and the ramifications of such restraints can be severe (Agens,

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.

Admissions in general acute hospitals for patients over the age of 65 is 38% with 60% of those patients ending up on a medical surgical unit (Boltz, 2013). The number of restrained patients within this age range varies from 13-27% for medical surgical or non behavioral restraints, this number can significantly decrease based on alternative interventions attempted prior to restraint application with the number of restrained days varying from 3 to 123 out of every 1000 days (Enns et al., 2014). Reasons for non behavioral restraints are when a patient is; pulling at lines/tubes, removal of equipment/dressing, inability to respond to direct requests/follow instructions, intubation, or falls/risk of injury/keeping patients safe. A typical hospital