By the 1960s health care journals and texts warned against the use of restraints with frail elders, citing numerous poor physiological, psychological, physical and ethical outcomes, yet many myths prevailed. , Full length bedrails are an impediment, but not a deterrent, to getting out of bed. Council for the Advancement of Nursing Science. Restrained patients are at risk for functional decline, serious injury or death from falls or strangulation, poor circulation, heart stress, incontinence, muscle weakness, infections, skin breakdown (pressure ulcers), reduced appetite, behavioral changes, social isolation and depression among other adverse events (Evans & Cotter, 2008). Restraint of hospitalized older adults contributes to serious medical and psychological problems, requires additional staff time, poses serious ethical challenges and results in longer hospital stays which are costly. Over the past 100 years, this practice has come to be seen as ineffective and dangerous as well as a violation of human rights. Hospitalized elders are at the greatest risk for being restrained when suffering from impairments in memory and cognition which compromise their judgment and full participation in care. The rate varied widely across the individual hospitals. The Joint Commission Journal on Quality Improvement, 27(11), 605-18. Staff have no prior knowledge of this information unless it is given verbally or in writing. In A.S. Hinshaw & P.A. Don’t use physical restraints with an older hospitalized patient. For centuries, shackles and restraints were used to manage violent behavior in severe mental illness. Evans, L.K., & Strumpf, N.E. Prevalence and variation of physical restraint use in acute care settings in the US. Behavioral expressions of distress in people living with dementia. Despite federal guidelines to the contrary, older patients—especially those with impairments in memory and cognition (whether acute from delirium or longer standing from dementia, or both) – are regularly restrained in hospitals at much higher rates than other adults. Avoiding Restraints in patients with dementia. These situations require immediate assessment and attention, not restraint. Bourbonniere, M., Strumpf, N., Evans, L, & Maislin, G. (2003). Speaking with the primary or supervisory nurse when you have a concern is important. (2011). Click Hereto download this page in PDF format. Organizational characteristics and restraint use of hospitalized nursing home residents, Journal of the American Geriatrics Society, 51(8), 1079-1084. American Academy of Nursing 1000 Vermont Ave NW • Suite 910Washington, DC 20005-4903(202) 777-1170. Vivamus in condimentum magna. Pressure on hospitals, and most especially on the nursing staff, regarding legal responsibility for patient-related accidents and injuries countered professional judgment, and no doubt contributed to use of physical restraints. The findings have in common several features: multidisciplinary rounds on restrained or at-risk patients to identify and address problems; use Mion, L.C., Fogel, J., Sandhu, Palmer, R.M., Minnick, A.F., et. (2011). Journal of Nursing Scholarship, 22(2), 124-128. There are three types of restraints: Physical restraints, which limit a person’s movement.
Devices that prevent people from being able to move their elbows, knees, wrists, and ankles. For example, frail older patients receiving consultation from an advanced practice registered geriatric nurse were nearly 7 times less likely to be restrained (Sullivan-Marx, Strumpf, Evans et.al. (2008). New York: Springer. American Journal of Nursing, 108(3), 40-50. 1500 King Street Ste 303 Alexandria, VA 22314.
Mezey (Eds.). Restraints cause more problems than they solve, including serious complications and even death.
All rights reserved. Copyright 2015 American Academy of Nursing Community. (2014). Strumpf, N., & Evans, L. (1988). Finally, patients with existing brain damage from dementia are unable to communicate needs and symptoms in an understandable way and are, thus, at the highest risk for additional acute impairments such as delirium and other complications. Evans, L.E., & Cotter, C.T.
2003). (2001). Minnick, A.F., Mion, L.C., Johnson, M.E., Catrambone, C., & Leipzig, R. (2007). New York: Springer Publishing. Journal of Nursing Care Quality, PMID: 2500761 [Pub Med ahead of One recent study across 40 hospitals in 6 U.S. metropolitan areas reported an average rate of restraint as 50 per 1000 patient days, with Intensive Care Units having the highest use (56%) (Minnick, Mion, Johnson et.al. Malone, & M.D. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses, Nursing Research, 37(3), 132-137. Journal of nursing Scholarship, 39(1), 30-7. Such older adults have difficulty recognizing where they are and why, can’t make sense of the environment, and may try to ‘go home’ or protect themselves from staff who perform any procedures, including something as simple as a bath.
Sullivan-Marx, E., Strumpf, N., Evans, L, Capezuti, E., & Maislin, G. (2003).
Research in the 1980s-2000s supported assessment and intervention, NOT the use of physical restraints, and gradually led to a revision in national guidelines and a re-interpretation of the standard of practice (Evans & Strumpf, 2011).
Third, have a discussion with the primary nurse about the care and the ways that safety and comfort will be assured and voice concern if restraint is under consideration, using the evidence provided here. First, families bring a wealth of knowledge about daily routines, communication patterns, things that bring pleasure and enjoyment, and usual behavioral expressions of pain and discomfort, hunger, need to toilet, boredom, loneliness, fear, and so on.
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