Physical Restraints on Elderly

Over the last few decades, U.S. nursing homes have started reducing their use of physical restraints; however, they are still being used more than necessary. Sometimes it is due to the culture in a nursing home. Some medical staff members believe they cannot do their jobs without them and they are unwilling to try alternatives. The fact remains that physical restraints are harmful to nursing home residents and hopefully the number of restrained patients will continue to decrease.

What Are Physical Restraints?

Physical restraints include all types of devices, equipment, and methods that are attached to the patient’s body and that physically restrict movement. These restraints are difficult or impossible to remove and make individuals feel stressed, agitated, and powerless. Some examples of physical restraints include

  • Lap trays and wheelchair belts
  • Arm restraints
  • Hand mitts
  • Leg restraints
  • Vests and soft ties
  • Bedrails
  • Hook and loop fasteners on clothing

Certain methods can also be forms of physical restraints if they are used to restrict a patient’s movements. Examples of this include pushing a wheelchair or bed close to walls and other obstacles so that the patient cannot back up or move.

What Are the Risks of Physical Restraints?

Research continues to show that physical restraints are not safe and do not decrease the risk of injury. These methods can be extremely harmful to patients, and can increase both physical and emotional suffering. One of the methods used to convince nursing home staff to stop using physical restraints is to encourage them to try them on themselves. Just putting them on for a few minutes can show you how dangerous and scary they can be.

Patients who are physically restrained have increased risk of infections, bed sores, and strangulation. Because they are not able to move, many suffer from loss of mobility and strength, stiffness, and lower bone mass. Incontinence and constipation are also possible results of restraint.

The loss of freedom of movement has serious emotional consequences as well. Restrained patients often experience agitation, depression, and loss of dignity and self-respect.

How Do Nursing Homes Decide to Use Physical Restraints?

Physical restraints are classified as medical devices so they can only be used for medical purposes at the discretion of a physician. Legally, doctors can only order the use of restraints after they have clarified the medical reason for the restraint, instruction of use, and how long it will be used for.

Restraints cannot be legally applied until the medical staff members receive informed consent. The staff must first explain to the patient why the restraints are being used, what benefits they will receive, and what the potential risks are of using the restraints. If the patient is not fit to make the medical decision himself, then the nursing staff will have to get consent from a responsible family member.

When Is Use of Restraints Not Allowed?

Although there are state and federal laws regarding the use of physical restraints, they are not always followed. In some facilities, physical restraints may be used before a doctor gives an order or before the patient has given consent. Though medical staff may believe they are doing what is best for the patient, they are violating the patient’s rights.

Federal law prohibits unnecessary use of restraints and specifies that some reasons for using restraints are unacceptable. Nursing facility staff may not use restraints to:

  • Punish or discipline a patient
  • Make patient care easier or more convenient
  • Substitute for other activities or treatment
  • Permanently control the patient

Sources:

Gastmans, Chris, and Koen Milisen. “Use of physical restraint in nursing homes: clinical‐ethical considerations.” Journal of Medical Ethics. 32.3 (2006): 148-152. Web. 24 Feb. 2014. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564468/>.

Goethals, Sabine, Bernatte, and Chris Gastmans. “Nurses’ Decision-Making in Cases of Physical Restraint: a Synthesis of Qualitative Evidence.” Journal of Advanced Nursing 68.6 (2012): 1198-1210. CINAHL Plus with Full Text.Web. 24 Feb. 2014.

Trueland, Jennifer. “A bid for freedom: nurses are working to reduce the use of physical restraint in care homes.”Nursing Standard. 27.3 (2012): 22. Print.

http://www.health.state.mn.us/divs/fpc/safety.htm

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