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Use of
Restraints in Nursing Homes
By: Dan Frith
There are
two kinds of restraints: Physical restraints and chemical
restraints:
Physical restraints prevent a person from moving
about freely. The most common types of physical restraints
include:
- Vest restraints used to
tie a person to a bed or chair
- Wrist restraints used to
prevent a person from moving their arms
- Chairs with tray tables.
roll bars, or lap cushions to prevent rising
- Bed side rails to keep a
person in bed
Chemical restraints are psychoactive or
mind-altering drugs used to control behavioral symptoms.
These drugs effect a person’s thinking, feeling, and
reactions. The most common types of chemical restraints
include:
- Antipsychotics or major
tranquilizers
- Sedatives/hypnotics (to
treat insomnia /sleeplessness
- Antidepressants (to treat
depression)
- Anxiolytics (to treat
anxiety)
Research has
shown that restraints can be dangerous and destructive.
Physical restraints often only increase a resident’s anxiety
and aggression. Professional caregivers have learned how to
eliminate restraints by studying the care of the elderly in
other countries. Unfortunately, many nursing homes still
use restraints inappropriately – often as a way to reduce
the amount of time and attention a caregiver provides to a
resident.
STRATEGIES
FOR REDUCING RESTRAINT USE
Although
reducing restraint use can be frightening for some families
and staff members, there are many facilities that have
successfully committed to a restraint-free environment
without an increase in resident injuries. Committed families
and staff members working together to follow an
individualized care plan can make this a reality which can
benefit both residents and caregivers. In fact, research
confirms that non-restrained residents require fewer minutes
of direct nursing care when compared to similar residents
who are restrained. However, a Federal government report
notes that in order to be effective, restraint reduction
activities must involve the whole facility, including
administrators, nursing directors, physical and recreational
therapists, service delivery staff including nursing
assistants, and housekeeping personnel. Family members
should expect and insist that the facility be responsible
and proactive in:
- Completing a comprehensive resident assessment:
Assessments gather information about how well residents
can take care of themselves and when they need help.
They identify strengths and weaknesses, plus lifelong
habits and daily routines.
- Formulating an individualized care plan: Based on
strengths and weaknesses identified on assessment, a
care plan is developed for how staff will meet a
resident’s individual needs. It should describe what
each staff person will do and when it will happen. The
care plan is designed at a quarterly care-planning
conference, attended by staff, residents, and their
families. The care plan should change as the resident’s
needs change.
- Training staff to assess and meet an individual
resident’s needs -- hunger, toileting, sleep, thirst,
etc. -- according to the resident’s routine rather
than the facility’s routine.
- Supporting and encouraging professional care giving
staff to think creatively of new ways to identify
and meet residents’ needs.
- Providing a program of activities enjoyed by the
resident, such as exercise, outdoor time, or small jobs
agreed to and enjoyed by the resident.
- Providing the resident with companionship,
including volunteers, family, and friends.
- Creating a safe environment with good lighting,
mattresses on the floor to cushion falls out of bed,
appropriate, comfortable seating, alarms, clear and safe
walking paths inside and outside the building.
- Making
permanent staff assignments and promoting staff
flexibility to meet residents’ individualized needs.
- Meeting with the resident’s doctor or the facility’s
Medical Director to discuss ways to care for the
resident without the use of chemical or physical
restraints.
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Dan Frith
is the founding partner of Frith Law Firm, P.C.,
a firm
focusing on medical malpractice, nursing home abuse, personal injury, lead paint poisoning and business torts. Copyright © 2004 by
Frith Law Firm, P.C. All rights reserved under U.S.
and international law.
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