Physical Restraints Use In Health Care Introduction to Physical Restraints
Physical restraints are devices or objects used to restrict a person’s freedom of movement. They include devices such as straps, belts, and even bed rails that are designed to prevent individuals from moving freely. While these restraints are intended to ensure safety or manage behavior, their use has been controversial due to their potential for harm and the ethical implications involved. This essay explores the prevalence of physical restraints, beliefs about their use in nursing homes, when and where restraints are needed, alternatives to restraints, the role of specialized nursing, the physical and psychological impacts of restraints, and current approaches to restraint use.
Prevalence of Physical Restraints
Physical restraints have been widely used in hospitals and nursing homes. In 1989, it was estimated that approximately 500,000 elderly individuals were restrained daily in these settings, indicating a significant prevalence. This high rate of restraint use in the United States contrasted sharply with lower usage in several Western European countries. The historical context of these differences can be traced back to the late 19th century when the belief in the therapeutic value of restraints was prevalent. Restraints were considered necessary to control troublesome behavior and prevent accidents.
Despite advancements in understanding and the growing emphasis on patient autonomy and safety, restraints remain a common practice, though their prevalence has decreased. Recent estimates suggest that restraint use in nursing homes in the U.S. has declined to approximately 8.86%, but it remains a global concern.
Beliefs About Restraints and Nursing Homes
For nearly a century, the use of physical restraints was largely accepted without significant challenge. This acceptance stemmed from the belief that restraints were necessary for patient safety and behavioral control. However, this perspective began to shift with advocacy efforts, changes in nursing home regulations, and research demonstrating the negative outcomes associated with restraint use.
The push for restraint reduction has been influenced by several factors, including warnings from regulatory agencies such as the Food and Drug Administration (FDA) and the growing body of evidence showing that restraints often fail to achieve their intended goals and can exacerbate health problems.
When and Where Restraints Are Needed
Physical restraints are commonly applied in hospitals and nursing homes for three primary reasons: to prevent falls, to protect treatment devices, and to manage behavioral symptoms such as agitation or wandering. Despite their widespread use, there is little scientific evidence supporting the effectiveness of restraints in achieving these goals. Studies have shown that restraints may not effectively prevent falls and can sometimes lead to serious injuries or worsened cognitive function.
Recent research suggests that restraints may increase the risk of falls and other adverse outcomes rather than prevent them. This has led to a reconsideration of their use and a push for more evidence-based practices.
Alternatives to Restraints
Healthcare professionals and caregivers often face challenges in finding alternatives to restraints. Concerns about legal liability, limited staffing, and perceptions of patient behavior can contribute to continued restraint use. However, there is evidence that restraint use can be significantly reduced through various strategies.
One key approach is to enhance staffing levels and provide additional training for staff. Studies have shown that restraints are more frequently used during weekends and night shifts, indicating a possible link between staffing levels and restraint use. Implementing effective alternatives, such as environmental modifications, personalized care plans, and behavioral interventions, can help reduce reliance on physical restraints.
The Role of Specialized Nursing
Advanced practice nurses specializing in geriatrics play a crucial role in reducing restraint use. These nurses provide expertise in aging and clinical problems specific to older adults, offering staff education and consultation to promote restraint-free care. Evidence suggests that models of care involving specialized nurses can effectively reduce restraint use in both nursing homes and hospitals.
Specialized nurses work to develop and implement individualized care plans that address the underlying causes of behavior that might otherwise lead to restraint use. Their expertise helps to foster a culture of restraint reduction and enhances the quality of care provided to older adults.
Physical and Psychological Impact of Restraints
The use of physical restraints has been associated with a range of negative physical and psychological effects. Physical restraints can reduce functional capacity, contribute to frailty, and lead to serious complications such as asphyxiation. Psychological impacts include increased feelings of helplessness, anxiety, and agitation.
Studies have shown that individuals who are restrained are often more likely to experience physical and psychological harm. Prolonged restraint use can exacerbate frailty and contribute to a decline in overall well-being. Addressing these impacts requires a shift towards more person-centered care approaches that prioritize patient dignity and autonomy.
Reducing or Eliminating Restraints
Achieving restraint-free care involves implementing a range of alternative approaches to assessment, prevention, and response to behaviors that might lead to restraint use. Successful restraint reduction emphasizes individualized, person-centered care, normal risk-taking, rehabilitation, and choice.
Cultural change within institutions is crucial for reducing restraint use. This involves adopting practices that support independent, safe functioning, engaging families and communities, and ensuring administrative support for change. Legislation such as the Nursing Home Reform Act of 1987 has contributed to raising standards in nursing homes and promoting restraint reduction.
Impact of Reduction/Elimination of Restraints
The reduction or elimination of physical restraints has been associated with several positive outcomes. In nursing homes, restraint reduction efforts have led to improved patient outcomes, including reduced incidence of injuries and enhanced quality of life. Research has also highlighted the benefits of restraint reduction in acute care settings, where the use of restraints can contribute to complications such as delirium, pressure ulcers, and infections.
Efforts to reduce restraint use have focused on promoting restraint-free care and addressing the challenges associated with achieving this goal. Successful initiatives have demonstrated that restraint reduction can lead to improved patient outcomes and reduced healthcare costs.
Current Approaches to Restraints
Current approaches to restraint reduction vary from promoting complete restraint-free care to tolerating restraint use under specific circumstances. Successful reduction of physical and chemical restraints in nursing homes has underscored the need for similar changes in hospitals. Addressing the use of restraints in hospitals involves focusing on prevention and alternative strategies to minimize iatrogenic complications and adverse reactions to restraints.
Objections to the Use of Restraints
The use of physical restraints remains a contentious issue, with professional organizations advocating for restraint-free care and appropriate use of psychoactive drugs. The debate surrounding restraint use involves considerations of patient safety, ethical concerns, and the need for comprehensive assessment and intervention strategies.
Clinicians in specialty areas such as critical care, trauma, and neurology face unique challenges in reducing reliance on physical restraints. A standard of least restrictive care requires careful assessment of individual behaviors and the implementation of a range of interventions to support physical, psychological, and social function.
Monitoring During Restraints
Monitoring during restraint use is essential to ensure patient safety and effectiveness. Physiological monitoring involves measuring various biological functions, such as heart rate, blood pressure, and temperature, to assess the impact of restraints on the patient’s health. Monitoring can be done using simple instruments like thermometers or complex systems for critically ill patients.
Effective monitoring requires the use of accurate and reliable measurement tools to assess both normative functions and disordered responses. Monitoring data helps healthcare professionals understand the effects of restraints on patients and guide interventions to minimize harm.
Physiological Variables
Several physiological variables are measured during monitoring, including:
- Electrical Potentials: Brain, heart, and muscle activity.
- Pressures: Arterial, venous, and other bodily pressures.
- Sound Waves: Mechanical vibrations in the ear and heart.
- Temperature and Gas Concentration: Body temperature and gas levels in the lungs and blood.
- Physical Symptoms: Bruising, stool characteristics, and wound appearance.
- Serum Levels: Hormones, coagulation factors, and proteins influencing responses to injury and illness.
Monitoring physiological variables provides valuable insights into patient health and the effects of interventions, including physical restraints. Research in physiological monitoring continues to evolve, linking physiological responses to patient outcomes and enhancing the accuracy of measurement tools.
Conclusion
The use of physical restraints in healthcare settings remains a complex and controversial issue. While restraints are intended to ensure safety and manage behavior, their use can have significant physical and psychological impacts. Reducing or eliminating restraint use requires a shift towards person-centered care, alternative interventions, and specialized nursing expertise. Monitoring and assessing the effects of restraints are essential for ensuring patient safety and improving outcomes. As the healthcare field continues to advance, ongoing efforts to address the challenges associated with physical restraints and promote restraint-free care are crucial for enhancing patient well-being and quality of life.