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It has also been observed that the methods used are not effective in preventing falls or serious injury as a consequence of aggressive behaviour. In many cases, Nursing restraints discomfort and anxiety of a restrained older person is only increased, resulting in a heightened risk of injury and even death as a result.
The older person Older people report mixed feelings about their experience with physical restraint. They can lend a feeling of security and stability: Many of them greatly appreciate the assistance being offered.
One could say that in these cases there is a positive reception of care: If I want to stand up, they help me. But I need it for my pillows; otherwise my arm slides away.
Many older people express feelings of imprisonment: Others express feelings of depression and apathy concerning the use of these methods.
It is so real, that we can never do the things we planned. Caregiver The application of physical restraint brings about a certain structure. The failure to apply these methods of restraint would put this structure at risk, increasing the chance of chaos.
In addition, Nursing restraints often have the impression that applying methods of restraint affords them a measure of control over older people; they experience it as a way of maintaining order.
This sort of approach is often regarded by older people themselves as a humiliating experience infantilisation and is frequently intended to sustain existing power relationships.
Values express what caregivers must aim at in order to attain greater human dignity; norms express concrete rules of behaviour that are generally accepted as responsible and adequate for imparting human dignity to caring. In what follows, we explain some of the values and norms that are important for an ethical evaluation of physical restraint in nursing homes.
Respect for the dignity of older people As a first value, we could state that every senior citizen should be treated as a person. Being a person embodies human dignity. This dignity is grounded in the fact that everyone is a unique individual who becomes more and more human by contact with others, thus taking part in society as a whole.
This value gives rise to the ethical norm that caregivers must give priority to respect for the dignity of older persons. Respect for autonomy As a second value, one should always consider older persons as responsible people. Human beings are not objects like the material things that surround us; they are persons who normally act according to their conscience, in freedom, and in a responsible manner.
They should provide information—as objectively as possible and in a way that is understandable to older persons and their relatives—about the various treatment possibilities, their nature and aim, their pros and cons, and effects and risks. Promoting overall wellbeing In the practice of care, the physical aspects of wellbeing are often a main focus because they can be translated most easily into objectifiable complaints, and physical restraint is often used in order to prevent physical harm.
Respect for overall wellbeing is the third value that must be protected. In certain cases, this value can come into conflict with the value of physical integrity.
In certain cases, the choice of another value can be justified, even though it may entail risks to physical wellbeing. During their lives, people pursue many kinds of activities with the aim of attaining values that they find important, even though it may cause harm to their physical integrity.
There is no reason to suppose that the lives of older persons must be dominated by the protection of their safety and physical integrity. The benefits should outweigh the shortcomings For caregivers, it is often not clear if physical restraint should be applied or if it would be pointless.
It is justified only if the benefits outweigh the shortcomings. The least restrictive methods should always be tried first.
In other words, there should be a reasonable or proportionate relationship between the physical restraint and the harm it intends to avoid. Every method should be individualised The choice to use or not to use physical restraint should be based on an individualised comprehensive assessment—for example, cognitive, physical, mobility, and sensory state; drug therapy; past history; and environmental issues.
Measures recommended for use with physical restraint are: Management Dealing with physical restraint requires an organisational policy supported by the daily management of the nursing home.
The key points of such a policy are vision, guidelines, operational policy, training, and communication. A policy based on ethical values can serve to motivate caregivers. The reduction of physical restraint requires an operational policy.
Elements of such a policy would include: The development of an ethical view, guidelines, and a policy goes hand in hand with the continuous training of caregivers in the application of methods of physical restraint, their ethical and legal aspects, their risks and indications, alternatives, etc.
Finally, good communication must ensure that all parties involved are aware of the institutional policy with respect to physical restraint.Sep 14, · A skills demonstration of use of restraints, developed by the Learning Resource Center for students at the Frances Payne Bolton School of Nursing in Cleveland, Ohio.
INTRODUCTION€ PURPOSE In this guide, we aim to assist nursing homes in minimizing the use of physical and chemical restraints. Toward that end, we present lessons drawn from the experiences of nursing homes that have made progress in reducing restraints.
Guide to help understand and demonstrate the Use of Restraints and Safety Devices within the NCLEX-RN exam. Pressure on hospitals, and most especially on the nursing staff, regarding legal responsibility for patient-related accidents and injuries countered professional judgment, and no doubt contributed to use of physical restraints.
The newly updated Position Statement on the Use of Seclusion and Restraint and the Seclusion and Restraint Standards of Practice were approved by the Board of Directors on April 8, To supplement these two resoruces, APNA is also offering a continuing education session: Seclusion and Restraint: Keys to Assessing and Mitigating Risks.
Typically, these types of physical restraints are nursing interventions to keep the patient from pulling at tubes, drains, and lines or to prevent the patient from ambulating when it’s unsafe to do so—in other words, to enhance patient care.