ntroduction:
The article I have chosen for the purpose of this essay is “Use of physical restraints in nursing homes: clinical-ethical considerations” by Chris Gastmans and K Milisen. The ethical dimension of care is an essential part of good nursing practice, and ethical reflection is necessary for nurses to come to thoughtful and balanced decisions. Critical reflection on what constitutes good care is required in everyday care, but even more so in ethically charged situations such as those requiring physical restraint (Goethals, Casterle & Gastmans, 2012)
Summary:
According to the paper physical restraints is defined as “any device, material or equipment attached to or near a person’s body and which cannot be controlled or easily
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The article explains that ethical assessments of care is an essential part of good nursing practice and that nurses must give priority to respect for the dignity of older people, respect for autonomy, promote overall well-being and self-reliance. It article concludes by saying restraints should only be used as a last resort and once initiated, physical restraints should be reviewed regularly.
Feelings:
I strongly believe physical restraints are used to increase the patient’s safety but often has an effect opposite of the intended purpose, which is to protect the patient from injury. Under the review of literature that I have gone through, in my opinion restraints should be used according to the Least Restraint Policy ( J. Williams et al, 2010). The first rule as a nurse is to understand your patient that you are taking care and only then you will be able to figure out the reasons for a patients behaviour and can act accordingly by taking into account the alternative measures. As nurses we should consider the risk of using a restraint and must use our clinical judgment and decision making power to make the best choice for the patient.
Discussion:
The use of physical restraints is relevant to nursing practise because restarts continue to be used in the majority of healthcare settings. Nurses need to be aware of the benefits and consequences that
Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.
Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.
J’s scenario is pressure ulcer. From analyzing Mr. J’s case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing-sensitive indicator in this case is restraints. As I have mentioned earlier the use of restraints in Mr. J’s case seems appropriate as he pose great fall risk which may further complicate his current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning, history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care throughout the hospital, the quality improvement department should scrutinize, and keep track of the
Restraints prevalence is another NIS that could assist the nurses in the above scenario to identify
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A restraint is any physical or chemical measure in the healthcare setting to keep a patient from being free to move (Craven, Hirnle & Jensen, 2013). Nurses are presented with dilemmas in deciding whether to use restraints to protect the patient from falls, harming themselves or others, suppress agitation and to facilitate treatment. Improper usage and misconceptions of restraining can have negative consequences including physical and psychological issues. Physical and psychological disadvantages from restraining could include low blood pressure, decreased circulation, thrombosis, constipation, urinary incontinence, depression, fear and increased confusion (Yeh et al., 2004). Educating nurses may reduce restraint usage by increasing
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