Third, have a discussion with the primary nurse about the care and the ways that safety and comfort will be assured and voice concern if restraint is under consideration, using the evidence provided here. There are three types of restraints: Physical restraints, which limit a person’s movement. Restraints cause more problems than they solve, including serious complications and even death. 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. Patients and families can help bring about change in practice by questioning the use of restraints and providing information about the patient’s usual patterns. 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). Effects of an advanced practice nursing intervention with physical restraint use among hospitalized nursing home residents. Avoiding Restraints in patients with dementia. The Gerontologist, 43 (Special Issue I), 310. Research in several hospital settings has demonstrated that restraint use can, indeed, be safely diminished. Don’t use physical restraints with an older hospitalized patient. Mion, L.C., Fogel, J., Sandhu, Palmer, R.M., Minnick, A.F., et. 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). Click Here to download this page in PDF format. Outcomes following physical restraint reduction programs in two acute care hospitals. 1500 King Street Ste 303 Alexandria, VA 22314. 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. It should never be the reason to apply a physical restraint. Malone, & M.D. Whether in-person or online, SGIM has the mechanism for you to connect with other professionals within your field including national meetings, regional meetings, and other CME opportunities. al. Encyclopedia of elder care (3rd Edition). Strumpf, N., & Evans, L. (1988). (2011). Restraint of hospitalized older adults contributes to serious medical and psychological problems, requires additional staff time, poses serious ethical challenges and results in longer hospital stays which are costly. 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. The increased use of physical restraints with medically ill elders is increasingly documented post-WWII, perhaps in relation to several changes occurring in health care: greater numbers of hospitalized elders (especially those with cognitive impairments), concerns about ‘protecting’ elders from falls and injuries, reducing patients’ interference with invasive medical devices (e.g., urinary catheters, IV lines, ventilators), growing scarcity of nursing staff, and fears concerning malpractice. 2007). Such older adults have difficulty recognizing where they are and why, can’t make sense of the environment, and may try to ‘go home’ or protect themselves from staff who perform any procedures, including something as simple as a bath. American Journal of Nursing, 108(3), 40-50. , Second, if possible, arrange for a family member stay around the clock or at least at night for the first 1-3 nights after hospitalization to help the elder orient to where s/he is and why, and that they are safe. 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. Council for the Advancement of Nursing Science. Belts or vests may be used to keep a patient in a bed or chair. Site Designed by Brightfind, Built by Kaylen Hickman, and Powered by Higher Logic. ), pp. August 25, 2016 getTheDay('25','08','2016'); A core goal of SGIM is to foster professional interaction among leading academic researchers and general internists. These studies of restraint reduction in hospitals support measures that are effective in providing safe, humane care for frail elders, particularly those with impairments in memory and cognition. Two decades of research on physical restraint: Impact on practice and policy. Advocacy by families of hospitalized elders can play a significant role in prevention of physical restraints with loved ones. Talerico, K., A., Evans, L.K., & Crandall, L. G. (2013). These situations require immediate assessment and attention, not restraint. Masks Lower Wearers’ Exposure to Viruses, Experts Propose, © Society of General Internal Medicine | SGIM Shaping health policy through nursing research. Research in the 1980s-2000s supported assessment and intervention, NOT the use of physical restraints, and gradually led to a revision in national guidelines and a re-interpretation of the standard of practice (Evans & Strumpf, 2011). May include devices that limit a specific part of the body, such as arms or legs. Grady (Eds. (2001). By continuing to use our site, you accept our use of cookies and revised privacy policy. Organizational characteristics and restraint use of hospitalized nursing home residents, Journal of the American Geriatrics Society, 51(8), 1079-1084. Over the past 100 years, this practice has come to be seen as ineffective and dangerous as well as a violation of human rights. Evans, L.K., & Strumpf, N.E. Finally, patients with existing brain damage from dementia are unable to communicate needs and symptoms in an understandable way and are, thus, at the highest risk for additional acute impairments such as delirium and other complications. Evans, L.E., & Cotter, C.T. For centuries, shackles and restraints were used to manage violent behavior in severe mental illness. First, families bring a wealth of knowledge about daily routines, communication patterns, things that bring pleasure and enjoyment, and usual behavioral expressions of pain and discomfort, hunger, need to toilet, boredom, loneliness, fear, and so on. This includes personalizing content. 2003). Flaherty, J.H, & Little, M.O. American Academy of Nursing 1000 Vermont Ave NW • Suite 910Washington, DC 20005-4903(202) 777-1170. Devices that prevent people from being able to move their elbows, knees, wrists, and ankles. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses, Nursing Research, 37(3), 132-137. Interviews with hospitalized, restrained older patients revealed considerable physical and psychological distress as well as social discomfort and pain (Strumpf & Evans, 1988). These myths, now refuted, included deeply held beliefs about frail, often ‘confused,’ older patients: that older patients were ‘more likely to fall and sustain serious injuries’; that restraint was supported by an ethical duty to ‘protect patients from harm’; that older confused people were really ‘not bothered by being restrained’; that ‘inadequate staffing necessitated’ use of restraint; that there were ‘no other interventions available’ meeting underlying patient needs, and that failure to restrain put individuals and hospitals ‘at risk for legal liability’ (Evans & Strumpf, 1990).