Reducing physical restraints use Reducing Physical Restraints Use

The issue of using physical restraints is one of the most difficult ethical issues to be discussed. There are several reasons for this situation. Using of physical restraints raise the question of basic human rights - dignity and autonomy. Second, the issue involves not only the patient, but his family also. It may cause problems in communication between medical staff and family members that may object the use of physical restraints. Finally, medical professionals are also involved in the discussion of ethical and legal problems involved in the question of physical restraints. The issue was chosen by me, because of its importance to the nursing practice. Indeed, nurses are those who make the physical action of restrain and this issue should be clear not only from ethical, but from legal point of view too. In addition, it is important to make literature review and analyze if there some ways to reduce the rate of physical restraints. There are those who claim for using restraints in all cases of potential damage to the patient that may be made by him or by other means. For example, physical restraints may be used to protect the patient from falling from bed or wheelchair, for protection over medical equipment, etc. However, I claim that there is an urgent need to reassess the practice of physical restraints, because using physical restraints may be in many cases dangerous practice. There are cases that report about physical and psychological complications in restrained patients, like depression, decline in physical activities, deprivation, breathing problems and even death. In addition the question of autonomy and dignity are raised many times when the issue discussed. I think, that the use of physical restraints should be restrained.

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Reducing physical restraints use In this paper the issue of physical restraints will be discussed. First, I will present the predictors that put patient at risk to be restraint, like specific age, physical impairment, etc. Second, I will explore potential risks of physical restraints, including psychological, physical and health problems. Finally, I will present practical guide for decision-making process about the use of restraints on particular patient. Restraints may be defined as any limitation of patient freedom of movement in one place or between different places (Hamers, Meyer, Kopke et al., 2009, p.249). Examples of physical restraints are numerous, like bilateral bedrails, belts and chairs with a table (Hamers et al., 2009, p. 249). There are restraints that are preferred by different institutions. The data of prevalence of the physical restraints is very controversial. According to Hamers et al. (2009): "The prevalence of restraint use in nursing homes reported in the literature ranges from 15 to 66% (p. 249). Using of physical restraints poses a lot of disadvantages to the patient. The major predictor to be restraint by physical means is the age above 65 years. Haut et al. (2009) claim that the use of physical restraints with older people has been reported as common practice in numerous countries. Hamers et al. (2008) claim that additional predictor for being restraint is the problem in patients mobility. The patient with mobility problems is in high risk for falls, whereby in most cases physical restraints are used as safety measures. Another predictor for being restraint is the impairment in the ADL. Many patients prefer to make their daily activities they used to by themselves. It may cause them different problems like spilling a hot tea on them. The last important predictor for using physical restraints is the place of admission of the patient. It was proven that admission to nursing home or intensive care unit raises the chance of admitted patient to

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Reducing physical restraints use be restrained (Haut et al., 2009; Hammers et al., 2008). Despite these reasons the practice of using physical restraints has a lot of potential risks that will be discussed now. The adverse consequences of using physical restraints may be divided on three major groups physiological consequences, psychological and mental consequences and change in health status. The physiological consequences are numerous. For example, that is restraint may alter the metabolic rate and decrease blood volume. These two pronlems may cause the patient problems of energy balance and decline or increase in blood pressure that any of this possibility has possible complications. In addition to these problems it may cause increase in heart rate and even cause a heart attack. The major problem in restraint patient is reporting of pain. The pain may be different. From superficial pain because of skin injury and even visceral pain. The increase in pain has also adverse effects on health of the patient and the chance of longer care (Hamers et al.,2008; Haut et al., 2009). Psychological consequences may include agitation, anxiety, depression and suicide thoughts. There are evidences that using physical restraints may cause not only these conditions, but also worsening if they already exist. For example, patient that have already mental decline may develop this decline to the higher level. The most dangerous adverse effects of restraints are those influencing the health status. Hamers et al. (2008) mentioned only some of them like aspiration, pneumonia, and pulmonary embolism. Those medical conditions are very dangerous and may result in death of the patient. I believe that there is a great possibility to reduce the rate of use of physical restraints. In many care facilities there is a use of special guidelines for physical restraints. I want to

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Reducing physical restraints use present one of them that may help to prevent not needed restraints. The use of restraints should be only in emergency cases. Second, using the restraints should be not recommended in case of preventing falls. Then, using the restraints should be followed by examining the medical condition that caused the decision. Using the physical restraints for protecting medical equipment is very important especially when this equipment is directly connected to the patient. Restraints should be used only after informed decision making by patients, families, or proxy decision makers. The most important rule is that restraints should never be used as a substitute for surveillance. Finally, it is important to monitor the restrained patient. In conclusion, using physical restraints, restraints as was shown in this paper has a lot of risks for patient health and life. The evidence that the rate of using physical restraints is varies between different facilities may be a prove that it is possible to reduce the rate of restraints. The possible to do so is using special guidelines and protocols.

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Reducing physical restraints use

References Hamers, J.P.H., Meyer, G., Kpke, S., Lindenmann, R., Groven, R., Anna R. Huizing, A.R. (2009).Attitudes of Dutch, German and Swiss nursing staff towards physical restraint use in nursing home residents, a cross-sectional study. International Journal of Nursing Studies, 46, 248255.

Haut, A., Kpke, S., Gerlach, A., Mhlhauser, I., Haastert, B., & Meyer, G. (2009). Evaluation of an evidence-based guidance on the reduction of physical restraints in nursing homes: a cluster-randomised controlled trial. BMC Geriatrics, 9:42. Retrieved November 7th , 2010 from http://www.biomedcentral.com/14712318/9/42

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