Module 14. Physical Restraint Reduction for Older Adults
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Transcript Module 14. Physical Restraint Reduction for Older Adults
Physical Restraint
Reduction for Older Adults
Objectives
Define physical restraint and describe the
characteristics of restraint use.
Identify the older adults most at risk of being
physically restrained.
Discuss myths and facts about physical
restraint use.
Discuss the reasons most frequently given by
health professionals for using physical restraint.
Objectives
Describe morbidity and mortality risks
associated with physical restraint.
Plan the nursing care of older adults,
using restraint-free strategies.
Explain alternatives to the use of
physical restraints.
Definitions
Physical Restraint
Any manual method or physical or
mechanical device, material or
equipment attached or adjacent to the
person’s body that he cannot remove
easily which restricts freedom of
movement or normal access to one’s
body.
Definitions
Medical Immobilization
Temporary
Performance of and recovery from medical
surgical treatment
Surgical positioning
IV arm boards
Bulky dressing
Forensic Restraint
Types of restraints
Soft
wrist/ankle
Straps/belts
Two- three- or
four-point
Wheelchair
safety bars
Mitt
Chairs
with
lapboards
Beds with
siderails
Bedsheets
Vest/jacket
Restraint Use for Older Adults
Nursing home residents = 15%
Acute care settings = 6% to 17%
Incidence
65+ population = 18% to 20%
75+ and older = up to 22%
Depression, agitation, confusion,
withdrawal, anger = 20% to 50%
Who are at risk for restraints?
Unsteady mobility or history of falling
Increased severity of illness
Multiple debilitating conditions
Cognitive impairment
Psychiatric conditions
Recent surgical procedure
Medical devices
Myths and Facts
“The old should be restrained because
they are more likely to fall and seriously
injure themselves.”
“The moral duty to protect from harm
requires restraint.”
It doesn’t really bother older people to
be restrained.”
“We have to restrain because of
inadequate staffing.”
Reasons for using restraints
Prevent falls and protect the patient
from harm
Prevent interference with medical
treatments
Protect medical devices
Decrease legal liability and family
pressure
Control disruptive behavior
Morbidity and Mortality Risks
Short Term Complications
Hyperthermia
New-onset bowel and bladder incontinence;
constipation
Decreased appetite
Pressure ulcers
Muscle weakness
Injury to nerve and joints
Increased risk of nosocomial infection
Pneumonia and respiratory complications
Severe or Permanent Injuries
Spiraling immobility
Risk for strangulation
Hypoxic encephalopathy
Deconditioning
Death from strangulation
Psychological Effects: anger,
aggressiveness, humiliation,
demoralization, depression, low selfworth, social isolation
Restraint Research
“Perception of Restraint Use
Questionnaire” (PRUQ)- revised 1998
“Subjective Experience of Being
Restrained” (SEBR)
Available at:
http://www.nursing.upenn.edu/centers/
hcgne/H_tools.htm
Hartford Center of Geriatric Nursing
Excellence
University of Pennsylvania
School of Nursing
Available at:
http://www.nursing.upenn.edu/centers/
hcgne/H_tools.htm
Hartford Center of Geriatric Nursing
Excellence
University of Pennsylvania
School of Nursing
Restraint-free guidelines
Establish restraint-free standard
Least restrictive but safest environment
Clinically appropriate situations; not
“routine”; evaluate patient
Rationale must be documented; orders
limited in duration to 24-hours.
Restraint-free guidelines
Monitor for complication every 4 hours and
more frequently
Educate patient and significant others
Medicate to mitigate need for restraints
Consider weaning and early extubation
Use adaptive equipment for impaired mobility
Institute fall prevention strategies
Restraint-free guidelines
Behavioral management strategies
Modify medical devices
Include family / surrogates
Become familiar with statistics and
institutional guidelines, policies and
procedures; evaluate compliance at unit and
institutional level
Alternative to restraints
Pharmacologic agents (NOT CHEMICAL
RESTRAINT) to treat patient’s agitation
Early identification of source of patient’s
discomfort and agitation
Increase patient observations - video
cameras, move closer to nurses station
Music and frequent reorientation
Allow family greater access; visit audiotapes
of family
Alternatives to restraints
Alter the environment
Reduce noise level
Turn TV off
Use bed exit alarms
Relocate patient near the nurse’s station
Use family members and sitters
Lower nurse-to-patient ratio
SUMMARY
Defined physical restraint, medical
immobilization, and forensic restraint
Types of restraints
Who are at risk for being restrained
Myths and facts
Reasons for restraining patients
Morbidity and mortality
Guidelines and strategies in promoting a
restraint-free environment