Injury Due to Restraints

Along with over-medicating patients to keep them calm, one of the stereotypes and fears about American nursing homes is that they often use restraints to control elderly patients. Although this is still a problem, and the amount of restraints should be reduced, the good news is that the use of restraints has declined significantly in the last couple of years.

Currently, about 10% of nursing home residents are restrained. This is a huge drop from before 1990, when nursing homes used restraints on 30-40% of their patients. Still, with the right practices and training, nursing homes can reduce their amount of restraints even more. In some European countries, the percentage of residents restrained is half that of the United States.

What Are Restraints?

Restraints are any type of item that is used to restrain a patient and keep him or her from moving too much, getting agitated, or hurting themselves. In nursing homes, restraints can be both physical and chemical in nature.

Physical restraints are any type of physical or mechanical device or method that is used on a patient’s body and restricts his or her movement. Physical restraint devices include arm restraints, leg restraints, ties and vests, lap trays and cushions, hand mitts, and bed rails. There are also methods that can physically restrain a patient, such as raising their bed so high they cannot get down, pushing their bed against walls to restrict them, and pushing a wheelchair into a wall so that it cannot be moved.

Chemical restraints are drugs and other chemicals that are used to pacify and sedate a patient. These can be any type of drug that has a calming effect, but typically includes tranquilizers, anti-anxiety medications, and antipsychotic drugs.

Why Should We Reduce the Use of Restraints?

Traditionally, restraints have been used when the nursing staff believes that the patient will hurt himself if he tries to move. In the hopes of reducing falls and dangerous movements, the patient is restrained. However, in recent decades, studies have shown that the harm caused by restraints usually outweighs the potential benefits. In addition, some studies suggest that restraints are less effective than safer methods for reducing falls and other accidents.

More than just improving safety and effectiveness, restraint use has dropped because more facilities are interested in preserving the independence, happiness, and dignity of their residents. Devices that restrain individuals make them feel powerless, depressed, and trapped.

Some of the Harmful Effects of Restraints:

  • Strangulation and restricted breathing
  • Bed sores/pressure sores
  • Infections
  • Cuts and bruising
  • Falls
  • Loss of strength and mobility
  • Reduced bone mass
  • Stiffness
  • Incontinence
  • Constipation
  • Frustration
  • Loss of dignity
  • Withdrawal and depression
  • Fear
  • Agitation

What Are Alternatives to Restraints?

There are actually many things that a nursing home can do to reduce the use of restraints without putting their residents in danger. Most of these alternatives are focused around giving individual attention and care to patients so that they can be given more freedom, but also have sufficient support and supervision.

Improving Mobility: By helping patients become stronger and more mobile, use of restraints becomes less necessary. To do this, nursing homes can provide strengthening and rehabilitation programs, increase the use of hearing aids and mobility devices, and also introduce Vitamin D programs.

Create a Safer Environment: Removing the many hazards in nursing homes can make it safer for residents to walk without assistance. Some potential hazards include wet floors, poor lighting, obstacles in hallways, and beds at unsafe heights.

Greater Individual Attention: Staff members should assess the mobility and safety of each patient individually. Also, by attending more closely to needs for food, water, use of bathroom, and fresh air, staff members can reduce the urge of patients to walk around without assistance.

Sources:

Gastmans, C., and K. Milisen. “Use of physical restraint in nursing homes: clinical‐ethical considerations.” PubMed Central. 2006. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2564468/>.

Gatens, Cindy. “Restraints and Alternatives.” Association of Rehabilitation Nurses. (2007): n. page. Print. <http://www.rehabnurse.org/pdf/GeriatricsRestraints.pdf>.

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