types of physical restraints in hospitals
Myths about elder restraint. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses, Nursing Research, 37(3), 132-137. Bourbonniere, M., Strumpf, N., Evans, L, & Maislin, G. (2003). 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. Vivamus in condimentum magna. 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. Encyclopedia of elder care (3rd Edition). Other ways to restrain a patient include: A caregiver holding a patient in a way that restricts the person's movement. Over the past 100 years, this practice has come to be seen as ineffective and dangerous as well as a violation of human rights. (2011). Council for the Advancement of Nursing Science. Recent emphasis on improving quality in hospitals includes tracking restraint use as an important indicator, signifying national awareness of the problematic outcomes of restraint use, especially with frail elders. Talerico, K., A., Evans, L.K., & Crandall, L. G. (2013). Evans, L.E., & Cotter, C.T. This includes personalizing content. 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. (2008). Please release me: Restraint reduction initiative in a health care system. Trays may keep a person in a wheelchair. 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. New York: Springer. 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. They can include: Belts, vests, jackets, and mitts for the patient's hands. Journal of nursing Scholarship, 39(1), 30-7. Others demonstrated success in medical but not intensive care units (Mion, Fogel, Sandhu, et.al., 2001) and another team reduced the rate to 2.3% following institution of a systematic plan to address restraint (Cosper, Morelock & Provine, 2014), and a special environment was successful in providing restraint free care to patients with delirium (Flaherty, Little, 2011). Don’t use physical restraints with an older hospitalized patient. American Journal of Nursing, 108(3), 40-50. Click Here to download this page in PDF format. These situations require immediate assessment and attention, not restraint. In E. A. Capezuti, M.L. Physical restraints are most often applied when behavioral expressions of distress and/or a change in medical status occur. Mion, L.C., Fogel, J., Sandhu, Palmer, R.M., Minnick, A.F., et. Mezey (Eds.). Patient behavior that may be interpreted by some as ‘unsafe’ now should trigger multidisciplinary assessment to uncover any change in medical condition or explore the meaning in behavioral expressions of distress (pain, need to urinate, hunger, fear)(Talerico, Evans, Crandall, 2013).


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