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Restraint Use in the Acute Hospital Setting Hannah Baldwin UNMC
material or equipment that immobilizes or reduces the ability of a patient to move his or her arms. or if it was her family that put the rail up while they were visiting. According to the Alegent Health policy a restraint is defined as: Any manual method. I was fortunate at this clinical site in that I was able to care for a variety of patients. body or head freely. When I went into the room I looked at the bed type and also noticed that she had all four rails up on her bed. When I got back to the computer and told my clinical instructor that she had four rails up. We looked in her chart to make sure the four rails were not an order from the physician and when they weren¶t we went and put a rail down on the bed. our clinical instructor was showing us information in the charting on bed types and number of rails put up. physical or mechanical device. at least 3 other times during our clinical experience at Bergan we found people lying in bed with all four rails up. In this case. we are not sure if it was the nursing staff that put the rail up. However. or a drug or medication when used as a restriction to manage the .Running Head: RESTRAINT USE Restraint Use in the Acute Hospital Setting 2 My clinical assignment this semester was at Bergan Hospital on Four East. she informed us that using four rails is a form of restraint. The floor was a general medical/surgical floor. legs. We got a lot of patients that presented to the Emergency Room with respiratory or GI problems and were then transferred to Four East for the duration of their stay. This particular week I was taking care of a patient who had severe Multiple Sclerosis and my clinical instructor asked me to go into the room to look and see what type of bed she was on. While we were on the floor learning the charting system.
& Leipzig. This group of patients who exhibit the following characteristics are at higher risk of being restrained: . and even death by strangulation and asphyxiation. pressure ulcers.100) There are several groups that are more at risk for being restrained. Direct application of 3 physical force to a patient. From there I decided to look at the policy for Alegent Health. (2009)the benefit of physical restraints is not supported by the literature. (2010) Both hospitals have a goal to reduce restraint use. nosocomial infections. and I looked into the evidence based practice for these decisions. physicians and LIPs are educated on the organization¶s policy and procedure for restraint/seclusion processes. Merkel. with or without a patient¶s permission. which reads: The policy of Alegent Health Behavioral Services is to create an environment that minimizes circumstances that give rise to restraint use and maximizes a safe environment without restraints. Berkman. discomfort. Cranston. We found out the NMC policy was aimed at reducing the use of restraints. They go on to mention that in fact it is the opposite that is documented most often. (2010) From these particular instances where restraints were being used and not ordered or documented. we decided to look into the restraint policy at the Nebraska Medical Center since we are able to look at those on our intranet. Physical force may be human or mechanical devices or a combination thereof.Running Head: RESTRAINT USE patients behavior or restrict the patient¶s freedom of movement and is not a standard treatment or dosage for the patient¶s condition. ³longer length of stay. confusion. to restrict his or her freedom of movement. According to Fogel.´ (p. The dangers are well documented and include.
(p. they list using diversionary activities like watching videos. altered mental status. ensuring adequate nurse staffing and providing consistent patient assignments to support nurse-patient relationships. The Alegent Health policy (2010) manual gives a list of items that can be used as alternatives prior to the application of restraints. in the article by Park and Hsiao-Chen Tang (2007) 4 the authors make several recommendations for implementing restraint-free care. Also. altered elimination. In particular. education. interference with treatment. These include: establishing a team or committee to oversee the policy of the institution and to implement the restraint-free policy. providing staff education about restraint-free practices and standards. providing education on erroneous beliefs or myths about physical restraints. advanced age. doing puzzles and aromatherapy. 4) All of these items that are applicable to the patient should be tried before restraints are used. agitated state or restless behaviors and presence of monitoring or treatment devices. TV. These interventions need to be documented in the patients chart to . Their list includes early identification of potential risks and potential alternatives which will provide the opportunity to plan for. They also state to provide comfort measures. looking at magazines. decrease stimulation and medication intervention. history and risk of fall. They also recommend that the family of the patient be involved in treatment of the patient to assist in the interventions. 2007) There are many alternatives to restraints that are mentioned throughout most of the articles we found.´ (Park and Hsia-Chen Tang. physical dependence. rather than react to. behaviors that may potentially cause harm to the patient or staff.Running Head: RESTRAINT USE ³wandering.
why are restraints still being used so often? According to McCabe. the physician will choose the least invasive procedure. ³Some participants indicated that it was easier to . McNulty. I think education is a huge part of restraint use. Moore &Haralambous list barriers to reducing the use of restraints in their article. family members reported that without the restraints serious physical injuries were more likely to occur. I know the nurses are very knowledgeable and care about their patients. After spending my first half of my semester at Bergan. The authors reported that. I just think maybe they are unaware of the current policy regarding restraint use. the physicians and nurses should always be looking for the least invasive method to control the situation. Most of the healthcare team that were using restraints said they used them in order to prevent falls. So with all the evidence based research out there.Running Head: RESTRAINT USE protect the nurse against liability. and Fitzpatrick (2011) health care professionals are still using restraints because they believe the benefits outweigh the risks. I know before I read over the policy for each of the hospitals I was not aware that using all four bed rails up was restraining a patient. (p. 1) In particular this article focused on the elderly and using restraints to prevent falls. but also the nurse should want to do these other 5 interventions first. For a medical procedure. Alvarez. The list was broken down into barriers reported by family and residents and those reported by the staff. Some of the barriers listed include: perception that potential harms to the resident were greater without the restraint that with the restraint. when in fact the evidence shows that restrained patients may actually fall more because of the increased agitation brought on by being restrained.
Angellika was in a Wisconsin day treatment program and had been restrained . So even though the staff reported not knowing alternative approaches to care. 7-year-old Angellika Arndt became a casualty of physical restraint. but this information should be handed out in a pamphlet or taught about in a safety seminar for the floor. but if the policy is not reinforced it doesn¶t have any good effect. or the alternative interventions they are unable to use them to better the care of the patients. The information is relevant to every nurse. In the article ³Restraints and the code of ethics: An uneasy fit. 535) In the same article. I know that every nurse is not going to go over the entire policy and procedure manual and be able to retain all the information. although some staff recognized that using restraints was sometimes more resource intensive than not using them. the patient¶s family were unaware that they were trusting this decision to restrain to a family member up to somebody who was no more informed than they were on alternatives to restraints. 2006. Also. if restraints are used without first trying these alternative interventions the nurses license is at risk. I think all hospitals have a similar policy regarding restraints. I think this information is very important and should be highlighted while orienting to the floor at the hospital. The policy at Alegent Health is a great policy. However.´ an example of restraint use gone wrong is highlighted. and it lists two pages of alternate interventions. On May 26. Most family members reported that they relied on the information 6 provided by the staff and they trusted them to make the best practice decision. if the staff is unaware of the policy. Thinking realistically. family members are interviewed about the use of restraints on their family member. patients can die from being restrained.Running Head: RESTRAINT USE apply restraints than to use other approaches.´ (p.
(Mohr. and knowledge is important in order to prevent these types of occurrences from happening.Running Head: RESTRAINT USE nine times in four weeks. . The patients will benefit and the nurse¶s licenses will be protected. 2010) Nobody wants to be responsible for the death of a 7-year-old girl. I hope that restraint use will continue to decline. The medical examiner ruled her death a homicide due to complications of chest compression asphyxiation. She was restrained by staff members in a prone. and that more alternatives are used. I hope that after seeing our presentation at the end of the semester that our clinical instructor will do some teaching on Bergan 4 East and hopefully bring light to this important issue. face-down 7 position for up to two hours during each episode.
M. C. Behrbalk. Changing the practice of physical restraint use In acute care.E. C. Care Management Journals. P. 100-08.. Moore K. Alvarez. . 39-51. Roffe. J. Barriers to reducing the use of restraints in residential elder care facilities. effective 5/10. Y.. Sister Rita. behaviors.K. N. & Fitzpatrick. Health Nursing. Melamed. Gelkopf.Running Head: RESTRAINT USE References Alegent Health. & Leipzig. D. Nursing Policy and Procedure: Restraint and Seclusion for Behavioral Healthcare Services.. M. (2007).M.. (32)1. (2007). T. J. Efficient and accurate measurement of physical restraint use in acute care. Journal of Gerontological Nursing. McCabe.. Geriatric Nursing.10. and emotions of the nursing staff toward patient restraint. (2011). opinions. Berkman. W. 11.D.S. R. &Werbloff. 8 Fogel. Journal of Advanced Nursing.58(6). Issues in Mental. (2009). 532-540. & Hsiao-Chen Tang.. (2009). Z. McNulty.. (2010). 758-63. C. Cranston. Mohr. Archives of Psychiatric Nursing. Perceptions of physical restraints use in the elderly among registered nurses and nurse assistants in a single acute care hospital.. 03-14. Park. Merkel.F... 24(1). Restraints and the code of ethics: an uneasy fit.J. J. &Haralambous B.. Attitudes. 30.
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